4 Challenges to Implementing OPPE Blog Feature
Tracey Meyer

By: Tracey Meyer on May 25th, 2016

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4 Challenges to Implementing OPPE

Healthcare Provider Credentialing

No doubt, the Ongoing Professional Practice Evaluation (OPPE) is meant to be a valuable screening tool to ensure care provided by practitioners does not fall below an acceptable level. As a major priority created in 2007 by the Joint Commission, the OPPE is designed to ensure quality of care and safety for patients – an essential part of the credentialing process.

In theory, the OPPE allows healthcare organizations to administer continuous performance assessments that are Joint Commission compliant. However, this results-driven process oftentimes creates issues that facilities must overcome for accurate credentialing. For a clearer picture of these hurdles, you must first review how the OPPE actually works.

The Joint Commission’s Framework for OPPE

The Joint Commission was explicitly flexible in developing the OPPE framework, rejecting a one-size-fits-all approach. With widely varying practices, state laws, and specialization of facilities, how could a single evaluation method work?

Instead, the Joint Commission’s requirements can be configured into a framework using three main principles[1]:

  1. A clearly defined, written process that facilitates the evaluation of each practitioner’s professional practice.
  2. The data collected for evaluations is determined by the individual departments and approved by the medical staff.
  3. Results gathered will be used to decide the continuation, limit, or revocation of existing privileges. 

The key takeaway from the framework is that the OPPE is designed to be used as a performance improvement tool – not to administer punitive consequences. The results found through the OPPE are intended to find medical staff faults and weaknesses for improvement, thus avoiding adverse outcomes.  

Depending on the structure of your facility, OPPE implementation can be challenging. When performed efficiently, the OPPE can help facilities raise the quality of care bar for practitioners while also ensuring that privileging decisions are objective and continuous.

Challenge #1: The Risk of False Positives

For starters, one major OPPE benefit is its use of quantitative data to formulate performance results through the use of baselines and triggers. Depending on the credentialing team’s criteria, OPPE triggers are calibrated to highlight signs of underperformance during testing. However, this does not mean that a lack of triggers is a result of good or excellent quality of care.

Correlating the findings of the OPPE with positive performance is a false positive. As with all screening tests, a positive finding must be followed up with a more specific diagnostic test. It is possible for the OPPE process to identify practitioners who show no signs of quality of care issues. Additional evaluations will need to occur to find practitioners who provide excellent quality of care.

Challenge #2: Deciding Who Conducts It

Ensuring checks and balance, the Joint Commission allows each faculty to determine who gathers and reviews the data and administers the evaluation. Typically, you will have the medical staff president or the chiefs of each department administer the evaluations.

However, this can be a daunting process when applied to scale as some criteria require direct observation and discussions with peers to collect data. For the OPPE process to operate efficiently and fairly, facilities will need to configure the screening process to fit their needs.  

Challenge #3: Data Collection

Data collection is hugely important, but just how frequently is the OPPE performed? The Joint Commission requires evaluations more than once a year for each member of the medical staff, resulting in three to four reports in a two-year reappointment cycle.

What makes data collection so challenging is that it must be obtained from a variety of sources. Your facility may require incident analysis, chart reviews, peer reviews, and direct observations – all of which can add up to an expensive and time-consuming exercise.

Challenge #4: Data Confidence

So, if the most accurate reports require large quantities of data and must be collected over time, what should you do if your practitioners see a low volume of patients?

Simply put, gathering data from small sample sizes can inflate the results, leading to a misevaluation of a practitioner’s performance. One way to restore data confidence is by conducting reviews more frequently. If facilities conduct reviews twice per year for their practitioners, it may be necessary to step up the process for low-volume practitioners.

However, the downside of conducting more reviews is more time spent gathering data, which ultimately increases the cost per-evaluation. An alternative to more evaluations is adding metrics with a high-level of context so results can be weighed and measured more accurately. This, too, will only increase time spent reviewing more in-depth metrics. Clearly, facilities will need to dedicate greater resources for low-volume practitioners.

The bottom-line is that the OPPE offers many opportunities for facilities to improve their quality of care. By regularly evaluating the performance of practitioners, facilities can ensure practitioners are qualified and its patients are kept safe. At symplr, we understand the stress of maintaining a high-level of healthcare quality. We offer full-suite solutions that will streamline your OPPE. To learn more about simple and effective OPPE solutions, schedule a demo today!

[1] Paul Z. “Using OPPE as a performance improvement tool”. The Joint Commission. http://www.jointcommission.org/jc_physician_blog/using_oppe_as_a_performance_improvement_tool/



About 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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