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ABPS Acknowledges Contributions of MSPs to Healthcare Leadership in U.S.

Friday, November 08, 2019

The American Board of Physician Specialties joins the U.S. healthcare community in acknowledging the importance of medical service professionals (MSP) in commemorating the National Medical Staff Services Awareness Week. In 1992, President George Bush recognized the first week in November as National Medical Staff Services Awareness Week and since then, medical facilities and government agencies have celebrated the importance of medical services professionals.  ABPS promotes the importance of MSPs in verifying physicians’ credentials to help ensure the highest quality of medical care is delivered.

MSPs continue to evolve as they now have more roles to fill than ever before. MSPs performed more administrative duties in the past, but their role has developed to have more responsibilities such as working with gap analysis, primary source verification, telehealth credentialing, allied-health practitioner credentialing, and reconciling a manual process with new technologies. The medical industry has switched to electronic record keeping, which has reduced the number of workers in an organizations managed services office. Due to the lack of workers, MSPs are overloaded with a number of duties such as coordinating medical staff onboarding, managing credentialing, and acting as the liaison between hospitals and staff.

There is more demand for higher education and training among MSPs because of how complex the job has become. It is important to recognize the hard work MSPs perform on a daily basis as their role continues to become more challenging. View the article here.

Roxanne Chamberlain Attended the AHLA Annual Meeting

Wednesday, September 18, 2019

In June, Roxanne Chamberlain, MBA, FACHE, FMSP, CPMSM, CPCS, Senior Director of Medical Staff Services at Baystate Health, Inc. and 2019 NAMSS President-Elect, attended the American Healthcare Lawyers Association (AHLA) Annual Meeting in Boston, MA. Health law professionals attend the meeting each year for the most current information and analysis on a variety of legal issues affecting the healthcare industry. The annual meeting included thoughtful, practical, solution-oriented sessions, luncheons, and networking events.

John P. Ryan, President and Managing Partner, Hall Render Killian Health & Lyman PC and Heather Brace, Senior VP and Chief People Officer, Intermountain Healthcare, delivered the Meeting’s keynote address, The Future of the Health Care Workforce.The keynote session focused on the leading influences affecting the healthcare industry and their potential legal challenges. Experienced health law professionals facilitated breakout sessions on practice-management topics, top-physician compensation risk areas, understanding and addressing conflicts of interest at non-profit organizations, and coping with the mystery and reality of artificial intelligence (AI) in healthcare.

Roxanne attended many of the Meeting’s AI learning sessions, which included AI liability, and how it could affect the standard of care in medical malpractice cases, as well as how AI bedside assistance will simplify doctor and nurse workloads. Roxanne also attended sessions about healthcare policy and hazard prevention where she learned that efforts to reduce healthcare costs have made little progress, as states continue to file lawsuits regarding the Affordable Care Act. Additional sessions surrounded topics on practitioner conscious clauses and hospital-acquired infection reduction rates in 2018-2019.

Drug price transparency was another popular topic, as well as how states and the federal government are combating rising drug prices. Nine states have passed drug-price transparency laws and seven other states are in the process of passing legislation.

Roxanne also attended sessions related to healthcare data and telehealth and noted that the U.S. Chamber of Commerce continues to call for a federal data privacy law due to inconsistent state laws and the number of data breeches. The healthcare sector continues to embrace digital invocations as consumer demand increases. Healthcare law professionals recommended that hospitals take an interdisciplinary team approach to implementing telehealth proposals and their legal staffs should have multi-faceted telehealth competencies to handle with regulatory issues.

As NAMSS liaison to AHLA, Roxanne stands by as a resource to the membership and is available to answer additional questions or provide additional information about AHLA.

A Conversation with Dr. Peter Hill, 2019 CVO Excellence Symposium Keynote Speaker

Thursday, September 12, 2019

The CVO Excellence Symposium, the first event designed for MSPs who work in credentials verification organizations (CVO), is a two-day event focusing on the crucial discussions related to the state of the CVO, exploring topics such as staffing models, legal and regulatory issues, technology and innovation, and streamlining processes from the top-down. NAMSS recently sat down with Dr. Peter Hill, the Symposium’s keynote speaker, who serves as the Senior Vice President of Medical Affairs for the Johns Hopkins Health System and Vice President of Medical Affairs/Chief Medical Officer for the Johns Hopkins Hospital, to discuss what he’ll cover in his keynote presentation:

  1. Can you give a small preview of what you’ll be covering in your keynote presentation at the NAMSS CVO Symposium?
·        How health systems are embracing the ongoing challenges in healthcare.
·        Impact of telehealth services and the impact on credentialing these practitioners within a health system
·        Credentialing the “Virtual doctor/practitioner” and its impact within patient safety and quality

  1. What are some of the primary challenges you’re looking to address in your keynote?
·        Developing delineation of privileges, credentialing criteria, and meaningful FPPE/OPPE for the use of artificial intelligence and the virtual doctor.
·        Onboarding practitioners in a timely manner within the hospitals and provider enrollment.  It is extremely important in today’s market that practitioners are “billable” on their effective start date.
·        Revenue cycle management begins with credentialing.

  1. Why is the NAMSS CVO Symposium important for MSPs to attend?
The CVO Symposium is important for MSPs to attend as it provides focused knowledge on best practices utilized within various health system CVOs.  We learn from each other.  It is an opportunity to ask questions, network, and collaborate with one another or strategize to move organizations forward and provide safe care to our patients. 

  1. Are you seeing a greater need for programming specific to CVOs in the larger MSP community?
Yes, as more and more health systems develop central credentialing or central verification offices, it is important for MSPs to learn from one another on various aspects of moving the profession, their specific organization and healthcare forward.  We are all working together to navigate the ever-changing world of health care.  By sharing knowledge with one another, we can all learn to become more lean and efficient while safe guarding our patients.

