Blog Feature
Zachary Hartsell

By: Zachary Hartsell on November 9th, 2015

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Fundamentals of FPPE/OPPE for Allied HealthPros, Part 1

Healthcare Provider Credentialing

Zachary Hartsell, MHA, PA-C provides an excellent walk-through of the use of FPPE and OPPE assessments in the Credentialing Process with insight on the complexity of applying them in modern institutions for our Symplr Education Series Webinar. We’ve organized some of the main points in a two part blog series to help you start thinking about The Credentialing Process.

The Credentialing Process was created to ensure that patients receive the highest quality care from referred health care providers and institutions. Patients want a rating system that not only reviews the quality of health care received, but a measurement of the overall patient experience.

Most healthcare providers have a system in place to review the quality of the healthcare that they provide. However, the credentialing process becomes complex because it does not clearly define who needs to be credentialed.

The Credentialing Process is Complicated

While The Joint Commission (TJC) has clear guidelines for medical staff, it defers whether a practitioner is a licensed independent practitioner (LIP) to State Law. Centers for Medicare Servicers (CMS) are stricter, requiring 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”.

Advanced Nurse Practitioners (APN) and Physician Assistants (PA) may be considered members of the medical staff by both The Joint Commission and Medicare’s Conditions of Participation, so long as they are allowed by State Law. Although APN and PA medical staff membership is dependent on State Law, all APNs and PAs must be credentialed and privileged as if they were staff members using the standards set by TJC and CMS. This will require all qualified practitioners to go through the Credentialing Process using 3 types of assessments – General Competency Assessment, OPPE, and FPPE

General Competency Assessment

The General Competency Assessment follows 6 general competencies as set by TJC and are endorsed by most medical and professional organizations:

  1. Patient Care
  2. Medical Knowledge
  3. Practice Based Learning & Improvement
  4. Interpersonal Communication
  5. Professionalism
  6. Systems Based Practice

Practitioners under TJC must be reviewed under these 6 general competencies. However, it does not specify on what the recommendations and requirements are. This is because there are many types of institutions, all of which provide different types of care, such as Critical Access Hospital, Academic Medical Center, and Government Medical Centers.

While the credential process may be different from hospital to hospital, the assessment requirements must have two core elements – the assessment of core competencies and a specialty or department-specific competency.

Ongoing Professional Practice Evaluation

The Ongoing Professional Practice Evaluation (OPPE) is a continuous evaluation of a provider’s performance at a frequency greater than every 12 months. OPPE involves a peer review process, where practitioners are reviewed by other practitioners of the same discipline and have personal knowledge of the applicant. The assessment must have both quantitative performance data and a narrative assessment, preferably given by more than one fellow practitioner.

OPPE Challenges

One of the biggest challenges of OPPE is in keeping it simple and scalable. The type of data collected is normally determined by the individual departments as stated by TJC. No matter what data is collected, the key is to remain consistent in collecting this information.

For NPAs and PAs, the OPPE process can be challenging if their data is combined with a physician’s data. Certain metrics that are valuable for clinical pharmacists or psychologists may not necessarily apply to general practitioners.

Collection Methods

There are many methods you can utilize to collect information, such as direct observations, chart reviews, discussions with peers and staff, or test for competency in performing specific procedures. One effective method in collecting information for OPPE is the use of simulations. In this way, you can isolate variables and determine a practitioner’s competency under normal settings.

No matter the collection method, it is key that information collected remain relevant and meaningful to the service provided. Slimming it to the essentials allows the process to flow smoother and is scalable.

The use of Triggers

A key principle of OPPE is the use of Triggers – noticeable drops in performance. The trigger level is a predetermined baseline level of performance within an established criteria.

Staff members who are below the trigger level then move into Focused Professional Practice Evaluation (FPPE). FPPE is used to evaluate and act upon concerns regarding a privileged practitioner’s clinical practice and/or competence.

While FPPE may act as an extension of OPPE, FPPE has its own myriad of complications that will be explored in part 2 of our coverage on the Fundamentals of FPPE/OPPE for Allied Health Pros webinar. For more information about the General Competency Assessment and OPPE, listen to our webinar by Zachary Hartsell, MHA, PA-C.

For more information on the credentialing process and how symplr can help your institution streamline its process with simple and effective solutions, Schedule a Demo today!


About Zachary Hartsell

Zachary Hartsell, MHA, PA-C, has been the Program Director for Wake Forest School of Medicine’s PA Program since November 2014. Hartsell joined the faculty as Associate Professor and Vice Chair of PA Studies in 2013 and became the first Director of PA Services at Wake Forest Baptist Medical Center (WFBMC). His work at the medical center has been centered out of the Chief Medical Officer’s office and focused on workforce innovation, credentialing, and redesigned care models. He also continues to practice clinically in hospital medicine at WFBMC and teaches healthcare management at the Wake Forest School of Business. Mr. Hartsell has served in several roles at the American Academy of Physician Assistants including as the liaison to the Society of Hospital Medicine and chair of AAPA’s Commission on Continuing Professional Development and Education.