Credentialing & Privileging | 06.17.21
International Verifications: Make ECFMG EPIC Part of Your Process
Processing a credentialing application for an MSP can be routine and straightforward, difficult and complex, or somewhere in between. Every application is unique and requires a level of expertise to determine the optimal pathway to obtain primary source verification. When the applicant requires non-US verifications, the file can be especially difficult and complex. For applicants with education, training, and practice outside the US, attempting to obtain the correct point-of-contact and subsequent follow-up with overseas sources can be a daunting task.
With the understanding that standardization and the level of credentialing requirements vary from country to country and that NAMSS welcomes its international members, I will share my knowledge of a service that I have found to be beneficial for my domestic-based organization.
International Medical Graduates (IMGs) are physicians who obtained their medical degrees outside of the USA and Canada, making up approximately a quarter of the US physician workforce. Some physicians may have received postgraduate training or specialist qualifications beyond their basic medical degree outside the US. Others may have been educated and trained in the US, then left to practice internationally, obtaining licenses or registrations that require verification.
Certification by the Educational Commission for Foreign Medical Graduates (ECFMG®) is considered an acceptable source for foreign medical education verification, and most IMGs will undergo ACGME training. These can typically be verified from the ECFMG and AMA standard sources. Occasionally, an applicant may show up with a non-standard pathway to US practice. The files for such applicants typically take much longer to process and necessitate a time-consuming “hunt” for contact information, even when placing the burden on the applicant. For these files, it is often difficult or impossible to meet standard turnaround times.
At the recent NAMSS Annual Educational Conference, the ECFMG session provided information about ECFMG’s Electronic Portfolio of International Credentials (EPICSM) services. EPIC provides primary source verification to physicians and organizations worldwide. It makes it possible for organizations responsible for evaluating physician credentials to obtain verifications they need. Could EPIC offer a solution for MSPs? The answer is yes!
At my organization, the University of New Mexico Health System in Albuquerque, New Mexico, we have many past examples of exhausted efforts and language barrier difficulties in trying to obtain overseas verifications. The UNM Health System includes an academic medical center at which we frequently see non-ACGME trained applicants who have been granted medical licenses to practice in our State.
According to the Federation of State Medical Boards (FSMB), while the pathway to medical licensure in the United States typically involves ACGME training, this does not necessarily apply to every individual physician. In addition, an increasing number of ABMS specialty boards are now offering alternate pathways to board certification for foreign-trained physicians. This may require faculty status at an academic medical center for several years as criteria for eligibility for entry to the examination process. As more internationally trained physicians obtain their ABMS boards through faculty appointments at academic medical centers such as ours, then move onto practice elsewhere, the need to verify non-US postgraduate training is likely to increase.
I am pleased to report that we have recently partnered with ECFMG to utilize their EPIC services and have found it to be a win-win situation for both the applicant and our organization. I will share our experience, and for organizations that could benefit from this service, I encourage you to make it part of your process.
Full details about EPIC and how to set up an EPIC Report Portal Account can be found on the ECFMG’s EPIC website: http://www.ecfmgepic.org/organizations-use.html.
After the initial contact is made with ECFMG via email or phone, an EPIC representative will reach out to set up a time to go over the process and discuss specific needs. An operational plan, specific to your organization will be drafted. Once the operational plan is complete and an account form is signed, you are then able to take advantage of primary source verification through EPIC services.
The way the EPIC service works is that the physician applicant establishes an EPIC Account to start building an electronic portfolio of their credentials. For each credential, the applicant first uploads it to EPIC to be verified. ECFMG’s credentialing team obtains primary source verification of the credential and adds it to the physician’s portfolio. The physician is notified that the credential has been verified. The physician then authorizes the release of the primary source verified credential to the organization along with a verification report. Some applicants will already have an EPIC portfolio established, such as our earlier example from Brazil. In these instances, any credential that has already been previously verified by ECFMG will be uploaded to the EPIC portfolio at no cost. The verification report can simply be sent to organizations at the physician’s request.
Organizations access EPIC Reports through the EPIC Report Portal. Organizations that partner with ECFMG to establish an EPIC Report Portal Account obtain access to additional features, including the ability to receive notifications about where a credential is in the verification process, access to reports for a full year, and access to the verification form completed by the verifying institution. Organizations with lower volumes that do not wish to establish an EPIC Report Portal Account can receive one-time-use reports.
There is no cost to organizations to become an EPIC partner and receive verification reports. Physicians pay for EPIC’s services as they request them, and current information about fees is outlined on the website. There is an initial charge to the physician to establish an EPIC Account and confirm identity. They are then charged per credential, with credentials previously verified by ECFMG added to the portfolio at no cost. While one verification report is included in the cost of the verification, there is a charge to send additional reports to other organizations. For the applicants that we have directed to EPIC, there have been no complaints about these charges, and they are happy to pay if it can help expedite their credentialing.
Since EPIC is a service of ECFMG and ECFMG is designated by accrediting bodies as an accepted source, items including medical degree, postgraduate training, licensing, and registration can be verified through the EPIC service. If a credential was not previously verified, timelines vary with approximately 66% of credentials verified within 45 days and 80% of credentials verified within 90 days. There are instances when verification is impacted by external factors such as war zones, political turmoil, or institutional closure. However, these occasions are rare, and ECFMG maintains regular contact with organizations around the world to ensure awareness and facilitate communication. In fact, we had an applicant state we would never be able to verify post-graduate training in his home country due to political turmoil, yet EPIC was indeed successful.
There are elements that EPIC does not verify such as work history and affiliation. For non-US work history and affiliation, these should still be verified in the same way you would verify domestic work history and affiliation according to your organization policy and procedures. Internet searches and applicant assistance will be needed for this element while keeping in mind that healthcare systems in other countries differ and most would not have a Medical Staff Services Department. A verification from Human Resources, Supervisor, or Colleague may be the best way to verify this element, and always engage the applicant to help provide contact information.
Back home at the University of New Mexico Hospital, we have added the following language to our Credentialing policy and procedure for a completed application “Applicants seeking credentials based upon foreign education and/or training, may be required to register for an ECFMG EPIC Account and authorize the release of information to Medical Staff Affairs”. We also drafted an email that when foreign education and/or training is identified, applicants are directed to set up an EPIC Account which clearly outlines the steps to do this.
It does take time for the initial setup, so don’t wait until you have that application that needs to be expedited. EPIC staff members are very helpful, our experience has been positive, and we are grateful to ECFMG for the opportunity to use this service and to become an EPIC partner. While processing a credentialing application with international, verifications may still present challenges and will likely still not be routine and straightforward. The EPIC service does offer a timesaving service that can offer a streamlined and standard approach. Of course, MSPs can always benefit from a timesaving service!