OPPE for Low Volume, High Risk Procedures

Peer Review, OPPE, FPPE, Privileging, Risk ManagementLately we've received questions regarding monitoring low volume/high risk procedures (LV/HR) related to privileging and OPPE (Ongoing Professional Practice Evaluation). Specifically, “How should we manage procedures performed so infrequently that required productivity numbers aren’t met?” thus, creating the dilemma of whether to approve/renew privileges for two more years.

Considerations when presented with a LV/HR procedure privileging request:

  • Is this privilege/procedure required by enough patients in the community to warrant your facility offering the service

  • How many local facilities offer the same procedure

  • How many times has the procedure been required/performed in the last two years

Low Volume, High Risk OPPE alternatives:

  • Perform an FPPE for the high risk procedure, include a plan for monitoring, so the Medical Executive Committee (MEC) can confidently approve re-privilege

  • Consider Peer Referencing from other facilities

  • Allow Department Chair proctoring for those procedures less likely to be performed often

Keep an open mind in relation to outcomes and observations and collegial interactions. Giving your medical staff flexibility will increase adoption and improve compliance with the program.

Address LV/HR issues in policies or bylaws:

  • Define LV/HR procedures for your institution

  • Keep an open mind in defining reliable confirmation of competency; don’t just use “the provider must perform ‘X’ number of procedures to maintain this privilege”

  • Consider peer referencing, proctoring or direct observation to validate competency of known LV/HR procedures

As with any unexpected situation, always keep your standards and regulations handy for reference. Don’t forget to utilize the resources of your surveying authority; there are few questions they haven’t already confronted and conquered so don’t be shy about taking advantage of their knowledge and experience.

Lastly, keep the intent of the standard in mind when answering questions and developing your plan. If you develop your processes from that perspective you will usually find yourself in good standing come survey time.

RESOURCE: The Medical Staff Handbook: A Guide to Joint Commission Standards, Third Edition, Joint Commission Resources, Inc., Oakbrook Terrace, Illinois, 2011.

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Melissa Outlaw

About the Author
Melissa Outlaw

Melissa Outlaw is a Vice President, Customer Success with symplr. Melissa and her team assist clients in learning and implementing our provider management software - credentialing, privileging, peer review, quality and event reporting applications. She supports clients in benchmarking current internal practices, identifying potential efficiencies, then driving the integration of technology with process improvement to reduce time of service and operating expenses. She works extensively with decentralized, multi-facility organizations in transitioning to a shared service center as well as assisting healthcare organizations bridge the gap between procedures performed by a provider and their privileges granted.

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