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Zachary Hartsell

By: Zachary Hartsell on November 16th, 2015

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Fundamentals of FPPE/OPPE for Allied HealthPros, Part 2

Healthcare Provider Credentialing

In our previous post, we discussed the complexity of the Credentialing Process and its assessments as presented by Zachary Hartsell, MHA, PA-C, in our symplr Education Series Webinars. Now we will be discussing the qualities of the FPPE assessment and its own set of challenges.

In all, healthcare institutions must have a Credentialing Process to ensure that their patients are receiving care of the highest quality. While most healthcare providers have a system in place to review the quality of service on a department level, the diversity in care providers and hospital specialties have made enacting the credentialing process complicated for each practitioner.

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) requires 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 so long as it is allowed by State Law.

While APN and PA staff membership depends on State Law, all APNs and PAs must go through the credential and privileges process using standards set by TJC and CMS. The Credentialing Process uses 3 types of assessments – General Competency Assessment, OPPE, and FPPE.

General Competency Assessments follow 6 general competencies that are endorsed by the majority of healthcare professionals. OPPE is a peer review processes used by many care professionals to measure the growth in the quality of their practice. FPPE is unique from these other two in the way it is used.

Focused Professional Practice Evaluation

Focused Professional Practice Evaluations (FPPE) involve more specific, time-limited monitoring of a provider’s practice performance for a couple of different situations.

  1. During an initiation: New hires who are given initial privileges and credentialing, regardless of past performance. Current staff members who are applying for an expansion or new privileges and credentials are also given an FPPE. This is done for all privileges to be granted, as well as any privilege they may ask for.
  2. As needed basis: After the initial FPPE, the assessment isn’t imposed again unless used as a corrective measure. When a trigger or serious complaint is identified during an OPPE, the trigger is inspected further with a FPPE assessment for corrective action to 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 made by the TJC in 2013, if triggers are never activated during the OPPE, then the triggers are not sensitive enough.

It is important that the process remain consistent for all practitioners, including APNs and PAs.

Clear Guidelines and Benchmarks

Many of the guiding principles of OPPE also apply to FPPE, such as measurements taken using quantitative data, a narrative assessment, and collection methods. Just like OPPE, best practice is to keep the assessment consistent, simple and scalable with clear guidelines and benchmarks.

Effective FPPE processes answer the criteria needed for the evaluation, the specific method for establishing a monitoring plan, a method of determining the monitoring duration, and an outline of circumstances by which monitoring will occur from an external source.

Since different roles have their own unique responsibilities and the FPPE is meant to be a method of enacting service quality improvements, TJC allows institutions to design their own FPPE process. However, they offer guidelines by which to shape the FPPE process:

  • The processes used for FPPE do not need to apply to all staff members, they only need to be applied consistently.
  • Training courses and board certification do not equal competency.
  • Sampling of group privileges does not mean someone is competent in every privilege in that group. Individual assessments must be made, regardless of what the group standard is.

One of the major differences between OPPE and FPPE is in the way they treat the concentration of time observed. OPPE is expected to be performed more than twice a year and the information is accumulative overtime.

During corrective action, FPPE is concentrated over a period of time to observe where corrections can be made on a trigger. The amount of time an FPPE takes can vary, depending on whether the hospital has specific bylaws detailing the amount of time observed.

Learn More about OPPE/FPPE and the Credentialing Process

The credentialing process is a valuable tool for not only verifying the qualifications of a practitioner, but a powerful holistic assessment of the quality of care given in an institution. For more detailed information about the TJC’s policies on the FPPE assessment, 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.