  1. What do you hope MSPs will take away from your keynote address?
First and foremost, that we are all in this together.   Healthcare is continuing to change and MSPs are at the forefront of patient safety.  With the emergence of digital healthcare and ongoing issues with “access,” I hope MSPs take away that they have a voice and opportunity to make a difference in their health system by working collaboratively with their leadership and feel empowered to share their innovative ideas.  There is never a dull day working in healthcare and by networking and collaborating with one another, we can make a difference.

The 2019 NAMSS CVO Excellence Symposium takes place October 19-20 at the Philadelphia Marriot Downtown in Philadelphia, PA. Register today.

New Member Resource: NAMSS-ATA Credentialing by Proxy Guidebook

Wednesday, August 14, 2019

NAMSS is pleased to introduce the NAMSS-ATA Credentialing by Proxy Guidebook, a resource for navigating the credentialing process for practitioners providing remote/telemedicine services. The Guidebook includes a standardized Glossary of Terms, an overview of the existing credentialing process with a focus on telemedicine providers, a review of existing laws and regulations around telemedicine credentialing, a set of guidelines for creating a credentialing by proxy program, and a review of hurdles and potential solutions institutions often encounter with credentialing by proxy.

The Guidebook is the result of a multi-year collaboration between NAMSS and American Telemedicine Association (ATA). In 2017, NAMSS staff and ATA staff convened a joint task force of NAMSS and ATA members to develop a credentialing by proxy guide. Credentialing by proxy is relatively new process by which hospitals using remote practitioners for telemedicine services can accept the remote hospital’s credentialing work, rather than requiring the full traditional credentialing process for practitioners who may never step foot into that facility.

NAMSS and ATA will continue to collaborate to provide resources that facilitate efficient and effective credentialing for institutions and practitioners providing or using telemedicine services. The NAMSS-ATA Credentialing by Proxy Guidebook reflects the current process and credentialing by proxy landscape. NAMSS and ATA will continue to work together to update the Guidebook as necessary and will review the Guidebook on a regular basis to ensure it reflects industry updates.

NAMSS would like to thank the following NAMSS members for their work on the NAMSS-ATA Credentialing by Proxy Guidebook Task Force: 

LouAnn Brindle, MSN, RN, CPCS, CPMSM
Susan Diaz, CPCS, CPMSM 
Beth Erwin, CPCS, CPMS 
Becky Findley, CPMSM, CPCS, FMSP 
Geneva Harris, CPCS, CPMSM 
Lisa "L.J." Jones, CPCS 
Judy Lentz, CPMSM, CPCS 
Diane Meldi, MBA, CPCS, CPMSM 
Kathy Risch 
Linda Waldorf, BS, CPMSM, CPCS

Please contact Molly Giammarco, NAMSS Senior Manager for Policy and Government Relations, with any questions on the Guidebook.

NAMSS Releases its Sixth-Annual Industry Roundtable Report

Monday, July 22, 2019

The 2019 NAMSS Roundtable Report is now available.  NAMSS held its sixth-annual Roundtable discussion with industry stakeholders from 20 organizations including NAMSS on May 9, 2019 in Washington, DC. The past five NAMSS Roundtables have helped institute significant reforms to the credentialing, privileging, and licensure processes. This year’s Roundtable, Credentialing for Tomorrow, facilitated a discussion around adopting a more modern credentialing process while prioritizing patient safety.

The 2019 Roundtable continued to delve into the technology innovations of 2018 with a focused discussion on digitizing credentialing. The report provides an overview of the high-level discussion about how credentialing will evolve as more entities adopt and embrace technology. The report addresses the perspectives of hospitals, practitioners, payers, accrediting bodies, and government oversight entities on the importance of digitizing credentialing and the challenges associated with full adaptation.

Susan Diaz, NAMSS President, moderated the Roundtable presentation and Susan DuBois, NAMSS Government and Industry Relations Liaison, led the Roundtable participants’ discussion. The Report outlines several themes Roundtable participants discussed, including inconsistent enrollment quality standards, the lengthy process of credentialing a practitioner, excessive verification processes, credentialing non-physician practitioners, and institutions unwillingness to invest in credentialing technologies.  

The Roundtable also featured a discussion by FSMB that provided an update on FSMB’s research into digital credentialing, which compared legal, compliance, and technical aspects of digital signatures, open badges, and block chain.

NAMSS led a presentation with participants discussing their main credentialing pain points and potential alternatives or solutions to these pain points. NAMSS will continue to work with Roundtable participants and other stakeholders to develop standards, embrace innovation, and identify credentialing gaps and shortfalls as technology continues to advance.

The following organizations participated in 2019 Roundtable:
  •          Accreditation Council for Graduate Medical Education (ACGME)
  •          American Association of Nurse Practitioners (AANP)
  •          American Academy of PAs (AAPA)
  •          American Board of Medical Specialties (ABMS)
  •          American Hospital Association (AHA)
  •          American Medical Association (AMA)
  •          Blue Cross Blue Shield Association (BCBS)
  •          Centers for Medicare and Medicaid Services (CMS)
  •          Council for Affordable Quality Care (CAQH)
  •          DNV GL Healthcare
  •          Educational Commission for Foreign Medical Graduates (ECFMG)
  •          Federation of State Medical Boards (FSMB)
  •          Health Resources & Services Administration (HRSA)
  •          Healthcare Facilities Accreditation Program (HFAP)
  •          The Joint Commission
  •          Medical Group Management Association (MGMA)
  •          Nation Council for Quality Assurance (NCQA)
  •          National Practitioner Data Bank (NPBD)
  •          URAC

ABMS Names Diane Meldi as Stakeholder Council Liaison to the Information and Data Sharing Task Force

Monday, July 08, 2019

NAMSS congratulates Diane Meldi, MBA, CPCS, CPMSM on being named as Stakeholder Counsel Liaison to American Board of Medical Specialties’ Information and Data Sharing Task Force. The Information and Data Sharing Task Force is one of five Task Forces ABMS created to execute its Achieving the Vision plan to develop a continuing certification program that achieves high quality patient-care standards.

