It is wise to have potential external peer reviewers in mind because the need for them can arise without warning. A good external peer review organization should provide the following:

The Centers for Medicare & Medicaid Services (CMS) recently unveiled a new pilot program that will give clinicians direct access to Medicare beneficiaries' claims data. CMS Administrator Seema Verma says the "Data at the Point of Care" pilot is designed to improve care, sharpen diagnoses, and reduce redundant services by knocking down silos that prevent patients and their providers from accessing their complete health history in one record.

Because all data are biased to a certain extent, it is important to include an explanation in physician performance reports about how the data are derived. When explaining data to physicians, or any group, keep in mind that the audience will be less familiar with the data than you.

It is imperative to discuss the implications of various findings from criminal background checks and other background investigations with legal counsel and medical staff leaders. A best practice would be to develop a policy and procedure to standardize follow-up actions concerning information learned from background checks, which includes getting a detailed response from the applicant about the discovery. This process is well-defined in this sample policy and procedure.

HCPro is currently seeking speakers to present at the 2020 Credentialing Resource Center Symposium, to be held April 20-21 in New Orleans. Find out how you can be a part of our one-of-a-kind credentialing event.

According to a study of private health insurance claims data, use of telehealth services is increasing rapidly. In 2005, the number of annual telemedicine visits in the data set was 206. In 2017, that number increased to more than 202,000. As telemedicine use continues to surge, it is becoming more important than ever to establish a peer review process for telehealth providers in order to promote patient safety and ensure quality care. However, because the nature of telemedicine differs from that of an in-person patient-physician encounter, organizations may have difficulty identifying their peer review obligations.

Telemedicine is a rapidly expanding activity, and more hospitals are making use of telemedicine resources. The regulatory and accreditation standards for the privileging of telemedicine practitioners have been in flux over the past decade. Some of this flux has been caused by the changing position of CMS regarding telemedicine credentialing. It is also important to observe that telemedicine and telehealth have been the subject of considerable state legislation in recent years.

As more and more healthcare organizations turn to APPs to fill gaps in patient care, MSSDs must integrate credentialing and privileging these practitioners into their current processes.

Featuring an unmatched combination of expert-vetted measures from the field and actionable guidance on their broader implementation, this book equips medical staff leaders, MSPs, and quality professionals with the tools and know-how to capture holistic competence data for clinicians spanning specialties. Expert author Teresa P. Sappington, FACHE, MBA, CIPM, CAPPM, CPHQ, CPMSM, provides in-depth strategy on selecting, structuring, operationalizing, and ensuring the continued effectiveness of professional practice evaluation metrics.