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Tuesday, July 6, 2010

Hospital Staff Priveleges:

Why I no longer belong to hospital staffs:

The Happy Hospitalist explains the byzantine maze required to see and treat patients.

Bill Gate’s web experience: Byzantine, idiotic logic

A medical license has always been an earned privilege. We are given the privilege of hospital staff memberships. However things have taken a terrible turn for the worst. At this point the hospitals should consider it is their privilege to have me on their staff. I agree with Happy that there is now a lot of “crap” in the system. Someone has made or is making a lot of $$$ producing software, and/or meetings for medical staff offices to ‘automate” their credentialing system. A great deal of information requested is repetitive and could easily be stored in a central location for medical staff credentialing purposes.




In their own words;

“CAQH, an unprecedented nonprofit alliance of health plans and trade associations, is a catalyst for industry collaboration on initiatives that simplify healthcare administration. CAQH solutions promote quality interactions between plans, providers and other stakeholders; reduce costs and frustrations associated with healthcare administration; facilitate administrative healthcare information exchange and encourage administrative and clinical data integration. provides the same type of services for physicians to become credentialed by health insurance companies.”

It just keeps on getting crazier. Physician credentialing software is out of control. Physicians now pay hundreds of dollars a year in government regulatory licensure fees. Doctors pay thousands of dollars to take the test. The test is a board exam documenting the physician's expertise in a field of medicine so they can hang a certificate on their wall that most patients will never see.

Physicians who take the test are supposed to be certified as experts in their field of practice. So why are physicians forced to jump through miles and miles of expense and complicated credentialing processes for every hospital they would like to see patients at?

For physicians to do a hospital admission or daily visits or procedures inside a hospital they must first obtain hospital credentials. In other words, if there are five hospitals in town and a physician wants to be able to see patients at all five hospitals, they must apply for the right to practice medicine within all five hospitals.

* It's not good enough to pay your money to your state licensing authority every year for the right to practice medicine.

* It's not good enough that most states require physicians to complete at least 50 hours of uncompensated continuing medical education (CME) every two years just to apply for a state medical license.

* It's not good enough to pay $500 every few years to the federal government for the right to prescribe medications.

* It's not good enough to pay several thousand dollars and spend hundreds of hours of uncompensated study to get your board recertification every few years.

Nope, none of that is good enough. To practice medicine inside the walls of a hospital, the hospital must then grant you the privilege of seeing your patients at their hospital. Every hospital has their own set of rules. Every hospital has their own credentialing committee that meets to give the yeah or nay to new staff appointments. Every hospital has their own physician credentialing software that guides them in their search for red flags.

I recently applied for hospital privileges to another hospital. Happy's billing company takes care of all the credentialing requirements for insurance companies and hospitals. In this case, they sent me a packet of information almost 40 pages long. They mark everything I need to sign with tiny little sticky pads. About 10-15 tiny little sign and date here sticky pads dotted the hospital credentialing paperwork. Forty pages of legal mumbo jumbo.

A lot of this physician credentialing software delves into your past history. Where did you train? What are your previous practice experiences? What procedures can you prove proficiency in? What procedures would you like to be credentialed to provide? What are your last three residential addresses? Have you ever been charged with a crime? Have you ever been convicted of a drug or alcohol related offense? Have you ever been sued? Not lost a lawsuit, just sued. Have you ever been treated for depression? There is some pretty personal information that gets requested on these hospital credential applications. Next thing you know, they'll want to know my sperm count.

Imagine the legal fallout hospitals must be worried about by allowing doctors who have been sued from seeing patients? Could they be held liable for allowing a bad apple to practice medicine in their walls. A physician who has been licensed by the government and certified by their specialty society as an expert capable of providing excellent care?

There are many ramifications for settling a lawsuit because it's cheaper just to make it go away than to fight for what you believe in. Would that prevent you from obtaining hospital credentials or perhaps even cause a hospital to revoke them?

Physician credentialing software these days must be based on an overwhelming mountain of legal fear. One of my partners failed to disclose a minor in possession ticket (MIP) during her teenage years. After failing to disclose this ridiculously unimportant legal request, her hospital credentials were delayed for weeks, perhaps months in order to send letters and appear in committee meetings to explain herself.

One local physician even told me that another colleague at another hospital had failed to disclose that he got a ticket for fishing without a license. That's right folks. A ticket for fishing. When he failed to disclose this dastardly deed on his hospital credentialing paperwork, his approval was denied and delayed. Unbelievable.

This is what the legal environment of doctors and hospital credentialing has become. MIPs and fishing licenses. The fear in medical credentialing is out of control.

In a new one for me, physician credentialing software asked me how many children live in my home and if I'd ever lived with any children in the past. The title of the document I was to sign had to do with any previous allegations or arrests for child abuse or sexual assault. Now the hospitals want to know if I have any children in my home. What has this world come to?

With such a large volume of legal detective work being done on every physician credentialed at every hospital, one has to wonder how is it even possible for a bad apple to fall through the cracks. If you have a hospitalist seeing you at your hospital, you can rest assured their past has been raked through the coals and their history and credentials have been picked apart by government agencies, specialty societies and even the hospital you find yourself in. And absurdly so.

HAPPY HOSPITALIST, I hear your angst.........and there is hope

Credentialling Solutions

which offers this service.

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