The Task Force will develop research and data-sharing strategies to guide future certification assessments, enhance diplomat education, and communicate requirements and standards to strengthen and advance specialty learning and improvement goals. Through collaborations between ABMS Member Boards and key stakeholders, ABMS seeks to learn how continuing certification affects change in diplomat practice, professional development, and patient-care delivery.

As Liaison, Diane hopes to serve NAMSS members by influencing and reporting on ABMS data update frequency and their timeliness of changes. Diane recognizes the challenges and opportunities MSPs have regarding data sharing, “MSPs need to ensure that all data sources are accepted by federal and state regulations and accreditation standards. Additionally, managed care plans need to accurately reflect a physician’s certification status for their marketing materials. Opportunities associated with data sharing are faster verification, lower costs, and the ability to share the importance of physician board certification.”

MSPs can benefit from, and influence, clinical data-sharing processes and policies by demonstrating the role timely and accurate data has in ensuring credentialing excellence and efficiency. Diane’s liaison role will also help show how data sharing can improve the payer and practitioner credentialing processes. “Health care organizations may require certification and recertification and depend on accuracy and timeliness. The number of days to complete the initial credentialing process is getting shorter and shorter. This would ensure that MSPs can get the verifications requested faster.”

The ABMS Stakeholder Liaisons will provide guidance to the Oversight Committee and providing recommendations to the five Task Forces:
  • Advancing Practice
  • Information and Data Sharing
  • Professionalism
  • Remediation
  •        Standards
The ABMS Commission Task Force Oversight Committee determines each Task Force’s deliverables and timelines. Stay tuned for more updates from Diane Meldi on the progress of the Information and Data Sharing Task Force.

Click here to read the Continuing Board Certification: Vision for the Future Commission's Final Report. Click here to read more about the ABMS Vision Initiative. Click here to read more about the five Task Forces.

NAMSS Updates Ideal Credentialing Standards for Practitioner Applicants

Monday, April 01, 2019

NAMSS has recently released an updated version of the Ideal Credentialing Standards, which outline best practices for the initial credentialing of independent practitioner applicants in medical facilities. The Ideal Credentialing Standards were initially released in 2014, having been developed with a coalition of notable industry representatives across the credentialing ecosystem. In 2019, members of the NAMSS Board convened to review and update the Standards to align with current best practices in the credentialing profession.

The Ideal Credentialing Standards have been recognized as an essential document for determining the gold standard of practitioner credentialing for the past five years. In order to ensure that the Standards remain reflective of the highest level of credentialing practice, NAMSS Board members reviewed the Standards and analyzed new developments in credentialing nationwide. The working group included updates to the standards around identity proofing, education and training, and military service, and revised the list of potential red flags. Additionally, the group detailed recommendations around Internet background checks and social media review, as applicants’ online history continues to be a thorny issue for Medical Staff Offices.

The updated edition of the Ideal Credentialing Standards can be found on the NAMSS website.

GAO Report Reveals VHA’s Need for Improvement in Credentialing and Hiring Process

Friday, March 08, 2019

            A report from the U.S. Government Accountability Office discovered that the Veterans Health Administration had overlooked or missed adverse actions that were reported to the National Practitioner Data Bank (NPDB) while hiring physicians and other healthcare providers. The GAO analyzed healthcare providers at the VHA as of September 2016 who were recorded in NPDB, and found that VHA facilities did not consistently act within VHA employment policies and hired providers with various disqualifying adverse actions.

Staff that were involved in the credentialing and hiring process in at least 5 facilities did not have knowledge of the VHA policy regarding hiring providers with revoked or surrendered licenses due to misconduct or incompetence. VHA officials have stated that they are developing improved processes to verify credentials of providers and ensure they meet all requirements. In December 2017, the VHA conducted a review of all licensed providers and removed 11 that did not meet the licensure requirements, but these reviews are infrequent.

 The GAO made seven recommendations on how the VHA can better their reviewing and hiring process. The recommendations included that the VHA should implement mandatory training periodically for facility staff that is responsible for verifying credentialing and hiring.

Click here for more information regarding the GAO report on VHA.

ABMS Vision for the Future Commission Releases Report on MOC Process

Friday, January 25, 2019

On December 11, 2018, the ABMS Vision for the Future Commission released a report regarding their review of the MOC process. The Commission was tasked with reviewing MOC within the current medical profession and confronted issues that ABMS Boards and Diplomats experience. The Commission addressed areas that are problematic for physicians and provided recommendations for overhauling the MOC system, including retiring the “maintenance of certification” terminology. It remains to be seen what specific changes the ABMS will make to the MOC process, but the commission’s report represents a concerted turn towards real change in the current status quo.

                The Commission also recommended that ABMS boards conduct research to analyze the success of continued certification in helping clinicians provide quality and safe care for their patients. In addition, ABMS should research potential activities that help clinicians maintain their skills. The commission did not directly address fees, yet the survey measured that 58% of doctors said MOC costs were their top concern, 52% said MOC was a burden, and 48% said MOC was not a true reflection of their abilities as clinicians. The Commission report suggested shifting from single point-in-time assessments leveraged years apart to more regular, longitudinal, multi-source assessments to provide more useful appraisals of physicians’ ongoing competence. The report also encouraged medical staff offices and other credentialing professionals not to make credentialing and privileging decisions solely on the basis of certification status, but to utilize certification as an additional data point when evaluating practitioner applicants.

Commission Co-Chairs Christopher Colenda, MD and William Scanlon, PhD told Medscape that while fee structures and pricing were not addressed in the Commission report, they noted that boards should implement reasonable fees. They believe that the changes recommended will enhance the value of the MOC process for all stakeholders. Former NAMSS Presidents, Linda Waldorf and Diane Meldi contributed to the Commission’s work.

