Leadership | 02.18.21
Takeaways from the 2021 National Credentialing Forum
Roxanne Chamberlain, MBA, FACHE, FMSP, CPMSM, CPCS, CPHQ, NAMSS Immediate Past President, attended the National Credentialing Forum (NCF) on Feb. 4–5, 2021, which was held virtually. Each year, the NCF brings together organizations and individuals interested in credentials verification for healthcare professionals for a day and a half conference to share information, provide networking opportunities, and develop strategies and initiatives to improve the credentials verification process in an informal setting. The forum is attended by the foremost experts in the field of credentialing.
Here, Chamberlain shares an overview of the topics covered at NCF.
New NCQA Changes
New NCQA changes include the following:
- Extending the credentialing cycle from 36 to 38 months
- Extending the provisional period from 60 calendar days to 180 calendar days
- Extending the look-back period for CR committee minutes if three sets are not available during the look back-period
- Removing files that were impacted from March 1, 2020–June 1, 2021
- Will receive a N/A score for any requirement impacted from March 1, 2020–June 1, 2021
- The plan must provide a disaster management plan and NCQA COVID tracker at time of the survey to show the impact of mitigation efforts
10 Lessons Learned in the Pandemic for Medical Staff Organizations Going Forward
This topic, presented by Dr. Mark Smith, focused on 10 lessons learned during the pandemic:
- Zoom Is King — The remote meeting is here to stay.
- There Are Times to Break the Rules — COVID showed us this in a lot of ways.
- Act on Less Data — We had no data when COVID started but had to act anyway.
- Working from Home Will be the Norm — This is because people are generally more productive.
- Reevaluate the Role of Workers — Some workers can work remotely, and some just can’t (need to address skills moving forward in a new way).
- The Gulf Between the Haves and Have Nots Will Widen — The small and financially weak will not survive.
- Public Health Does Matter — The public health system has disintegrated over the years, and it needs to be rebuilt.
- Education Matters — We are not great at providing baseline education through remote learning.
- Humans Are Truly Social Animals — Human social interactions decreased, so how will we interact in the new world?
- Real Information Is Required — There has been a lot of disinformation related to COVID, meaning there is too much information through social mediums and not enough expertise.
- Bonus Lesson — Be better at expecting the unexpected.
In 2020, Healthcare Facilities Accreditation Program (HFAP) joined the Accreditation Commission for Healthcare (ACHC) and will be rebranding their name to ACHC. When an FPPE for cause is put in place, its results must be communicated to the provider.
For the Center for Improvement in Health Quality (CIQH), its accreditation is designed to assure hospitals comply with the COPs. It is a fairly new accreditation body, and it currently accredits 113 hospitals and continues to grow.
There also is a Healthcare Accreditation Certification Program (HACP) you can earn which demonstrates you are an expert in accreditation and regulatory standards.
The DNV GL gave an update on reaccreditation surveys. It has suspended doing surveys for a while in person but now is doing some remotely. ISO is helping to guide them on how to work with clients remotely during the pandemic. It accredits about 500 hospitals. It is rebranding and will be dropping the “GL” off the company name.
The Joint Commission said most surveys are being withheld from March–May 2021. Virtual surveys are being done first, which started in May 2020 (using Zoom). Initially, there will be a single surveyor per day, and all documents will need to be uploaded from the organization being surveyed to SharePoint ahead of the survey. This also will give the surveyors more time to go through all the documents. The account executive will reach out to the organization that is going to be surveyed to ask if they are ready for their survey and, if yes, they will have five days to upload their documents but will not be told of the exact survey dates. It will be scheduled within 1–2 weeks of receiving the documents for review. Right now, 90% of organizations say they want their surveys done. When surveys are done, most surveyors are allowing the MSO to pick the files they want to show the surveyor based on the category requested. They also are reviewing disaster credentialing to see how it was/is managed and to make sure the reassessment is occurring, too. They have been lenient with credentialing due to the pandemic.
CMS 1135 blanket waivers are still in effect (retroactive date of March 1, 2020). Medical staff waiver 42CFR48222 (a) (1)–(4) addresses workforce related concerns due to COVID. Physicians are allowed to continue to practice before full medical staff and governing body approval. It also allows physicians to continue to practice at hospitals after privileges have expired. Waiver 42 CFR 482.12 (a) (8–9) makes it easier for hospitals regarding telemedicine services to be furnished to patients through an agreement with an off-site hospital. There are other waivers that CMS has issued for hospitals as well.
