FPPE: What's new for 2019 | symplr Blog Feature
Joni Orand

By: Joni Orand on July 22nd, 2019

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FPPE: What's new for 2019 | symplr

Quality | FPPE | Provider Management | best practices

The U.S. spends over $3.5 trillion a year in healthcare, the equivalent of nearly $11,000 per person, supporting the continued need for qualified medical practitioners at every level. In order to get reimbursed for their services, healthcare organizations are being challenged to implement systems that improve the quality and consistency of patient care, as well as the patient experience.

A traditional, stand-alone peer review program may no longer be enough to ensure the quality performance of Physicians and Allied Health Practitioners (AHP). Review and certification processes that routinely evaluate the quality of care are now essential to a thriving and profitable organization.

FPPE sets performance standards

FPPE sets performance standards

The Focused Professional Practice Evaluation (FPPE) process was developed in 2007 by the Joint Commission in conjunction with the Ongoing Professional Practice Evaluation (OPPE). These two tools work together to not only evaluate practitioners but to identify follow-up steps to improve performance.

The OPPE was designed to screen all practitioners with credentials to identify if any of these professionals were delivering substandard care. If an OPPE “positive” result was found (meaning there was evidence of care that did not meet standards), the FPPE serves as a follow up to improve the performance of the small number of practitioners identified in the OPPE process.

FPPE is typically performed at the department level and requires that standards are objective and capable of accurately determining if a practitioner’s performance is falling below acceptable levels.

An initial FPPE may be performed:

  • At the time of initial appointment to the clinical staff;
  • Upon the request of a new privilege;
  • If the practitioner cannot provide prior documentation of competence to perform the requested procedure;
  • When a question arises regarding the ability of a currently privileged practitioner to competently and safely exercise the privileges he or she is currently granted.

A Medical Staff Services FPPE is a structured and time-limited evaluation of the competence of a practitioner to safely exercise a clinical privilege or set of privileges. 

An Ongoing FPPE may be performed as a follow-up process to determine the validity of any positives (whether true or false) found after initial onboarding FPPE. This process is typically applied only to the small number of clinicians who were identified by OPPE.

Performance Standards are part of an organization’s Bylaws

All standards require that FPPE processes be included in your organization’s bylaws and specify: 

  • Requirements (reasons for an FPPE, who will review, facility-specific criteria)
  • Timeframes
  • Intended framework
  • Measure to be used
  • How data will be collected
  • Criteria or triggers for initiating a performance improvement plan

Established metrics should include two hospital-specific measurements and two department-specific measurements that properly represent both a physician’s and AHP’s performance.

Another area for consideration is the advancement of Artificial Intelligence (AI) applications that are a growing part of the healthcare landscape. AI can assist in the diagnosis of disease and treatment and have a great impact on physician effectiveness and patient outcomes. However, an organization’s evaluation policies may need to be revised to reflect these advancements by incorporating new measurements into the FPPE process and bylaws.

FPPE triggers

FPPE Triggers

FPPE processes are in place for a primary reason: to keep patients safe. When unsafe events arise, the evaluation process starts by looking at standard measurements that may include:

  • Defined # of events occurring
  • Defined # of individual peer reviews w/ adverse determinations
  • Elevated infection rates
  • Sentinel events
  • Increasing LOS compared to others
  • Increasing number of returns to surgery
  • Patterns of unnecessary tests/treatments
  • Failure to follow approved clinical practice guidelines

Not only are the number of triggers reviewed, but the time period in which they occur is also taken under advisement. The combination of the time period and/or the activity or trigger may start the FPPE process.

Startling Statistics: Why FPPE is crucial

Triggers may lead to long-term events, so identifying and taking immediate corrective action is important. If the FPPE process is overlooked, organizations will carry significant risk to their patients, finances, and reputation as a result of their medical professionals’ behavior. 