Click hereto read the Commission’s draft report and herefor more information regarding the ABMS commission report on MOC. NAMSS will continue to monitor any further actions of the Commission and changes to the MOC process.

2018 Updates to the NPDB Guidebook

Tuesday, December 11, 2018

           The Health Resources and Services Administration (HRSA) recently updated its online National Practitioner Data Bank (NPDB) Guidebook on October 26, 2018. This is the first time the Guidebook has been updated since April 2015. The October 2018 Guidebook added a new section titled “Length of Restriction” under Chapter E: Reporting Adverse Clinical Privileges Actions and alters language regarding the reportability of proctoring. The Guidebook also adds seven new questions and answers to the end of Chapter E. Additionally, the Guidebook clarifies that indirect action taken by a physician during an investigation maybe reportable.

            The new section titled “Length of Restriction” states that if a restriction has an adverse effect on a practitioner’s privileges for more than 30 days, then it is reportable on the 31st day, regardless if the length of the restriction is in writing. The seven new questions that address reporting requirements address the following topics:
  1. Agreements not to exercise privileges while under an investigation (Q. 22)
  2. Leave of absence while under investigation that restricts privileges (Q.23)
  3. Reappointment application review (Q.24)
  4. Resignation while subject to a “quality improvement plan” (Q. 25)
  5. Restrictions versus generally-applicable guidelines regarding first assistants and practitioner specific requirements (Q.31)
  6. A practitioners lapse of privileges at the end of a scheduled term (Q.46)
  7. Guidelines on updating NPDB reports modified by Court order (Q.49)
Click here for more information regarding the NPDB Guidebook.  

Foreign Medical Graduate Commission Updates Identity Certification Process

Tuesday, September 04, 2018

The Educational Commission for Foreign Medical Graduates (ECFMG) recently announced an enhancement to their process for certifying the identities of applicants, beginning in mid-September 2018. The current Certification of Identification form (Form 186) will now be required to be completed online, using NotaryCam is an online service that provides 24 hour access to professional notaries, allowing applicants to bypass the sometimes complicated and burdensome process of using a notary in person.

Additionally, the online Form 186 will now be a requirement for applicants as part of the Application for ECFMG Certification. This is required before submission of an application to take the United States Medical Licensing Examination (USMLE). All new Certification of Identity forms will require the online process, as well as expiring or invalidated forms. Currently, the Certification of Identity form lasts for five years from the accepted date. Find more details about the new process here.

The ECFMG is the standard for international medical graduates (IMGs) to be evaluated on their qualifications before entering the US graduate medical education (GME) process, or to take the USMLE and obtain a license to practice medicine in the US. ECFMG also provides application, visa, and verification assistance for IMGs. Learn more about the ECFMG at

NAMSS Releases Position Statement on MOC

Wednesday, August 29, 2018

Maintenance of Certification (MOC), the program through which ongoing physician competence is demonstrated through American Board of Medical Specialties (ABMS) and American Osteopathic Association (AOA) boards, has been controversial since its launch. As NAMSS members have heard, the ABMS has recently launched an initiative to reexamine MOC and provide recommendations for the future state of physician certification. NAMSS has engaged with this Vision Commission, with several NAMSS leaders participating in past meetings, and with other organizations to contribute the MSP perspective on this issue. As the issue has continued to affect MSPs directly and indirectly, NAMSS has released the following organizational statement on Maintenance of Certification.

The National Association Medical Staff Services (NAMSS) supports efforts by the American Board of Medical Specialties (ABMS) and stakeholders across the health care industry to re-envision the process of continuing board certification and the Maintenance of Certification programs. Demonstrating ongoing physician competence is an essential piece of maintaining patient safety, and is an important part of evaluating practitioners for credentialing and privileging decisions. Concerns around the existing continuing certification programs have led some states to propose or enact laws restricting their use in making these decisions, which infringes on the ability of Medical Services Professionals and Organized Medical Staffs to fulfill their duty in evaluating providers. However, physician burnout is an increasingly difficult issue as additional burdens are being placed on providers across the continuum of care.

Increased standardization, clarity of requirements, and reduced physician burden will all be integral parts of a modern, effective board certification program. NAMSS looks forward to the outcomes of the ABMS’ Vision for the Future Commission and to aiding in the evolution of board certification to best support our ultimate goal of patient safety.

NAMSS will continue to monitor the work of the ABMS Commission and other progress in the area of continuing physician education, and work to inform our MSPs about important developments. Find our position statement and others at the NAMSS website, and be on the lookout for further communications on this issue.

AMA Releases New Resource on Addressing Disruptive Physician Behavior

Thursday, July 26, 2018

As MSPs, maintaining an organized, productive staff office is an essential part of the job. Disruptive behavior by physicians can pose a threat to the functioning of your hospital, and dealing with instances of such behavior is a struggle for anyone working around it. Dealing with disruption in the workplace can be confusing, and it is important to be prepared if you encounter it in your hospital.

The American Medical Association (AMA) has recently released a free learning course addressing this topic. This 30-minute module will show you how to define appropriate, inappropriate, and disruptive behavior and present guidelines for dealing with these behaviors. Additionally, you will receive your own downloadable copy of the AMA Model Medical Staff Code of Conduct that you can integrate into your own medical staff bylaws.

You can access the module here. The course is designed for physicians and hospital administrators as well as medical staff, so please feel free to share within your facility.

How the Leadership Certificate Program Helped Meredith Land a New Job

Thursday, June 21, 2018

The NAMSS Leadership Certificate Program can have a great impact on you and your career path. Read how Meredith Miller used the program to gain the confidence she needed to land the job she wanted. 

