New Medicolegal Issues in Hospital Credentialing
How a Medical Expert can add Value in Hospital Credentialing Cases.
New Medicolegal Issues in Hospital Credentialing
The Evolution of Medical Credentialing
Over the past 20 years, the scope of credentialing for hospitals has changed dramatically. In the past, Credentialing was limited to physicians providing hospital care, and an administrative team would periodically review their performance. However, with the changing landscape of healthcare, the credentialing process has become increasingly complex. Now, multiple provider types enter the credentialing process in addition to physicians - physician assistants, nurse practitioners, and pharmacists are additional providers that must now enter the credentialing process. Additionally, the scope of practice now allows nurse practitioners and physician assistants additional leeway to practice independently, with specific requirements varying by state. Regulatory changes have also made the process challenging, with both CMS and the Joint Commission having their own credentialing requirements.
What is Negligent Credentialing?
Hospitals, by law, are required to ensure that medical professionals have completed the required competencies. Negligent credentialing is the term used when hospitals allow a physician or other provider to continue to practice medicine even if there are questions about his or her credentials. Common areas of concern for a provider during the credentialing process include:
Educational background: Can the providers’ educational background be verified and confirmed (i.e. medical school, residency training, fellowship training)
Board Certification: Has the provider successfully passed their board certification tests to be considered board-certified, or if they are new graduates are they board-eligible?
Updated licensure requirements: Do the providers have prior malpractice history, disciplinary action, or failure to keep continuing medical education credits (CME)?
Providers practicing within or outside the scope of practice: Are providers performing procedures that are not outlined in their delineation of privileges?
Role of a Credentialing Medical Expert
The role of the medical expert in credentialing can revolve around several areas:
Standard Industry Practices
The expert witness can explain what constitutes standard practice in medical credentialing, including the policies and procedures that should be followed by healthcare institutions. This information can establish whether an entity was negligent in following the appropriate protocol.
Verification Procedures
Experts can detail the verification process of a medical professional's credentials, discussing how primary source verification is conducted and the typical timeframe for such processes. They can highlight any shortcuts or oversights that may have occurred.
Accreditation and Regulatory Compliance
Medical credentialing experts can speak on compliance with accreditation standards (like those of the Joint Commission) and state and federal regulations. They can discuss how non-compliance could affect the quality of care and patient safety.
Risk Management
The expert can discuss the implications of insufficient credentialing on risk management, including potential risks to patients and liability risks for the institution.
Implications of Credentialing on Patient Care
Experts can correlate how proper or improper credentialing can directly affect patient care outcomes. They can assess whether a lack of credentialing contributed to a medical error or malpractice incident.
Litigation and Disciplinary Action
In cases of litigation or disciplinary action, the expert witness can review the credentials of the healthcare professional in question and provide an opinion on the adequacy of those credentials and any potential impact on the legal matter at hand.
ABOUT THE AUTHOR: Dr. Vipul Kella, MD MBA FACEP
Professional Experience Summary
? Board-Certified Emergency Physician
? Fellow, American College of Emergency Physician
? 18- years experience in Level 1 Trauma, community, rural suburban setting
? States Licensure in MD, KS, MI, UT
? Deep health tech, administrative, and consulting expertise
? CEO Healthcare Consulting Firm
Medical Expert Witness/Consulting Summary
? Nationwide Experience across >20 states
? Retained in multiple high-profile federal, criminal and civil cases.
? Plaintiff/Defense
? Reports/Certificates of Merit/2nd Opinion/Case Analysis/Deposition/Testimony
? Extensive Advisory Network of Experts
? Areas of expertise: Hospital Administration, Long-Term Care Facilities Medical Devices,
Medical Ethics, Medical Standards of Care, Digital Health, Medicare Fraud and Abuse,
Medicaid, Value-Based Care, Remote Patient Monitoring, Chronic Care Management,
Non-Traditional Medical Care, Health Innovations.
Copyright Vipul Kella, M.D., MBA. FACEP
Disclaimer: While every effort has been made to ensure the accuracy of this publication, it is not intended to provide legal advice as individual situations will differ and should be discussed with an expert and/or lawyer.For specific technical or legal advice on the information provided and related topics, please contact the author.
