Major Challenges Implementing FPPE

Let’s face it, regulating clinical privileges can have a major impact on the quality of care provided by healthcare facilities and their physicians. The Joint Commission (TJC) developed the Focused Professional Practice Evaluation (FPPE) and the Ongoing Professional Practice Evaluation (OPPE) as objective standards for the fair assessment of physicians.

While they are both used to assess physician privileges, they serve completely different purposes.

3 Specific Cases for FPPE

Performed at least more than once annually, OPPE is a continuous process that has a broader application, ensuring all physicians meet the organization’s healthcare standard. FPPE is much more specific in its purpose and serves as a micro utility to be used under 3 conditions[1]:

  1. When a new provider is initially granted a privilege.
  2. When a new privilege is requested by a privileged provider.
  3. When performance non-conformance involving a privileged provider are identified, either through the OPPE process or significant incidents.

Creating an Effective FPPE Plan

For FPPE to be effective, the organization granting privileges must have clear guidelines, standards, and criteria for conducting evaluations. Unlike OPPE, the FPPE process is conducted for a limited amount of time and is focused on the scope of the privilege in question. The TJC allows healthcare organizations to develop their own FPPE process as long as they follow specific guidelines[2]:

  1. The FPPE process must be applied consistently.
  2. Training courses and board certification doesn’t equal competency.
  3. Sampling of group privileges doesn’t equal individual competency.

Created to be interpretive, the FPPE guidelines provide minimal structure for how organizations utilize them. This is mainly due to the large variety of specialties and unique practices within health systems. However, an interpretive guideline can introduce its own challenges in how to effectively apply FPPE.

Challenge #1: Assigning Proctors for Reviews

One major FPPE component is assigning proctors to review physician performance. TJC allows healthcare organizations to assign their own proctors as medical staff members will more commonly tackle this role. However, this can be problematic when the proctors or physicians have highly-sensitive roles or low availability, such as surgeons and pediatricians. In these cases, an outside firm offering Peer Review services may be needed.

What’s the best way to assign proctors for a review? Healthcare organizations should take the context of the review into consideration. Typically, there are three main types of FPPE proctoring methods, each with its own advantages[3]:

  1. Prospective Proctoring: Test cases are planned, either through simulations, oral and written examinations, or interviews. This is best for physicians with multiple instances.
  2. Concurrent Proctoring: Proctors perform a direct observation of a procedure being performed, such as interacting with patients, using equipment, or performing tasks. This is highly recommended for physicians whose tasks have a high degree of risk.
  3. Retrospective Evaluation: Proctors review a physician’s case record after care has been completed. This may also involve interviews with personnel directly involved with the patient. This is most appropriate for low-risk physicians.

Challenge #2: Assessing Low-Volume Physicians

What if it’s difficult to determine if a case is an isolated incident or an indicator of a lack of knowledge and skill? This is common with physicians with a low-volume of patients and new physicians who are initially granted privileges. To validate an incident, proctors should consider performing more reviews to find behavior patterns.

However, this can be costly and unfavorable for proctors with limited time. If assessing a low-volume physician’s performance continues to be a problem, then you should consider whether or not the physician needs the privileges in the first place. FPPE was developed to ensure that privileges were given to practitioners who actually use them. A low-volume of patients may be an indicator of a physician who doesn’t require that privilege for their practice.

Challenge #3: Accessing New Technologies

Healthcare organizations assessing privileges for a new technology may want to find an outside proctor (as mentioned above); especially if they do not have physicians experienced enough to offer a fair assessment. However, finding an external proctor to perform your FPPE privileging can be a lengthy process.

symplr provides healthcare facilities and providers a way to streamline their privileging and FPPE / OPPE processes to help maintain a high standard of care. To learn more about user-friendly solutions with symplr, Schedule a Demo today!

Schedule a Peer Review Demo

[1] “What are OPPE and FPPE”. College of American Pathologists. http://www.cap.org/apps/docs/reference/oppe_fppe.pdf

[2] “Standards BoosterPak for FPPE/OPPE”. The Joint Commission. http://www.mc.vanderbilt.edu/documents/CAPNAH/files/Forms/Competency%20Evaluation%20Forms/TJC%20Booster%20Pack%20FPPE-OPPE.pdf

[3] “Proctoring/FPPE (Focused Professional Practice Evaluation)”. Health Leaders Media. http://healthleadersmedia.com/content.cfm?content_id=224604&topic=WS_HLM2_LED


Tracey Meyer

About the Author
Tracey Meyer

Tracey Meyer is responsible for all symplr software product management, and was in the Cactus Software product development group for 2 years before being selected to helm the product management team for symplr. She brings 20 years of business and technical software experience building products to simplify and enhance the user experience for her clients.

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