The credentialing process was created to make sure patients get top-notch care from trusted healthcare providers and institutions. Think of it like a rating system, but for doctors and hospitals. Patients are not just looking for good medical results; they want an all-around great experience.
Most healthcare providers already have some ways to check the quality of the care they give. But here’s where things get tricky: the credentialing process can be a bit of a headache because it doesn’t clearly spell out who exactly needs to be credentialed. This grey area can cause confusion and make the whole process more complicated than it needs to be.
To provide clarity and structure to the credentialing process, healthcare organizations often rely on two key evaluation methods: Focused Professional Practice Evaluation (FPPE) and Ongoing Professional Practice Evaluation (OPPE). FPPE is typically employed when a new provider is introduced to the medical staff or when existing providers seek new privileges. This evaluation is designed to ensure competence and involves the direct monitoring of a physician’s performance over a defined period. On the other hand, OPPE is an ongoing process that continuously monitors and evaluates a provider’s practice. Its goal is to maintain high standards of care by identifying performance trends, facilitating continuous improvement, and addressing any areas of concern. Together, FPPE and OPPE provide a framework for consistent and comprehensive evaluation, enhancing the quality of care patients receive and supporting the professional development of healthcare providers.
The difference between FPPE and OPPE
One of the major differences between FPPE and OPPE is the concentration of time observed. OPPE, which is expected to be performed more than twice a year, accumulates information over time to provide a comprehensive view of a provider’s performance. This ongoing process helps identify consistent trends and areas for continuous improvement.
In contrast, FPPE is concentrated over a specific period to address targeted issues or concerns identified in a provider’s performance. This evaluation is typically initiated by a trigger, such as a particular incident or a general performance concern, focusing intensely on that period to implement necessary corrective actions. The duration of an FPPE can vary significantly, often dictated by hospital bylaws that specify the required observation period.
The complexity of the credentialing process
Although The Joint Commission (TJC) has clear rulings for medical staff, it defers the licensing of independent practitioners (LIP) to State Law. Centers for Medicare and Medicaid Services (CMS) require both an initial and ongoing review of the credentials of “all practitioners who provide a medical level of care and/or conduct surgical procedures in the hospital.”
A common question for licensing is whether or not Advanced Nurse Practitioners (APN) and Physician Assistants (PA) are to be counted as medical staff. Under both TJC and Medicare’s Condition of Participation, they are included as long as it is permitted by State Law.
While APN and PA staff membership depends on State Law, all APNs and PAs must undergo the credentialing and privileging process using standards set by TJC and CMS. The credentialing process uses three types of assessments: General Competency Assessment, Ongoing Professional Practice Evaluation (OPPE), and Focused Professional Practice Evaluation (FPPE).
General Competency Assessment
The General Competency Assessment encompasses six fundamental competencies as established by TJC, which are widely endorsed by numerous medical and professional organizations:
- Patient Care
- Medical Knowledge
- Practice Based Learning & Improvement
- Interpersonal Communication
- Professionalism
- Systems Based Practice
Practitioners under TJC must be evaluated based on these six core competencies. However, specific recommendations and requirements are not uniformly defined, acknowledging the diversity of institutions, whether they are Critical Access Hospitals, Academic Medical Centers, or Government Medical Centers, each providing varied types of care.
Although credentialing processes differ from one hospital to another, the assessment requirements universally include two principal elements: the evaluation of core competencies and a specialty- or department-specific competency assessment. This dual approach ensures that practitioners not only possess the essential skills and knowledge necessary for general medical practice but are also competent in the specialized fields in which they operate.
Ongoing Professional Practice Evaluation (OPPE)
OPPE is a continuous evaluation of a provider’s performance, conducted more frequently than every 12 months. This evaluation involves a peer review process where practitioners are assessed by their peers within the same discipline who have direct knowledge of the applicant’s clinical work. The assessment must include both quantitative performance data and a narrative assessment, ideally provided by more than one fellow practitioner.
