CVO and Credentials Committee Vetting of State Medical Board Data

CVO and Credentials Committee Vetting of State Medical Board Data National Credentialing Forum 2022 February 2022

Why Is There A Concern? An exponential rise of negligent credentialing lawsuits has triggered this issue Increasingly savvy plaintiff’s attorneys and some recurring plaintiff’s experts have routinely accessed public state medical board information to present in their negligent credentialing allegations

Case Examples Scenario 1: Substance abuse background Scenario 2: Behavioral allegations arising out of divorce and multiple board complaints

The Questions Raised How often do CVO’s go beyond confirmation of an unrestricted license to obtain the full public medical board record on an applicant? (*For purposes of this presentation, “CVO” is a proxy for any entity that is gathering applicant data for the credentialing process and performing data verifications.) How accurate and prompt are website postings of medical board actions against licensed practitioners?

The Questions Raised How effective are current credentialing software packages at identifying underlying medical board issues with an applicant? How much should we expect credentialing committees to evaluate from an applicant’s history with a medical board?

How often do CVO’s go beyond confirmation of an unrestricted license to obtain the full public medical board record on an applicant? Anecdotally – it appears most check the verification from the licensing board website to see if there is are any actions against the license and to confirm it is current and unrestricted. Is this impression accurate?

How accurate & prompt are website postings of medical board actions against licensed practitioners? TSBME suspended practitioner 10/5/21 However, verification performed 10/13/21 – no notice of suspension (see next slide) Website finally updated 10/22/21

Examples from the field:

Y

CVO Software – auto response

How effective are current credentialing software packages at identifying for CVOs underlying medical board issues and sanctions with an applicant? TSBME– No disciplinary action but permit is suspended. No red flag in software. New York just recently added automated board action notice, previously CVO had to manually search for info Some software programs do not reflect red flags thus CVO has to assure 100% review of all licensure and other verifications System Auto- Review if no identified red flag – thus audits are critical

CVO Due Diligence Required CVO’s experience organizational pressure to shorten turn-around times Lack of training of staff to watch for red flags reflected or not reflected on verification Lack of effective CVO file audits to assure all red flags are identified

How much should we expect credentialing committees to evaluate from an applicant’s history with a medical board? Who Should Decide? When is the information a ‘red flag’? Clearly, if the content deals with clinical competence or professional conduct, the material is relevant and should be assessed. What about personal background data: troubles with the law, family related matters, health issues, unsubstantiated complaints? Is more knowledge always better? What about the burden of work and time on credentialing bodies Will physicians find it an uneccesary invasion of privacy? Is there a growing imperative to evaluate applicants beyond their clinical competency and professional conduct?

Other Issues? Ineffective tracking of license suspensions once board takes action Obligation of MEC followup of identified issues resulting in license suspension (e.g. child pornography, threat to patient safety, DUI, etc)