An Introduction to OPPE and FPPE
Ongoing Professional Practice Evaluation and Focused Professional Practice Evaluation (OPPE and FPPE) are standard protocols in healthcare organizations today. They bring together compliance, quality, and safety initiatives in their focus on provider performance improvement. While OPPE and FPPE are The Joint Commission’s (TJC) terms, the ideas they represent are universal. All hospitals and healthcare organizations must evaluate and validate providers’ performance at regular intervals, and under certain circumstances, according to their healthcare accreditation and/or regulatory body’s standards.
OPPE and FPPE are not new concepts; TJC launched them in 2007 and 2008, respectively, in rebranding its standards around provider proficiency improvement. Long before then, quality and performance improvement were accomplished through various means including peer review. Before that, morbidity and mortality conferences—traditional forums wherein clinicians discuss medical error and adverse events—occurred.
What was new when TJC launched OPPE and FPPE? The standards linked provider competency assessments to clinical privileges for the first time, placing the function squarely in the domain of medical staff services professionals (MSPs)—not just in that of the quality department. In short, TJC’s OPPE and FPPE standards were created to set a new, higher bar of accountability by the organized medical staff to help manage quality and safety among privileged practitioners.
OPPE for nonphysician providers
Today, there’s an increased focus on OPPE and FPPE for nonphysician providers, such as physician assistants, certified registered nurse assistants, nurse practitioners, pharmacists, and more. The growing scopes of advanced practice professionals (APPs), as they’re sometimes called, require more stringent quality and performance-related oversight. Plus, like physicians, reimbursement for the care and services they provide to patients is increasingly tied to the achievement of quality targets.
Organizations with robust physician OPPE and FPPE practices are typically able to translate their techniques to nonphysicians with ease. However, common performance monitoring challenges among APPs include:
- The inability to find and track APP data, especially within supervisory arrangements
- The proliferation of team-based care, where multiple practitioners contribute to outcomes
- The growth of specialized APPs (e.g., oncology PA) who treat more complex or acute patients, thus requiring different measures than their peers and/or the associated physician specialty
All about OPPE
What does OPPE stand for?
OPPE stands for ongoing professional practice evaluation. Looking at a practitioner’s performance evaluation over the long term—by gathering and reporting data for quality improvement—requires a complex set of activities. OPPE is a part of the peer review process and generally provides most of the data needed to make reappointment decisions. Reappointment might mean a provider is green-lighted to keep their privileges at a facility, remain on the medical staff, or both.
Is OPPE reportable?
OPPE is not an adverse action and isn’t an investigation reportable to the National Practitioner Data Bank (NPDB). Negative views of OPPE may linger in healthcare because, historically, review activities were often punitive. However, OPPE is not punishment, and it’s not designed to be subjective. Nonetheless, some dimensions of practitioner performance do require providers to accept and use data that relies on the perceptions (i.e., qualitative data) of patients and other healthcare clinicians and staff.
Effective OPPE aims to be an objective program that relies on measuring quantitative and qualitative data at predetermined thresholds (targets or indicators). Further, it’s designed to engage providers in managing their own performance and being more accountable for the quality of patient care and the goal of constant improvement.
Is OPPE required?
Providers’ ability to deliver high-quality, safe care is essential whether your organization is:
- A system, hospital, critical access facility, or ambulatory facility that follows TJC
- A health plan that adheres to the National Committee for Quality Assurance’s (NCQA) standards
- A group practice following state law for reimbursement by the Centers for Medicare & Medicaid Services (CMS)
And whether or not your accreditor calls the process OPPE, it’s essential to use regularly scheduled assessments to tie providers’ competency to their current ability to maintain privileges or continue to practice within a given scope. The safe delivery of high-quality patient care demands it, and you can’t risk waiting two years for a recredentialing process to let providers know they could have done something better.