Whether intentional or accidental, adverse incidents can be quite common and include:

  • Malpractice: 17,000 malpractice suits are filed annually
  • Medical Errors: According to a Johns Hopkins study, Medical Errors are now the #3 cause of deaths in America, representing 10% of all deaths
  • Hospital Deaths: Over 251,000 hospital deaths occurred in 2017, making it 500 times the number of accidental gunshot deaths
  • Patient Care Harm: Over 440,000 cases occurred in 2017 and is expected to rise
  • State Hopping: Over 250 physicians were detected as “state hoppers” (those who moved to a different state to avoid penalties) and sued in 2018 but the actual number could be significantly higher

Without proper evaluation processes, practitioner behavior may go unchecked. In a recent case in Tennessee, a physician was identified as part of a $65 million over-prescribing scheme to defraud the U.S. Military. In another incident, a leading cancer treatment physician was found to have 27 cases of overdosing. Yet another physician made racial statements about who she would - and would not - treat appropriately. Other incidents show prosecuted physicians moving to another state to start over to avoid carrying past negligent reputation with them. 

In addition to lawsuits, social media can be beneficial - or devastating - to an organization. Patients now depend on social media to choose physicians, practitioners and hospitals, so maintaining a positive, patient-centered social media presence is critical to the success of an organization.

Despite the Hippocratic Oath, medical practitioners may have unknown personal motives that put an organization at risk. Implementing a consistent and diligent FPPE process can identify risky or substandard behaviors before they happen.

FPPE value based

Value-Based Care (VBC): the new reimbursement norm

Value-Based Care is gaining a foothold since it was introduced in 2013 by the Centers for Medicaid and Medicare Services (CMS). The quality standards issued included changing how care is given through better teamwork, coordination across healthcare settings, and increased attention to population health.

VBC now guides how healthcare institutions are reimbursed. It’s no longer about the volume of services but the value of services provided. The regulations now focus on the quality of care, consistent clinical practices, and the patient’s experience.

Reimbursement now focuses on two key areas: 

  • How well an organization performs on each measure compared to other hospitals’ performance during a baseline period 
  • How much they improve their performance on each measure compared to their performance during a baseline period 

The reporting measures use a weight of 25% to Safety, Clinical Care, Efficiency and Cost Reduction, and Person and Community Engagement, Having these measures reflected in their FPPE process is critical to the organization’s revenue stream.

FPPE and Allied Health

Allied Health and FPPE

AHP’s are an integral part of patient care and include over 5 million professionals in 80 different occupations. While no clear standards exist, AHP’s are evaluated based on 6 Core Competencies:

  1. Patient Care - Has an AHP appeared in customer surveys for commendations or complaints?
  2. Medical and Clinical Knowledge - Have any concerns been noted by the collaborating provider, Peer Review committee or patients?
  3. Practice-Based Learning and Improvements - Do charts indicate an appropriate level of knowledge? Is the AHP participating in advanced education?
  4. Interpersonal and Communication Skills - Do they interact well with patients, peers, and superiors? Do they take feedback well?
  5. System Based Practice - Does the AHP understand the holistic view of the patient, linking medical, family, and community issues to the patient’s wellbeing?
  6. Professionalism - Does the AHP demonstrate professional competency in all areas?

Guidelines for AHP’s should be described and documented in your organization’s bylaws, policies, and procedures as surveyors look for established plans and consistent compliance. Including meaningful measurements that properly reflect these competencies is also critical.

FPPE protects your Organization

In short, the FPPE does four vital things for your organization:

  1. Sets a performance standard for medical professionals
  2. Prepares your organization for accreditation
  3. Reduces risk and liability by identifying behaviors before they happen
  4. Identifies corrective action once an adverse situation arises

Physicians and AHP’s are critical to organizational success and benefit not only profits but reputation. Ensuring that FPPE’s are conducted consistently improves the performance of outstanding practitioners while identifying professionals that need guidance and education.


About Joni Orand

Joni Orand has worked in the healthcare industry for twenty eight years’, in both managed care and hospital environments, working with providers and staff gaining unparalleled experience in all aspects of provider management and quality improvement initiatives. She holds a degree in Corporate Communications, with minors in Interpersonal Communication and International Studies in Communications. Joni is a certified trainer, speaker and coach, and is known for helping, educating, and supporting clients as they develop quality improvement plans. Currently working as a Senior Solution Consultant for symplr, Joni speaks as a Subject Matter Expert at industry events.

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