Download a PDF of the Current Issue 2015 Volume 12 Number 3 July- September

Credentialing for New Procedures

Cristina Palacio, Esq. Associate General Counsel Shands Healthcare, Inc.
Carol Shaw, CPMSM, Director, ShandsHealthCareCredentialingVerification services and Shands at UF Medical Staff Services
6-1-3   New technology creates challenges for many in the healthcare field. Prior to granting privileges to perform a new procedure or use new technology, The Joint Commission requires hospitals to have a process to determine whether sufficient space, equipment, staffing, and financial resources are in place to support each requested privilege. In the field of credentialing, many questions must be answered when new technology is introduced, including whether or not credentialing criteria should be developed for the new technology. Generally, if the new technology or procedure is one in which special training and/or experience would be required, the challenge of developing criteria to demonstrate competency to use the new technology or perform a newly developed procedure that can then be applied consistently to any individual requesting these new privileges must be addressed. Patients on whom new procedures are being performed should feel confident that the physician performing the new procedures is appropriately trained and competent. When new technologies are introduced, hospitals may not be able to rely on residency training completion as one validation of competence. Eventually, as residency training programs begin training all residents for the new technology, hospitals may be able to rely on the training received in residency training as a measure of competence. Introduction of procedures and/or technologies such as carotid stenting, Da Vinci robotically-assisted procedures, or even laparoscopic procedures in the 1980s, requires establishment of criteria against which applicants for the privileges may be measured to assure their competency and ultimately to assure the safety of patients. As an academic medical center, Shands at UF has had numerous opportunities to address new technology through the credentialing process, since those cutting edge procedures are often introduced in the academic medical center setting. The credentialing process must be responsive to new procedures and be able to identify appropriate credentialing criteria to apply to these new procedures. There are several resources that are used to develop credentialing criteria for new procedures and technologies.   The Credentialing Resource Center, a national consulting firm on medical staff matters, develops credentialing white papers that are compilations of recommendations from professional societies and other organizations, along with suggested credentialing criteria. These provide an excellent starting point when a hospital receives a request  for  privileges  for  new  procedures. Oftentimes, however, academic medical centers are introducing new procedures for which clinical white papers have not yet been developed. In addition, many of the professional societies publish literature in which training requirements for particular procedures are analyzed and recommendations are outlined for application to the credentialing process. In some cases, professional societies have joined together to develop consensus recommendations. Such consensus documents were used, for example, in developing credentialing criteria for carotid stenting procedures. Finally, benchmarking with other hospitals may result in identifying credentialing criteria that can be adopted or used by the Medical Staff as a starting point for developing appropriate criteria. In each case in which a new procedure or technology is introduced, which may require development of credentialing criteria, Medical Staff representatives of the specialties involved in the procedure are consulted for input into the development of the credentialing criteria. When literature is available, and/or when clinical white papers have been developed, those documents are provided as a basis for the development of the criteria. The Medical Staff Office coordinates the review of the information and the development of criteria that, ideally, is agreeable to all involved specialties. However, in the absence of agreement of all specialties, the Medical Executive Committee, with input from the Credentials Committee agrees upon a final recommendation for submission to the Shands HealthCare Board of Directors for final action.  Once those credentialing criteria are approved, individuals may then apply for those privileges and must meet those criteria to be granted the privilege. In recent years, the development of credentialing criteria also includes criteria for the renewal of those privileges that often includes a requirement for continuing medical education related to the new procedure or technology. Some examples of credentialing criteria that have been developed to address new technologies over the past several years have included robotically-assisted procedures and carotid stenting procedures. Sometimes, credentialing criteria are developed for technologies that cross specialty lines and a number of such criteria have been developed over the past several years, including: cardiac imaging with computed tomography and magnetic resonance (performed by both cardiologists and radiologists); obstetrics (performed by both OB/GYN and Family Medicine physicians); peripheral vascular procedures (performed by vascular surgeons, interventional radiologists, and interventional  cardiologists),  all of which have led to the development of specific credentialing criteria. With ever-changing and evolving new technology in health care, today’s new technology becomes tomorrow’s norm and the need for specially developed criteria is reduced as training eventually becomes routinely accomplished through the residency training programs. Until such procedures become the norm, however, the need for development of credentialing criteria for new technology will continue to require the attention of hospitals and their medical staffs.