1. NUR 607 Credentialing & privileging

2. Significance of these activities Initial Ongoing Ensure protection of the public Autonomy and independence of the APN role = same attention to processes as required of physician counterparts. Risk management plan

3. Credentialing Collection, verification, and assessment of information determining the eligibility and qualifications of the provider to provide health-care services. Includes 3 categories: Current licensure Education and training Experience, ability, and current competence to perform the privileges that are requested/provided. Credentialing process guarantees the integrity of the data on the APN Serves as the basis of decisions regarding authorization for scope of practice and appointment in a facility

4. Privileging Based on evaluation of the applicant’s credentials and performance.

5. Data requirements Depends on federal and state regulations Professional standards Facility requirements Policies Procedures Voluntary oversight bodies Although the details of the requirements vary, in general there are common data elements for APNs.

6. Common data requirements Personal and practice demographic information Education and training Work history State licensure history Certifications DEA certificates Liability insurance and claims history History of sanctions and penalties imposed on practice Voluntary relinquishment of licenses/certifications Disclosures of physical, mental, substance, or criminal problems Attestation of information completeness and accuracy Authorizing statement to collect information

7. Verification of application data Primary source verification: attests to the accuracy of credentials based on evidence obtained from any source issuing the credential or attestation of clinical performance. Secondary source: Verification based on data obtained by means other than direct contact with the issuing source of the credential e.g. unofficial copies of documents.

8. Credentialing verification organizations Collect primary and secondary data on which the decision for appointment will be made. Quality of the CVO serviced must be monitored by the contracting organization. CVO may be accredited. Institution maintains liability.

9. Analysis of credentialing application Institutional procedures. Process is time-consuming. Can take 3 to 4 months. Typically includes physicians. Applicant should respond quickly to requests for additional information and should alert primary sources of the impending request by the verification body.

10. Appointments Vary in length. Guided by institutional policy. Obtain copies of the reappointment process and criteria. Continuously collect data. Need to understand the minimum criteria for credentialing in new procedures. Document accordingly.

11. Emergency credentialing Generally have time limitations. Developed in response to national and local emergencies.

12. After credentialing verification Subsequent decision to authorize the practice activities. Sometimes have separate privileging application. Institutional policies vary.

13. PRIVILEGING are increasingly involved in this process. Had been primarily related to physician practice. Used to monitor the clinical activities a provider is authorized to perform in that facility. The process of authorizing a health-care professional to order specific diagnostic or therapeutic services within well-defined limits. Privilege granting is based on: state practice acts, agency regulations, license, education, training, experience, competences, health status, and judgment. See page134 for a list of privileges.

14. Privileging Component of the facilities’ credentialing process. National accrediting bodies establish both the credentialing and privileging standards and processes by which organizations are accredited. The Joint Commission has a significant influence on privileging processes. Charged hospitals to establish criteria for clinical privileging and a process to ensure that care providers are competent. TJC standards require time frames, appeals processes, criteria for appointment and for determining specific privileges, determination of who is responsible for these decisions, reappointment processes, temporary privileging, telemedicine privileges, disaster privileges, and QI processes.

15. Telemedicine Providing agency and the recipient agency have privileging requirements.

16. Staff privileges categories 1. Active—admit patients & participate in hospital activities 2. Courtesy—Limited number of patients will be admitted and the provider is an active member of another medical staff. 3. Affiliate-No longer active but has long-standing relationship with the hospital. 4. Outpatient—HCP regularly engaged in patient care in outpatient settings or in programs sponsored by or on behalf of the organization. 5. Honorary—HCP is no longer active but has outstanding accomplishments or reputation. 6. House—can admit within a specialty area with the approval of an active staff member. 7. Allied health professional—non-physician HCP to provide specified patient care services. [p. 134]

17. 6 areas of competence required by TJC Patient care Medical and clinical knowledge Practice-based learning and improvement Interpersonal and communication skills Professionalism System-based practice Overall evaluation of an individual’s credentialing and privileging file needs to incorporate these parameters.

18. Other processes for evaluation Focused professional practice evaluation Need to evaluate the individual more closely than just paper credentials to ascertain competence. Ongoing professional practice evaluation that allows for a more evidence-based approach to credentialing rather than just the formal process every 2 years.

19. Implications for APNs Scope of practice as outlined in the state practice act. Each state regulates differently. Agency regulations are usually defined by the medical staff and hospital board and may restrict APNs from performing certain procedures. Education provides the components to develop specific outcome competencies—these are determined by the professional organization and the profession in scope and standards of practice.

20. Critical considerations Learning a particular procedure does not mean the provider is legally allowed to perform it because it may be outside the scope of practice and license. Untreated substance abuse problems and physical impairments may interfere with performance.

21. National Practitioner Data Bank (NPDB) Plays an important role in credentialing. Most institutions use this process. There are concerns about non-reporting so this is one piece of the data set—not the “be all, end all.”

22. Portfolio Example: Decision Critical Includes a variety of ongoing itemization—portfolios are built. Resume Personal statements Case studies Research Health-care project descriptions Brief papers and assignments Publications and presentations Evidence-based examples Practice logs Video clips Certificates Letters of support and recommendation CE activities Course syllabi transcripts

23. Managed Care Panels Competitive environment—do not forget this fact. More than one type of provider may be able to provide the same scope of practice or provide partial activities within another scope of practice. Ability to be credentialed and apply for privileges is dependent upon the credentialing structure. Sometimes APNs are excluded as a result of anti- competition; other times the result of a lack of knowledge about APN practice parameters.