Did the Leadership Certificate Program help you gain any new skills, or help increase your confidence as a leader?
I absolutely gained new skills and confidence from the Leadership Certificate Program. I felt that the online modules were a great learning tool and the extra resources provided were a bonus. As a Credentialing Specialist, and not a manager, this program was extremely helpful in learning new skills, and I was able to gain a wealth of knowledge from both the online modules and the in-person course. I really feel as if I now have more effective communication skills, even in my personal life, which has greatly increased confidence in myself. 

How are you using what you learned from the Leadership Certificate Program in your current role?
Just prior to attending the in-person course, I resigned from a hospital that I had been working as a Credentialing Specialist for 14 years, with the past 12 having been offsite working from home. I decided at the beginning of January that I wanted to go back into the office setting and work closer to where I live. I applied for a Credentialing Coordinator position and was offered the job the day after the interview. During the hiring process, I was able to use the effective negotiating skills and communication techniques that I learned from the Leadership Certificate Program. I felt that my communication, calmness, and confidence during the interview process was very effective and I can say that the gained knowledge I attained from the program played a role in getting the job.

What aspect of the program did you enjoy most?
I immensely enjoyed the In-Person Course -- the instructors were fantastic and made everyone feel relaxed and at ease in being ourselves. It was fun working in teams and interact with other professionals that held different positions from mine. I ended up working with three managers in my group and it was very interesting to see their different management and leadership styles.

Would you recommend the Leadership Certificate Program to your peers?
I would absolutely recommend the Leadership Certificate Program to my peers and have already done so! In my opinion, the online modules are a wealth of useful information for both experienced and entry-level MSPs. The program helped me look at things from a different perspective in terms of communicating with others in a professional setting. I think the In-Person Course really allows you to apply what was learned during the online portion, and the live group scenarios was a confidence builder. Overall, I felt it was a very effective course and will continue to recommend it to others!

Visit the NAMSS website to learn more about the Leadership Certificate Program.

NAMSS Hosts 5th Annual Industry Roundtable in Washington, DC

Wednesday, June 06, 2018

As part of its ongoing efforts to work with industry leaders on meaningful reforms to the credentialing and licensure process, NAMSS held its fifth annual roundtable discussion with industry stakeholders on May 10, 2018 at the Dupont Circle Hotel in Washington, DC. This roundtable, entitled The Future of Digital Credentialing, is an important next step in achieving a more streamlined, more efficient, and more modern credentialing process while preserving our ultimate goal of patient safety.

The 2018 roundtable expanded the focus of our 2017 event on blockchain technology, examining an array of new and emerging technologies for the credentialing ecosystem. The wide-ranging discussion touched on a number of important ideas for preparing the industry for technological developments. This year’s roundtable marked the beginning of a new conversation around disruptive technology and its impact on credentialing. The discussion was thoughtful, engaging, and productive, but it is only the beginning. NAMSS will continue to work with the roundtable participants and others going forward to create and implement process guidelines, governance, and best practices that will be needed as technology continues to develop. Stay tuned for more exciting news to come!

The official 2018 roundtable report can be found on the NAMSS website, or by clicking this link.

The following organizations participated in this year’s roundtable: Accreditation Council for Graduate Medical Education (ACGME), Administrators in Medicine (AiM), American Association of Collegiate Registrars and Admissions Officers (AACRAO), American Board of Medical Specialties (ABMS), American Hospital Association (AHA), American Medical Association (AMA), Council for Affordable Quality Healthcare (CAQH), DNV GL Healthcare, Educational Commission for Foreign Medical Graduates (ECFMG), Federation of State Medical Boards (FSMB), Healthcare Facilities Accreditation Program (HFAP), The Joint Commission, Medical Group Management Association (MGMA), National Council for Quality Assurance (NCQA), and the National Practitioner Data Bank (NPBD).

MedPage Today Investigation Highlights Gaps in Credentialing Process

Friday, April 06, 2018

Instances of incompetent or malicious practitioners have always made headlines, but rarely are the wider systemic issues discussed that allow such events. A recent investigation by MedPage Today and the Milwaukee Journal-Sentinel catalogued at least 500 physicians from 2011-2016 who exploited gaps in the medical licensing system to avoid sanctions or red flags.

In these instances, doctors who had actions taken against them by one state medical board were able to “slip through the bureaucratic net” and operate under clean licenses in other states. Physicians who had formal complaints, suspended licenses, or even permanent revocations maintained their licenses with other state boards, many of whom were not even aware of the action in the first place.

MedPage Today found that the majority of state boards only report their own disciplinary actions against physicians. Their investigation, titled “States of Disgrace: A Flawed System Fails to Inform the Public,” outlines seven categories of information on physician history, including state medical board disciplines, discipline by other states, malpractice claims/payouts, loss of privileges, criminal convictions, Medicare and Medicaid exclusions, and DEA/FDA actions.  Only five states (Florida, Kansas, Massachusetts, Maryland, and North Carolina) regularly reported six of the seven – no state routinely checked and reported all of the above.

The National Practitioner Data Bank, which was created to serve as a central identifying tool for all adverse actions, has not fulfilled its promise of transparency, according to MedPage. A survey conducted by the former NPDB research director found that few state boards made regular queries of NPDB – most states performed only 10 to 20 searches a year, and some didn’t submit any at all. High costs may make NPDB searches prohibitive for some states, but this can result in severe lapses in the information they hold about physicians who are licensed in their states, leading to gaps that can affect patient safety. Out of 64 state medical boards, only 13 subscribed to the “Continuous Query” service which provides alerts for new updates to physician records.

“States of Disgrace” emphasizes the issues that stem from the patchwork system of state licensing boards, but also flags the problem of physicians omitting relevant information in their own applications – whether for licensing or privileging directly at a hospital. NPDB’s survey found that almost 10% of the time, organizations querying the Database found new information about the physician, which shouldn’t occur if the physician was fully forthcoming in their application. “They should never find anything new in an NPDB report,” says Dr. Robert Oshel, formerly of NPDB. This problem is faced in credentialing offices across the nation as well. While it can’t fill in every gap, NAMSS PASS provides a unique ability to understand a practitioner’s full affiliation history, and can protect patient safety by guarding against reticent applicants. Find out more about NAMSS PASS here.