Brian Betner, JD, covered the following:
- The Biden Administration picked 42 healthcare industry focused actions to work on.
- Effective Jan. 19, 2021, there will be sweeping amendments and updates to the Stark Law.
Betner’s observations included the following:
- COVID has exploited tremendous inefficiencies.
- COVID is accelerating greater integration, process standardization, innovation in healthcare delivery, and reliance on apps, etc.
- Experience from regulatory flexibilities will inevitably spark regulatory and legislative action (the operation warp speed effect).
- There will be an increase in liability claims and allegations due to COVID and possibly negligent credentialing due to deviation from standards of care due to the pandemic.
Physician Assistant Update
Greg Thomas, PA-C, representing the NCCPA, discussed statistics related to the PA profession. In 2020, 47 states relaxed or modified existing regulatory requirement related to PA practice. No states made any changes to laws, regulations, or rules specific to issues of certification or certification maintenance. Exploration of a PA license compact is underway under the leadership of the FSMB. No state allows for true independent practice of PAs.
Jama Ball discussed the FSMB’s response to the pandemic. FCVS is now a data repository for closed hospitals. They created an ad hoc task force on pandemic preparedness, a COVID website with state-by-state details on licensure waivers/other resources, and released recommendations for increasing license portability during COVID. They mobilized data and advocacy resources to assist states and territories in their efforts to quickly increase the healthcare workforce. Ball discussed ProviderBridge, which is a cloud host for scalability, portability, and security purposes of records. It allows the healthcare professional to volunteer during a pandemic or emergency. There is a lot of pressure on different state licensing boards to make some of the waivers put in place, due to the pandemic, permanent.
Jennifer Michael from the ABMS discussed COVID’s impact on board certification. Several ABMS member boards have adjusted their programs to accommodate the needs of their stakeholders. Many boards have extended the eligibility period for initial certification. Visit the ABMS website for more details. Recertification also has adjusted its programs to allow diplomats to complete their continuing certification activities as well. New standards also are currently being worked on. Public comment on the new standards will begin in April 2021, and this period will last 75 days.
Kathleen Creason reported there has been a dip in the use of the AOA profiles that have been ordered. The AOA will be transitioning to a longitudinal assessment instead of a periodic assessment. All boards will transition by 2023.
American Academy of NPs (AANPCB) (Certifying Board)
Diane Tyler noted that a task force has been established to review current MOC requirements. She also provided statistics on how many NPs are certified.
Tammy Weaver discussed strategic work around chronic disease and professional development. The resources on the AMA website have been widely utilized during the pandemic. The COVID-19 Healthcare Coalition Telehealth Workgroup has completed a lot of work. They also have been focusing on physician wellness.
New initiatives include:
- An interoperability secure exchange
- Policy on personal protective equipment (PPE)
- Assessing competency in late career physicians
- Assistant physicians (a new crop of practitioners that has emerged in the U.S.)
- Profile enhancement changes
David Lowenstein stated the NPDB has waived fees due to COVID for organizations but not for self-queries. Overall reporting to the NPDB is down right now. The NPDB is currently re-defining self-queries.
Sorin Davis gave a CAQH update and reported the changes made in response to COVID. The addition of telehealth/telemedicine at practice locations now allows a physician to add this information to their profile in ProView. CAQH is now allowing electronic signatures to be accepted for authorization and release documents. NCQA has published new standards for CVOs that will go into effect July 1, 2021. CAQH will provide advanced notification of any changes that impact users. There will be an addition of the National Uniform Claim Committee Provider Taxonomy Code Set (NUCC) grouping information. They also are working on a national FHIR End-Point directory for plans and a third-party application vendor registry. This will allow patients to access their own health information from their health plan. However, patients will need to be granted access to this by request. This registry is considered a national source of truth.
MD Review Update
Sharon Beckwith talked about trends in external peer review and MD review. It has slowed down since April–August 2020, but volume has picked back up at the end of 2020. They saw an increase in telehealth, and there were a lot of questions around credentialing for telehealth. They created quality metrics for telehealth patient visits guide, and it is on their website.
