Negligent Credentialing Risk Management: 4 Best Practices

Negligent Credentialing Risk Management: 4 Best Practices
Marketing Director

Hospitals can be drawn into lawsuits involving physician negligence with “negligent credentialing” claims and the results can be costly for any healthcare organization. Attorney fees and the costs of settling a negligent credentialing case can exceed $100 million, as in the 2012 case of Jane Doe v. Bradley, for example. Besides the monetary costs, these types of cases can be detrimental for a healthcare organization’s reputation, further expanding the potential damages.

The good news is that there are ways to avoid negligent credentialing claims. The following are four ways healthcare organizations can mitigate risk while strengthening their credentialing process.

1. Primary Source Verify All Training Programs

While verifying completed training programs is key, credentialing experts suggest there could be pertinent information uncovered from incomplete training programs. The majority of the time, physicians simply change their minds regarding the specialty of medicine they want to pursue, and there’s nothing wrong with that. “However, in some cases… you may find that an applicant has been terminated from [his or her] program due to behavior issues or not performing well,” Frances Ponsioen, Consultant and Senior Director for Credence Business Units at the Greeley Company, explains in a 2017 article. “Reasons behind an applicant not completing a training program may be very crucial in the decision-making process.”

2. Run Criminal Background Checks (More Than Once)

Most hospitals recognize that a criminal background check is an important part of the credentialing process. “Criminal background checks fill in any potential gaps in credentialing search efforts and help assure that those gaps do not present quality of care or safety concerns for the organization and its patients,” Jesse Adam Markos of Wachler & Associates states in a PreCheck article.

While criminal background checks have become the new norm in credentialing, it is no longer a practice that is only implemented at the initial appointment. It is now more common for healthcare organizations to run background “rechecks” in their credentialing process at time of reappointment. As a best practice, PreCheck recommends background “rechecks” any time there are changes in privileges.

3. Provide Medical Staff Department Chairs With Proper Guidance

With most medical staffs being departmentalized in nature, taking the steps to involve each department properly in the vetting process can make a big difference in mitigating risk for negligent credentialing. “It is especially damaging in negligent credentialing lawsuits when a chair states that he or she did not understand the role or thought someone else was doing a task that the credentials committee or medical executive committee (MEC) believed was the chair’s responsibility,” according to an article from the Credentialing Resource Center. “Department chairs are often given little guidance as to what their review should entail.”

4. Practice Effective Communication in the Medical Staff Department

Not only is providing the right guidance necessary, but establishing effective communication can help mitigate risk as well. “Communication is key to preventing and defending allegations of negligent credentialing,” according to a 2017 article by Willis Towers Watson. “It is important to communicate with the medical staff office and the chief medical officer on issues involving physicians, even when it has not risen to the level of a claim or lawsuit.” Communicating concerns relating to potential physician negligence, disruptive behavior and ethical violations can prevent issues from arising as well as mitigate current issues.

Negligent credentialing claims are costly, but healthcare organizations can take several steps to mitigate risk. By conducting primary source verifications and frequent background checks as well as establishing effective communication, medical staff services departments can prevent these types of incidents at their organization.

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