Recent Incidents Underscore Importance of Patient Safety

Wednesday, January 24, 2018

MSPs know that among all their responsibilities, the #1 priority is patient safety. Performing the oftentimes challenging work of credentialing is an essential part of protecting patients and allowing the delivery of high quality health care. Doctors are trusted to care for patients, and it is the job of MSPs to confirm their ability to provide care and that hospitals are aware of any negative incidents that could affect the doctor-patient relationship. Two recent stories underscore just how critical the work of MSPs is.

In Cleveland, USA Today found that a surgeon was accused multiple times of sexually assaulting patients, yet confidential settlements precluded formal charges against him. The Cleveland Clinic, where he was employed, placed him on leave, but did not prevent him from continuing to see patients after a settlement was reached. In fact, when the surgeon later moved to the Ohio State University Medical Center, the facility was unaware of any past allegations regarding the physician. While OSU maintains that the proper credentialing procedure was followed, having official notations of the investigation would have allowed an MSP to determine whether credentials should have been issued in light of the allegations.

Even if the Cleveland Clinic had progressed with formal actions, there was no criminal charge filed. The physician’s record might not have even reflected the settlement, especially if facility itself took on liability, as they often do. If the physician had not disclosed his affiliation with Cleveland Clinic when applying at OSU, or replaced it with another facility where he had privileges, the OSU credentialing department would have had no way of knowing whether he was ever employed at the Clinic, much less whether there had been misconduct.

In an even more recent example, a Maryland-based OB/GYN was found to have falsified his identity, including his Social Security number, to obtain licensure in the state. In fact, over the course of his career, the physician used four different Social Security numbers, three names, and forged dates of birth and education histories to obtain multiple credentials, licenses, and privileges at multiple facilities.

He failed the Foreign Medical Graduate Certification multiple times under different identities before finally passing, and went on to be removed from a residency program in New Jersey for falsifying information and rejected from Medicare for using different Social Security numbers. However, the Maryland facility, Prince George’s Hospital Center, completed the credentialing process for the physician and allowed him to practice medicine for years after the rejection. The intricacies of the fraud demonstrate just how important a thorough and exhaustive credentialing process is.

As all MSPs know, credentialing is an intricate and often winding process. Even the most conscientious MSPs can run into issues of information gaps, whether it is a missing document, an undisclosed affiliation, or any number of other problems that can arise. NAMSS PASS is a free, secure, online database that provides quick and easy access to the affiliation history of practitioners applying for credentials. Through NAMSS PASS, you can automatically review past affiliations for practitioners, disclosed by the hospital, not the physician. This allows you to quickly analyze for any gaps in history, or to identify undisclosed affiliations (a major red flag). In a health care system where patient safety continues to be at risk and must always be a priority, NAMSS PASS can help your facility ensure the highest standard of credentialing is completed. To learn more about NAMSS PASS, please visit

AHA Releases Regulatory Overload Report

Friday, October 27, 2017

The American Hospital Association (AHA) recently released a report entitled Regulatory Overload: Assessing the Regulatory Burden on Health Systems, Hospitals and Post-Acute Care Providers. The report details the extent of regulations promulgated on healthcare providers, spanning four federal agencies.

AHA and Manatt Health found that the four agencies – the Centers for Medicare & Medicaid Services (CMS), the Office of Inspector General (OIG), the Office for Civil Rights (OCR), and the Office of the National Coordinator for Health Information Technology (ONC) – produced 629 separate regulatory requirements across nine domains, in addition to health regulations from agencies outside the four studied. The scope of these regulations and the compliance actions required are significant – health systems, hospitals and PAC providers spend nearly $39 billion combined on compliance per year, and an average-sized hospital dedicates 59 full-time equivalents to compliance.

The AHA report also provided specific recommendations for regulatory relief, including canceling Stage 3 of Meaningful Use, suspending electronic clinical quality measure requirements, and expanding Medicare coverage of telehealth services. MSPs can find the full report here

UPDATE: New Guidelines Released as Telemedicine Services Expand

Wednesday, September 20, 2017

Update: The Joint Commission has retracted the draft standards for telemedicine outlined below, announcing that "At this time, we have closed the field review and decided not to move forward with the proposed telehealth standards." The proposed changes had garnered pushback from some in the industry who were concerned that the standards would be more restrictive than current requirements from the Centers for Medicare & Medicaid Services and state regulators. A spokesperson from TJC told FierceHealthcare that internal review had determined TJC's existing requirements for accreditation adequately applied to telehealth services and that further requirements would be unnecessary. In the future, TJC plans to address enhancements for survey guidance examining telehealth practices and quality and safety issues with telehealth provision.

Telemedicine continues to expand into the healthcare delivery system, and the recent natural disasters across the country have demonstrated just how useful telemedicine can be in a crisis and beyond. As federal and state governments, accrediting organizations, and other healthcare stakeholders recognize the growth and potential of these services, new rules, regulations, and guidelines are beginning to be released. Two major telemedicine efforts were released this month by The Joint Commission and the National Quality Forum.

First, The Joint Commission released proposed revisions to their hospital accreditation standards for hospitals providing “direct-to-patient telehealth services.” TJC, one of the largest and most widely accepted accreditation organizations for hospitals in the United States, introduced changes to two existing standards (Provision of Care Standard 01.01.01 and Rights & Responsibilities of the Individual Standard 01.03.01) and introduced a new standard, Ri.01.08.01. The proposed changes, which are examined in detail here, include requirements for informed consent for patients about the nature of the telehealth services and the provider. The National Law Review article linked above examines how the proposed standards go beyond statutory requirements in some cases, and how they may affect hospitals and other telehealth providers.

