How Physician Background Screening and Credentialing Work Together in Medical Staff Services

How Physician Background Screening and Credentialing Work Together in Medical Staff Services
Director of Credentialing Programs

As Product Manager for PreCheck’s healthcare license management system, LicenseManager Pro, I’ve taken the National Association Medical Staff Services’ (NAMSS) Certified Provider Credentialing Specialist (CPCS) training course and am familiar with some of the challenges facing medical staff services managers. While the goals may be quite similar, these are some notable differences between background screening and the credentialing process for medical staff services. Credentialing, according to The Joint Commission Glossary, is defined as “the process of obtaining, verifying and assessing the qualifications of a healthcare practitioner to provide patient care services in or for a healthcare entity.” There are three key components of the credentialing process: current licensure; education and relevant training; and experience, ability and current competence to perform the requested privilege(s).

Medical staff services professionals deal with credentialing every day, but how do background checks complement this critical process?

Similarities and Differences of Background Checks and Credentialing

Medical staff services is a self-governing body within a healthcare organization and is responsible for keeping with independent practitioners who serve healthcare facilities. Most physicians appointed by medical staff services are not usually employed by the facility, which is a different scenario from that of the human resources department, who performs the verifications and background checks for employees. The background check process can include criminal searches, primary source professional license verification, and education verifications, to name a few components. For medical staff offices, the credentialing process involves verifying the qualifications for individuals who may have privileges to practice in their facilities. The medical staff credentialing process also involves peer recoommendations, insurance statuses, as well as looking for malpractice claims. The goal is the same, to protect patients and the organization from unqualified individuals, but there are different components to each process.

Physician Background Checks as a Risk Mitigation Tool for Medical Staff Services

While medical staff services is not involved with employment screening in the traditional sense like HR departments, performing background checks on physicians applying for privileges can be a great way to mitigate risk for your hospital and protect your patients from preventable serious medical events (link to patient safety blog article). It can help save your hospital’s reputation by checking a possible criminal history on a physician treating your patients. While it’s true that some state medical boards perform criminal background checks on physicians applying for licensure, not all of them have authorization to do so. Even among those that have access to performing background checks, they differ on their level of access. In addition, recent research suggests that state medical boards fail to properly discipline troubled physicians. So if you’re not performing background checks on your hospital’s physicians, there are many gaps when it comes to criminal history and what is normally evaluated through the credentialing process alone.

Physician Background Checks: Once Is Simply Not Enough

Even if the state medical board performed a background check on a particular physician applying for privileges at your facility, what’s to say they haven’t committed any crimes since then? Even if your medical staff office has a physician background screening policy in place, do you only perform background checks at time of appointment? If you are not performing background checks at time of re-appointment as well, you may be placing both your facility and its patients at risk. In a recent article, our Director of Operations Dana Sangerhausen discusses the emerging trends in healthcare for performing ongoing background checks. At PreCheck, we have clients that perform re-checks on an annual basis, for example, to minimize the level of risk for their organization. In medical staff services, the re-appointment process typically occurs every two years, and a lot can happen in 24 months. As Dana explains in the aforementioned article, a criminal background check represents a snapshot in time—so you may find something new later down the road than what you found on the background check performed at the time of appointment.

PreCheck Background Screening Resource Kit