Hospital and Provider Credentialing
...ussions and the dissemination of these issues to the whole medical network, it puts everyone on the same playing field. In addition, competitors will work together to resolve an issue that can impact the whole industry. Consumer’s Perception and Expectations Consumers want quality healthcare for themselves and family. Knowing JCAHO has made available information to assist with quality care and ensuring that a consumer’s needs are met helps to remove worry and doubt. Consumers expect to have quality care from nurses, doctors and other staff involved with healthcare for their loved ones. They want to know they are guaranteed confidentiality and patient rights, guaranteed effectiveness of communication among caregivers, and that a facility provides security and accuracy of patient identification. Consumers want guarantee that wrong-site, wrong-patient, and wrong-procedure surgery will be eliminated. They expect effectiveness of clinical alarm systems and safety of using high-alert medications. Consumers expect to have quality and safety when utilizing the services offered by JCAHO. They want to know that facilities have met the approved accreditation and that physicians and facilities are stamped with the seal of approval showing that compliance and standards of JCAHO are met, and the same goes for selecting a facility or program for their loved ones. Consumers want to know that a facility or program manager knows what questions to ask and what they will need to help their loved ones get prepared and acclimated to a new environment. JCAHO is committed to making consumers aware of their commitment to quality healthcare. Regulatory Changes Affecting This Profession The Joint Commission is committed to making the accreditation process more relevant, meaningful and valuable. JACHO has continued to fine-tune the accreditation process to better align the requirements with day-to-day business practices. JACHO has recently made regulatory changes regarding performance measurement requirements, telemedicine services, as well as public policy issues, just to name a few. JACHO has modified the performance measurement requirements for managed care organizations (MCOs), managed behavioral health organizations (MBHOs), and preferred provider organizations (PPOs). The new performance measures that are relevant to patient populations have been reduced from earlier requirements. These changes have been made in an attempt to ease the data collection burden, while maintaining an important focus on performance improvement. (JACHO, Network News, 2004) They include: • MCOs will be required to collect on twenty-two measures, rather than thirty. • MBHOs will be required to collect data on nine measures, rather than fifteen. • PPOs will be required t collect data on five measures, rather than nine. According to the McDermott Newsletter, “Telemedicine is the use of medical information exchanged from one site to another via electronic communications for the health and education of the patient, the education of the health care provider and for all purpose of improving patient care, treatment and service.” JACHO has recently revised its hospital standards for credentialing providers that use this service. Prior to these changes, JACHO required all practitioners who diagnosed or treated patients using a telemedicine link to be subjected to credentialing and privileging processes of the organization the receives the telemedicine service. (http://www.mwe.com/index.cfm/fuseaction/publications.nldetail/). In an attempt the reduce the burden of credentialing and privileging on the site where the patient is located, JACHO has adopted a new standard, MS.4.120, which is applicable only to licensed independent practitioners (LIPs) at distant sites where the practitioner provides professional services. The new standards include: • Orginating sites are required to credential and privilege distant site telemedicine providers through one or three mechanisms. • Medical staff at both the originating and distant sites must recommend the clinical services to be provided by LIPs through a telemedical link at their respective site. • LIPs who provide official readings or images, tracings or specimens through a telemedicine link must be credentialed and privilged under the contracted services standard, LD.3.50. (http://www.mwe.com/index.cfm/fuseaction/publications.nldetail/) These are just a few of the regulatory changes affecting hospital and provider credentialing. (JACHO, Public Policy Initiatives, 2004) Future Trends The Joint Commission on Accreditation of Healthcare Organizations continues to implement programs and campaigns for health care issues. Several new certification programs are established, and there are several different issues being studied for future certification programs. The first program to certify disease management programs, the Disease-Specific Care (DSC) Certification program, began i...