The National Quality Forum, an organization contracted by the federal government to develop healthcare performance measures, recently released a report developing a framework for a telehealth quality measurement program. NQF’s Telehealth Committee recommended various methods to measure telemedicine as a care delivery system along four basic categories: access to care, financial impact to patients and providers, patient and clinician experience, and clinical and operations effectiveness. The report, analyzed hereby mHealthIntelligence, also highlights specific existing measures that can be applied to telehealth, as well as examining how telehealth activities can fit into the Merit-based Incentive Payment System (MIPS) introduced in the Medicare Access and CHIP Reauthorization Act (MACRA).

NAMSS will continue to monitor developments in telemedicine and their impacts on MSPs. Specifically, NAMSS recently formed a working group in partnership with the American Telemedicine Association to examine the issue of credentialing by proxy for hospitals attempting to credential telemedicine providers at other locations. The group will be developing a packet of educational and instructional materials to introduce MSPs who may not be as familiar with telemedicine to the topic and provide guidelines for developing credentialing by proxy programs at their own facilities. 

CMS Clarifies Guidance on Hospital Definitions

Monday, September 11, 2017

The Centers for Medicare and Medicaid Services recently released a memoclarifying guidance under Appendix A of the State Operations Manual (SOM). This guidance is meant to shed light on the definition of a hospital under the Social Security Act.

With the rise of “microhospitals,” small facilities that operate like acute care hospitals with a low number of inpatient beds, there has been some confusion regarding the certification process for such facilities. A variety of other facility models have run into the same issues, as care providers attempt new innovations in care and locations that may stray from the traditional idea of a hospital facility.

The CMS memo clarifies that the federal Medicare definition of a hospital under the Social Security Act may not always mesh perfectly with state requirements for the same certification. That is, “a facility may have a license from a state to operate as a hospital,” but “that facility may still not meet the Medicare definition of a hospital.” Hospitals approved, certified, and licensed by state or local authorities are still required to fit the Medicare criteria, including Conditions for Coverage (CfCs), Conditions of Participations (CoPs), and observations by the CMS Regional Office in order to be approved to accept Medicare patients. The details of these observations are described in the memo, linked above.

To read more about microhospitals and their growing role in the care delivery system, click here

Illinois Blockchain Initiative to Pilot Credentials Verification Program

Thursday, August 17, 2017

On August 8th, 2017, the Illinois Blockchain Initiative announceda pilot program in partnership with Hashed Health to use blockchain technology to streamline the medical credentialing process in the state. By exploring opportunities through distributed ledger technologies, the program could be able to reduce the complexity of licensing and credentialing. The program will look to provide a new blockchain-based registry to act as a repository for credentialing data.

Eric Fish, senior vice president of legal services at the Federation of State Medical Boards, praised the initiative, remarking that, “If successful, this effort may prompt other state medical boards, as well as others within healthcare, to investigate potential benefits that can be derived from the use of distributed ledgers, and may ultimately result in a more efficient regulatory process without any sacrifice to patient safety.”

To read more on the pilot program, see the full story at Health IT Analytics.

Blockchain technology is a decentralized peer-to-peer system through which digital transactions are created, shared, verified, and stored. This technology consists of three main components: a distributed network, a shared ledger, and digital transactions. The network is the basic skeleton of the blockchain: individual network members generate, verify, and store data on the blockchain, instead of contributing to one central database. The ledger provides a mechanism to share and verify information in the network, protecting the data from tampering and ensuring quick and easy verification of the information within. Finally, a digital transaction is the actual act of generating or verifying data.

NAMSS is continuing to monitor the development of blockchain technology in healthcare, especially with regards to the credentialing process. In May, we hosted our 4th annual Government Relations Industry Roundtable, entitled Building Blocks for the Future. A panel of NAMSS staff, stakeholders and strategic partners discussed the impact of blockchain and its potential applications for the industry. Be on the lookout for further information from NAMSS on blockchain technology and its potential impacts on MSPs!

Obamacare Repeal and Replace Dead, For Now

Friday, July 28, 2017

In the early hours of the morning on July 28, 2017, the Senate held its final vote on Republican efforts to repeal and replace the Affordable Care Act (ACA). The Health Care Freedom Act, referred to by some as “skinny repeal,” fell 51-49, with Republican Senators John McCain (R-AZ), Lisa Murkowski (R-AK), and Susan Collins (R-ME) joining all Democrats in voting against the bill.

The path towards repeal in the Senate had been winding at best. After multiple delays, the Senate narrowly voted to proceed to debate on the House version of the bill, the American Health Care Act (H.R. 1628). Sens. Murkowski and Collins were opposed to the motion, requiring Vice President Mike Pence to provide the tiebreaking vote. The Senate then considered several different options on the repeal efforts, which were all defeated. Senate Republican’s own original plan, the Better Care Reconciliation Act, was soundly defeated, with 9 Republicans from the conservative and moderate wings voting against (57-43).

[Republicans voting against the BCRA were Susan Collins, Lisa Murkowski, Bob Corker (TN), Tom Cotton (AR), Lindsey Graham (SC), Dean Heller (NV), Mike Lee (UT), Jerry Moran (KS), and Rand Paul (KY)]

Next, Senate Majority Leader Mitch McConnell brought up a partial repeal bill, the Obamacare Repeal and Reconciliation Act, which would have repealed essential ACA provisions like the individual mandate, Medicaid expansion, and premium subsidies after a period of two years, during which the Senate hoped to draft a replacement plan. This was voted down 55-45, with Sens. Collins, Murkowski, Heller, McCain, Shelley Moore Capito (R-WV), Rob Portman (R-OH), and Lamar Alexander (R-TN) voting against.