Center for Professional Education for Providers (CPEP) Update
Beth Korinek stated the CPEP does competency assessments on providers. They get referrals from the 50 U.S. states plus Canada. They focus on remediating the healthcare professional. CPEP has transitioned all seminars and assessments to a virtual format. They offer remote competency assessments, reentry, and other evaluations. Right now all clinical interviews are done via Zoom. They are totally virtual right now until September 2021 and maybe even beyond. However, there are some things that do have to be done in person. They have seen a big dip in hospital referrals for six months but have seen an increase in seminar attendance, so they decided to add more seminars.
Mark Malachesky reported the ECFMG has been maintaining verification services as the world stayed at home. They developed an assessment mechanism when the U.S. government temporarily suspended USMLE Step 2 CS for 12 –18 months. This accelerated their efforts to leverage electronic communication, and they bent their procedures to support officials working remotely. Layoffs included about 675 full- and part-time employees, and now they have around 320 employees. Exam administration had stopped since mid-March 2020. They also are reducing hurdles for International Medical Graduates (IMG) entering GME. There are still a lot of things up in the air at ECFMG.
Negligent Credentialing Update
Carol Cairns reported that depositions are starting back up again, but they are now being done via Zoom. There also have been some trials done on Zoom. A lot of trials in 2020 were postponed due to the pandemic. Cairns is concerned about the number of liability cases rising against advanced practitioners. She also noted it is important to document in the credentials files when waivers have been used during the pandemic, in case a negligent credentialing case arises years later as it can take this long for a case to get to trial.
It was reported by a few in attendance that a new category of provider is being seeing in the U.S., and they are referred to in many cases as an “assistant physician.” An assistant physician is sometimes referred to as an associate physician or house physician depending on the state. They help to tackle the tasks of primary care in medical underserved areas. They have completed medical school at a certified school but have not entered into a residency or have a license to practice. They work with a collaborating physician and are usually coming to the U.S. from another country. They also are nationally certified through ECFMG/ACGME. This is not a physician assistant. They have a medical degree only. States who use this new type of provider include Missouri (where it started), Arkansas, Kansas, Utah, and now Florida. New Hampshire, Virginia, Oklahoma, Washington, and Colorado are looking into allowing this, too. They can perform medical staff functions the medical staff feels is within their capabilities (i.e., lab work, H & Ps, recording physical exams) and are under the direct supervision of an MD or DO. It is left up to the hospital for how these providers are credentialed. Surveyors feel it should be done through the medical staff as they are performing clinical duties.
Dr. Todd Sagin said more and more hospitals will be joining big healthcare systems. There is still a lot of clinical integration that remains to be done. The U.S. government did a poor job in relation to COVID, and that is why we are behind compared to other countries. We will see more medical staff departments being formed into a single entity due to working remotely. There will continue to be a slow but steady trend to unify medical staffs, and there is less resistance now. We are now seeing more system credentials committees. Burnout for physicians is now greater than 50%. We need to reduce the burden on physicians by creating efficiencies. Unification and redesign will continue to occur. The only way the organized medical staff will go away is when the accreditation bodies change their standards around this. Peer review protections are diminishing.
The Tomorrow’s MSP campaign was discussed. The focus is on supporting MSPs as they future-proof their careers in the changing healthcare landscape. Many more webinars, podcasts, and courses were offered in 2020 due to the pandemic. In 2020, NAMSS had its first very successful all-virtual conference, which was well attended. The Government Relations team released the Hospital Closure Toolkit and the Credentialing by Proxy Guide. The Verification of Graduate Medical Education Training (VGMET) and the technology standards for practitioner credentialing (Inventures project) were discussed. Statistics were given on NAMSS PASS and the courses offered during Education Month in March 2021.
Other Updates From Attendees
- Discussions about working remotely
- Diversity, equity, and inclusion (DEI) initiatives have really increased in organizations
- Additional skill sets are needed for telemedicine
Roxanne Chamberlain, MBA, FACHE, FMSP, CPMSM, CPCS, CPHQ, is the senior director of medical staff services at Baystate Health System. She is the NAMSS Immediate Past President.