Credentialing & Privileging | 09.30.20
NAMSS COVID-19 Survey Reveals a Significant Impact on Medical Staffs That Continues to Evolve
In August 2020, NAMSS launched a membership survey to learn how COVID-19 has so far affected medical staff workforces and medical staff workflows. The survey included questions about pandemic-related department downsizing, workflow interruptions, and utility of nine medical-staff related waivers the Centers for Medicare and Medicaid Services (CMS) issued early in the pandemic.
Over 300 members responded to the survey and provided information (see Survey Highlights below) about changes with their workforces and department workflows. Survey respondents stated whether each of the nine waivers was applicable to them, how the waivers affected the credentialing and privileging process at their institutions, and whether they would benefit from these waivers becoming permanent.
Roughly, half of all survey respondents reported their institutions taking advantage of the nine COVID-19 waivers. Some members noted that the waivers allowed needed flexibilities to account for workflow disruptions ensuing from patient surges, reduced workforce, or remote work. Other members were ambivalent about their utility and noted the extra documentation that the waivers require. The survey’s residual theme, however, was patient safety and the mounting pressures to ensure this safety while also meeting COVID-related demands.
While the survey results indicated that waivers provided some relief to MSPs, they also revealed a hurried, and sometimes, ill-fitting response to an event unforeseen by many disaster-preparedness planners. Ultimately, many hospital systems’ disaster privileging scenarios did not account for pandemics, which resulted in rushed emergency measures to meet patient demand, or anticipated patient demand.
The noted CMS waivers and other system-based policies focused on increasing medical staff personnel by fast tracking certain steps within the credentialing and privileging processes. Many of these quick fixes provided blanket policies for all practitioners and did not focus on the type of practitioners hospitals would need most to meet COVID-related demands.
For example, most patients suffering from COVID complications require critical-care support within the ICU. Practitioners providing such care undergo critical-care medicine training and require specific certifications. Rather than honing in on the process for onboarding critical-care support, hospitals expedited the onboarding processes for all practitioners. In hindsight, hospital systems should have focused efforts competencies of critical-care practitioners, rather than removing certain credentialing and privileging steps for all practitioners.
Many survey respondents indicated that this blanket approach was unnecessary and posed patient-safety hazards. Some respondents also expressed concerns about the waivers that expedited these processes impeded the integrity of the practitioner-credentialing process. Respondents also reported being pressured to use the COVID-related waivers to fast-track practitioners unrelated to COVID. One survey respondent reported this pressure, and a disregard for the customary comprehensive review, significantly affected the entire team, “professionally, emotionally, and ethically.”
Hospital responses to COVID-19 continue to steady as caseloads ebb and flow and we learn more about the virus. In the months ahead, we will more clearly compare healthcare systems’ initial COVID responses to the ideal COVID response. This information will help hospitals manage the now-ever-present virus, prepare for the next pandemic threat, and reflect on lessons learned to ensure disaster-response plans are more comprehensive. In the meantime, COVID-19 is still an ominous threat. As we adjust to life with COVID, we as MSPs need to ensure that we are prepared to handle the impending surges that the cooler weather promises to bring.
It was important to educate leaders regarding the waivers to avoid compromising patient safety. Even in a disaster such as the COVID-19 pandemic, safe and quality care must always be the priority. MSPs are the torchbearers for this effort — and our role is critical.
- MSP Furloughs and Layoffs
- 21% (n 326) of respondents reported MSP furloughs at their institutions.
- 36% (n 72) of those whose facilities furloughed MSPs stated that 50% or more of their MSP workforce was furloughed.
- 56% (n 71) of those whose facilities furloughed MSPs indicated that furloughed colleagues would return to full-time employment.
- 75% (n 40) indicated that furloughed MSPs would return full time within one-to-three months (i.e., fall of 2020).
- 11% (n 325) stated that their facilities eliminated medical staff positions and 40% (n 34) indicated that their institutions eliminated between 0 and 10% of their MSP staff.
- Education and Certification
- 53% (n 319) stated that their organizations reduced or eliminated their education budgets.
- 23% (n 319) stated that their organizations reduced or eliminated their budgets for professional organization memberships.