The “skinny repeal” bill was brought up as a last-ditch effort to garner consensus from the Republican caucus on repeal efforts, with the intention of passing a bare-bones bill in order to come up with a fuller plan in conference with the House of Representatives. It would have repealed selected provisions of the ACA, including the individual mandate, delay the employer mandate until 2025, extend the moratorium on the medical device excise tax through December 31, 2020, and modify ACA State Innovation Waivers, among other provisions. For the moment, Republican efforts to repeal the ACA are dead, and Senate leadership has expressed a desire to move onto other business. However, some House Republicans, including Rep. Tom MacArthur (R-NJ), Greg Walden (R-OR) and Freedom Caucus Chairman Mark Meadows (R-NC) have stated they will continue in their efforts to take down the ACA. 

Senate Republicans Release Draft Healthcare Bill

Monday, June 26, 2017

On June 22, 2017, Senate Republicans released the Better Care Reconciliation Act (BCRA), their much-anticipated version of the House’s American Health Care Act (AHCA), which repeals and replaces the Affordable Care Act (ACA).  Here’s a breakdown of how the Senate and the House versions align and how they break away from the ACA.

The Senate and House Similarities:

  • Eliminate the ACA’s controversial individual mandate, which required all Americans to have health insurance.
  • Eliminate the ACA’s unpopular employee mandate, which required most employers to offer employees health insurance.
  • Enable payers to implement age-based pricing determinations for health insurance.
  • End the ACA’s Medicaid state-expansion and reduces overall Medicaid funding (although the Senate version proposes a deeper rate than the House version). 
  • Enable states to waive the ACA’s requirement that payers cover the following 10 essential health benefits: 1) ambulatory patient services; 2) emergency services; 3) hospitalization; 4) maternity and newborn care; 5) mental health and substance abuse; 6) prescription drugs; 7) rehabilitative and habilitative  services; 8) laboratory services; 9) preventive and wellness services and chronic disease management; 10) some pediatric services.
  • Defund Planned Parenthood for one year. 
  • Repeal most of the ACA’s taxes. 
  • Continues the ACA’s policy that enabled children to remain beneficiaries of their parents’ health plans until age 26.
The Senate and House Differences:

  • Tax Credits: The Senate version lowers the income eligibility level for tax credits.  The House version fixed tax credit eligibility to age.
  • Pre-Existing Conditions: The Senate version maintains the ACA’s requirement that payers cover individuals with pre-existing conditions without charging these individuals higher rates.  The House version would enable states to allow payers to opt out of mandating coverage for preexisting conditions.  In lieu of this requirement, the House version would provide states funding to establish high-risk pools to cover individuals with pre-existing conditions.
Key Medicaid Points

Medicaid Expansion

The BCRA would overhaul the current Medicaid expansion system by phasing out the Federal Medical Assistance Percentages (FMAP) to states by 15 percentage points between 2020 and 2023 (90-percent funding in 2020 to 75-percent funding in 2023).  In 2024, FMAP reductions would continue until they matched the state rate for other benficiaries, which is, on average, 57 percent.

Traditional Medicaid Funding

While both the Senate and House versions would reduce federal funding to the Medicaid program, the Senate version replaces the program’s current open-ended entitlement with individual beneficiary caps. Beginning in 2020, states would be eligible to receive federal block grants instead of the proposed funding cap if they meet specific requirements and agree to cover 14 essential services.  States may also begin to implement optional work requirements for non-disabled, non-elderly, and non-pregnant beneficiaries.

Looking Back—and Ahead

The ACA’s collapsing state exchanges shows just how difficult and costly it is to expand and ensure coverage.  Theoretically, the ACA’s individual and employer mandates would alleviate the burden to payers by requiring young and healthy Americans to buy health insurance.  The ensuing support from these mandates did not come through as expected, causing payers to leave state exchanges—and leaving many Americans with little or no insurance options.  Coverage and care are two critical—but distinct—components to healthcare.  Policymakers’ efforts to provide insurance to all Americans is misguided if that coverage does not equate to quality care.

The Congressional Budget Office, which provides price estimates to legislation, is currently assessing BCRA.  This cost assessment will shed more light on who would pay more or less for premiums and how the bill would affect the market stability of insurance companies.

Healthcare reform is a complex and complicated process that will impact the way we provide and receive healthcare.  A lot needs to happen before we see these changes—including enough support among Senate Republican to pass BCRA.  The process continues to be partisan and Republicans are finding that repealing and replacing the ACA is not easy.  Stay tuned.

Efforts to Repeal Affordable Care Act Halted

Monday, March 27, 2017

Late last week, the U.S. House of Representatives decided to halt further pursuit of legislation - the American Health Care Act (AHCA) - that would have repealed and replaced large portions of the Affordable Care Act, more commonly referred to as "Obamacare."

After several weeks of intense debate between Republicans and Democrats - and concerns from the conservative House Freedom Caucus that the AHCA did not go far enough - House Speaker Paul Ryan and President Donald Trump pulled the bill from being voted on by the House of Representatives once it became clear that it would not garner enough "Yes" votes to pass.

Becker's Hospital Review provides a good overview of this decision and the course of events that led to it. For now, the Affordable Care Act will remain in place - as the path forward for a repeal and replace by Republicans in Congress is uncertain at this time.

So what would the AHCA have done to change American healthcare? The Kaiser Family Foundation has made available a point-by-point tool to compare provisions in this legislation with current law under the Affordable Care Act. Some of the main provisions in the GOP bill were a repeal of the individual mandate for health insurance coverage, an end to Medicaid expansion and a cap on future federal funding for Medicaid, a repeal of tax subsidies to help cover the cost of health insurance, and a repeal of multiple taxes included in the Affordable Care Act - such as the medical device tax.

NAMSS Membership Surpasses 6,000

Tuesday, February 28, 2017

NAMSS is proud to announce that our membership has grown to over 6,000 members! This continued growth is the result of countless hours of work from devoted volunteer MSPs all across the nation to make NAMSS a leader in advancing patient safety and ensuring the efficient and effective credentialing of healthcare providers.

Thank you all for your continued support and we look forward to even greater growth in 2017 and beyond!