OPPE Challenges
One of the primary challenges of OPPE is maintaining simplicity and scalability. The type of data collected is typically determined by the individual departments, as specified by The Joint Commission (TJC). Regardless of the data collected, consistency in data collection is crucial to the success of the OPPE process.
For nurse practitioners (NPs) and physician assistants (PAs), the OPPE process can be particularly challenging when their performance data is combined with that of physicians. Certain metrics that are valuable for evaluating clinical pharmacists or psychologists may not be applicable to general practitioners, necessitating tailored approaches for different healthcare roles.
OPPE collection methods
There are several effective methods for collecting information for OPPE, including direct observations, chart reviews, peer and staff discussions, and competency tests for specific procedures. One particularly efficient approach is the use of simulations, which allow you to isolate variables and assess a practitioner’s competency under controlled, typical conditions. Regardless of the method used, it is essential that the collected information remains relevant and meaningful to the service provided. By focusing on essential data, the evaluation process becomes smoother and scalable.
The use of triggers
A fundamental principle of OPPE is the use of triggers—predetermined baselines of performance. These triggers help to identify noticeable drops in a provider’s performance. When a staff member’s performance falls below the trigger level, they transition into the FPPE phase. FPPE is designed to evaluate and address concerns regarding a practitioner’s clinical practice and competence. While FPPE can be seen as an extension of OPPE, it comes with its own set of complexities.
Focused Professional Practice Evaluation (FPPE)
FPPE involves specific, time-limited monitoring of a provider’s practice performance in a couple of different situations.
- During initiation: New hires who are granted initial privileges and credentialing undergo an FPPE regardless of past performance. Current staff members applying for expanded or new privileges and credentials also receive an FPPE. This assessment is conducted for all privileges to be granted.
- As needed basis: After the initial FPPE, the assessment is not imposed again unless it is used as a corrective measure. When a trigger or serious complaint is identified during an OPPE, further inspection is conducted through an FPPE assessment for corrective action according to The Joint Commission (TJC) standards.
The Joint Commission defines triggers as “unacceptable levels of performance within the established defined criteria.” FPPE, as well as other assessments, are only effective if they provide the medical staff with opportunities for improvement. According to a report by the TJC, if triggers are never activated during the OPPE, the triggers are not sensitive enough.
It is crucial that the process remains consistent for all providers, including advanced practice nurses (APNs) and PAs.
FPPE guidelines and benchmarks
Many of the guiding principles of OPPE also apply to FPPE, such as measurements taken using quantitative data, narrative assessments, and consistent collection methods. Just like with OPPE, the best practice is to keep the assessment consistent, simple, and scalable with clear guidelines and benchmarks.
Effective FPPE processes should meet the criteria for evaluation, establish a specific monitoring plan, determine the duration of monitoring, and outline the circumstances under which monitoring will occur from an external source. Given the unique responsibilities of different roles and the aim of FPPE to improve service quality, TJC allows institutions to design their own FPPE processes. However, they provide guidelines to shape these processes:
- FPPE processes do not need to apply to all staff members but must be applied consistently.
- Training courses and board certifications do not equate to competency.
- Sampling of group privileges does not ensure competency in every privilege within that group; individual assessments must be made, regardless of the group standard.
Conclusion & next steps
Creating and maintaining a successful FPPE/OPPE program is absolutely crucial for healthcare executives who are looking to drive organizational growth and excellence. By designing your program to be intuitive and adaptable, you’ll ensure that your processes can grow and change right along with your organization. Investing in software that keeps everything structured but still allows for flexibility is definitely a smart move for any dynamic healthcare environment.
Let’s face it, if your organization’s professional practice evaluations are a hassle or only used to tick boxes for compliance, then you and your patients are missing out on the true benefits. The goal here is to boost the quality of the healthcare we provide and receive. Streamlining and optimizing these evaluations can help us achieve continuous improvement and make a real difference in patient care.