OPPE targets should be specialty-specific, but can broadly use qualitative and quantitative data categorized by a list of general competencies established by the Accreditation Council for Graduate Medical Education and the American Board of Medical Specialties, and later adopted by TJC and others. The Six General Competencies are:1. Patient Care
2. Medical/Clinical Knowledge
3. Interpersonal and Communication Skills
5. Systems-based Practice
6. Practice-based Learning and Improvement
Regarding subjective data and perception, the ACGME acknowledges that “assessment requires observations and judgments of performance in the workplace.”
Organizations with successful OPPE programs often use software to ensure their measures capture the right data and engage providers in co-managing their own performance toward quality improvement. OPPE software can track privilege use and trend quality indicators (e.g., CMS core measures, case review, etc.), match provider performance measures to organizational initiatives for improvement, and more.
All about FPPE
What does FPPE stand for?
FPPE stands for focused professional practice evaluation. While the OPPE process looks at a practitioner’s performance evaluation over the long term, the FPPE process is just as its name implies—it’s a focused, “snapshot” evaluation used when:
a practitioner lacks documented evidence of having recently and competently performed the requested privilege(s) at the organization, requiring the medical staff to evaluate their privilege-specific competence. It’s important to remember that privileges are site-specific. In a healthcare system, a provider may have privileges at one facility and not at another, for myriad reasons.
a question arises regarding a currently privileged practitioner's ability to provide safe, high-quality patient care (e.g., their data shows outliers from predetermined thresholds of acceptable performance). This is often referred to as “for-cause” FPPE.
A comprehensive, high-quality software program can help by guiding and automating the management of initial and for-cause FPPE. It can also track data milestones that help determine when to send an FPPE to peer view, or include it in an OPPE or any improvement plan.
Is FPPE required?
A period of FPPE is required for all new privileges—including privileges requested by new applicants and all newly requested privileges for existing practitioners. There are no exemptions based on board certification, documented experience, proctoring, reputation, etc.
Many medical staffs struggle to develop the right tools for compliance and risk management, especially with regard to FPPE. They ask questions such as:
- For how long should we conduct FPPE?
- How many procedures should we monitor?
- Which monitoring techniques work best?
- What are best practices for conducting FPPE for nonphysicians who must be credentialed and privileged through the medical staff process?
According to TJC, a consistent and pre-defined FPPE process must be implemented for all newly requested privileges. The performance monitoring process must also be clearly defined and include, at a minimum, the following:
- Criteria for conducting performance evaluations
- A method for establishing the monitoring plan specific to the requested privilege
- A method to determine the duration of performance monitoring
- The circumstances under which monitoring by an external source is required
Is FPPE reportable?
Actions such as proctoring, monitoring, FPPE plans, case reviews, educational requirements, etc., are not reportable. Organizations with questions about investigations should refer to the NPDB Guidebook, or seek in-house legal counsel or external legal help from a firm that specializes in healthcare law.
OPPE and FPPE best practices
To assist in creating or updating your OPPE and FPPE program to meet or exceed minimum standards, ensure that your policies and procedures address the following considerations:1. Standardize the frequency of performing evaluations.
2. Handle reviews consistently for all providers.
3. Establish and document standard workflows for conducting OPPE and FPPE.
4. Define clinical performance benchmarks (i.e., measures).
5. Document event types that trigger automatic evaluation.
6. Establish guidelines for how FPPE and OPPE are used for recredentialing/reappointment decisions.
7. Determine whether internal or external staff will perform the evaluations.
8. Define the methods used for collecting information (e.g., chart review, direct observation, etc.).
9. List all possible outcome actions and next steps.
10. Ensure feedback to providers is consistent regardless of the outcome.
Creating and maintaining FPPE and OPPE programs that allow your providers to improve and prosper is essential. Structure your program to be intuitive and nimble, allowing your processes to grow and change with your organization. Start with investing in provider credentialing software that maintains the structure needed, yet allows for the flexibility required.
After all, if your organization’s professional practice evaluations are cumbersome or used only for surveys, neither patients nor providers receive the benefits intended by OPPE and FPPE requirements, diminishing the quality of the healthcare we deliver and receive.
Learn more about how symplr’s quality software automates OPPE and FPPE workflows, offers insight for education and improvement, and helps maintain strict control over the quality measures affecting reimbursement.
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