- 25% (n 319) stated that their organizations reduced or eliminated their professional certification budgets.
- Waiver Utility
- About half of the respondents to each waiver-related question indicated that the said waiver benefited medical staff workflows.
- Top Reasons Why Organizations Did Not Use Waivers
- Organizations had disaster-privileging/credentialing plans in place and did not need to use these waivers.
- MSPs could work remotely to meet credentialing demands with organization’s traditional process.
- States did not permit organizations to use waivers.
- Top Reasons for Why Organizations Did Use Waivers
- Enabled reduced staff levels to maintain workload.
- Removed pressure on MSPs to meet workforce demands and allowed additional flexibility to respond to demands on the medical staff.
- Allowed additional flexibility to adjust to remote environments.
- Top Concerns Regarding Waivers
- Permitted shortcuts, at the expense of patient safety.
- Placed additional pressure on MSPs to credential practitioners.
- Set expectation to fast-track practitioner credentialing for non-COVID-related purposes.
- Undermined importance of full medical staff/governing body review.
- Downplayed importance of comprehensive credentialing processes among practitioners.
- Created new workflows and required additional MSP tracking.
- Placed additional work on MSPs who need to account for all the temporary extensions and flexibilities given to practitioners during the pandemic.
Waiver Response Summary
- Medical Staff: CMS waiver to allow physicians with expiring/expired privileges to continue practicing at location and for new physicians to begin practicing before their full medical staff/governing body reviews are complete.
- Waiver Applicable? Yes: 36%; No: 64% (n 302)
- Make Waiver Permanent? Yes: 23%; No: 77% (n 271)
- Telemedicine: CMS waiver to make it easier to furnish telemedicine services through agreements with off-site hospitals.
- Waiver Applicable? Yes: 42%; No: 58% (n 284)
- Make Waiver Permanent? Yes: 41%; No: 58% (n 248)
- Physician Services: CMS waiver to lift supervision requirement that Medicare patients be under the care of a physician.
- Waiver Applicable? Yes: 26%; No: 74% (n 264)
- Make Waiver Permanent? Yes: 25%; No: 75% (n 216)
- Anesthesia Services: CMS waiver to make physician supervision rules for certified registered nurse anesthetist.
- Waiver Applicable? Yes: 18%; No: 82% (n 242)
- Make Waiver Permanent? Yes: 23%; No: 77% (n 196)
- Nursing Services: CMS waiver to remove requirement that nursing staff develop and maintain a care plan for each patient as well as requirement that hospitals have protocol for determining which outpatient departments need to have a registered nurse present.
- Waiver Applicable? Yes: 11%; No: 89% (n 224)
- Make Waiver Permanent? Yes: 11%; No: 89% (n 169)
- Physician Services: CMS LTCF waiver relaxing physician-services requirements for physician task designation.
- Waiver Applicable? Yes: 9%; No: 91% (n 217)
- Make Waiver Permanent? Yes: 11%; No: 88% (n 153)
- Physician Visits: CMS waiver lifting required visits that physicians must make.
- Waiver Applicable? Yes: 26%; No: 74% (n 203)
- Make Waiver Permanent? Yes: 24%; No: 76% (n 152)
- ACS Medical Staff: CMS waiver lifting requirement that medical staff privileges and scope procedures be periodically reappraised.
- Waiver Applicable? Yes: 15%; No: 85% (n 196)
- Make Permanent? Yes: 11%; No: 89% (n 137)
- Practitioner Locations: CMS waiver lifts out-of-state licensure requirements so practitioners can more readily practice across state lines.
- Waiver Applicable? Yes: 45%; No: 55% (n 184)
- Make Waiver Permanent? Yes: 41%; No: 59% (n 150)
- ESRD: Transferability of Physician Credentialing: CMS modifies requirement that all medical staff appointments and credentialing are in accordance with state law, including attending physicians, physician assistants, nurse practitioners, and clinical nurse specialists.
- Waiver Applicable? Yes: 10%; No: 90% (n 178)
- Make Waiver Permanent? Yes: 12%; No: 88% (n 124)