Physician CredentialingIn the heath care industry, physicians are expected, and in some cases required, to report peers who are underperforming, impaired or are deemed too incompetent to provide sufficient medical care. In addition to proper credentialing and background screening, this self-reporting policy is a fundamental way for hospitals to maintain a high quality of patient care.

However, a recent L.A. Times article shared alarming statistics about the number of underperforming doctors that go unreported by peers. Published in a study by the Journal of the American Medical Association, and cited by the L.A. Times, one-third of doctors did not report on a suspect colleague and 17 percent of MDs had direct, personal knowledge of an incompetent physician within the last three years.

These findings expose a grave set of risks to patients, employees, hospitals and care facilities. When incompetent physicians are not caught by a sufficient credentialing and background screening system, or are not reported by their peers, they can pose a risk to patient safety and staff. It can also impact the hospital and its ability to operate and serve the community in some of the following ways:

• Negative impact on the hospital's brand
• For private institutions, a decrease in fundraising activity
• Outside vendors may not want to continue doing business with the hospital
• Hospitals can lose their accreditation or certification status
• Loss of Medicare and Medicaid reimbursements for any case that the implicated physician was involved in
• Potential fines imposed for each day the implicated physician retains privileges at the hospital
• Sanctioning by the Office of Inspector General and imposition of a Corporate Integrity Agreement (CIA), which involves a stringent policy review and lengthy audit

The Benefits of Comprehensive Credentialing Programs
Hospitals can better protect themselves against incidents of incompetency by building a more comprehensive credentialing program. This will help the hospital to better mitigate financial, legal and brand risks that arise when bad physicians are caught, and help ensure only the best candidates are hired. Below are some of the main benefits of creating a more thorough medical credentialing process:

1. Mitigate legal risk
A thorough credentialing procedure that meets all the requirements of The Joint Commission and the National Committee for Quality Assurance (NCQA), and includes an additional background check and criminal check, will help a hospital defend against liability in the event of malpractice lawsuits.

2. Reduce incidents of incompetence
Increasing the scope and efficacy of the credentialing process will help hospitals reduce the number of poor physicians they hire and in turn reduce the rate of incompetent performance.

3. Maintain compliance and funding
Creating a consistent, comprehensive credentialing policy and strictly abiding by those policies with every new candidate can help medical facilities uphold their accreditations and certifications. It also helps maintain payments from insurance companies and allows for participation in federally funded programs.

4. Minimize financial risk
When hospitals are found culpable for inadequate credentialing, the ensuing audits may drain financial resources and personnel hours. Following best practices for credentialing can mitigate this financial risk.

5. Protect brand integrity
Negative press can damage a hospital's reputation in the eyes of its employees, customers and in the case of private institutions, donors. Ensuring high credentialing standards will protect the hospital's brand integrity and ability to attract top-tier talent to work there.

Medical institutions rely on their reputation and quality of care to continue to serve their community. A credentialing program that is inadequate can put patients, staff and the institution at risk. By implementing a robust credentialing program, you will help ensure a safer work place, help mitigate risk and maintain a positive brand image.

To learn more about building a comprehensive credentialing program, and other health care industry best practices, download our complimentary white paper: Best Practices: Background Screening in the Health Care Industry.


The HireRight Blog is provided for informational purposes only and should not be construed as legal advice. Any statutes or laws cited in this article should be read in their entirety. If you or your customers have questions concerning compliance and obligations under United States or International laws or regulations, we suggest that you address these directly with your legal department or outside counsel.

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The HireRight Blog is provided for informational purposes only. It is not intended to be comprehensive, and is not a substitute for and should not be construed as legal advice. HireRight does not warrant any statements in the HireRight Blog. Any statutes or laws cited herein should be read in their entirety. You should direct to your own experienced legal counsel questions involving your organization's compliance with or interpretation or application of laws or regulations and any additional legal requirements that may apply.

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