More states are expanding nonphysician providers’ scopes or allowing them to practice without supervision, making their ongoing professional practice evaluation (OPPE) more important than ever. They include physician assistants, advanced practice registered nurses, certified registered nurse assistants, psychologists, and others. Take time to revisit your policies and procedures for monitoring these nonphysicians'—and all advanced practice professionals' (APP)—current clinical competence and professionalism to support the delivery of safe, high-quality care.
Challenges of OPPE for nonphysicians
Notably, APPs who are credentialed and privileged through the hospital medical staff process require OPPE, according to The Joint Commission (TJC) and other accreditation bodies. TJC retooled and rolled out its current OPPE policy in 2007, but the concept of ongoing provider performance review has been around much longer than that.
With regard to APPs, however, OPPE still causes healthcare organizations headaches due to multiple common challenges, such as:
- The inability to find and track APP data, especially within supervisory arrangements
- The proliferation of team-based care, where multiple practitioners contribute to outcomes
- Absence of, or inconsistencies in, policies and procedures for monitoring APPs, especially when tying OPPE to reappointment for nonphysicians
- 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
- Monitoring low-volume APP providers
Further, OPPE for nonphysicians has yet to find a permanent home in many healthcare systems. It’s often shared by the quality and medical staff services functions. For example, the medical staff may gather all or some of the performance data, but quality reports on it and is ultimately responsible for improvements. If communication between departments is weak or policies are unclear, there’s a potential for data to fall between the cracks. That’s where a comprehensive software program comes in. Regardless, OPPE is a critical process that links nonphysician provider competency assessment to privileges—and the right to deliver care or services to patients.
Check these boxes to improve OPPE
While the APP OPPE process shares many of the same elements as physician OPPE, the process of collecting and evaluating data is often different. And as OPPE does for physicians, the process should contain a dynamic process of checks and balances for nonphysicians, serving to create a system of care that is:
- Current, accounting for the rapid expansion of APP practices
- Data-driven and transparent
- Performance-improvement focused, not punitive
- Controlled, with specific oversight understood by all
- Standardized to the extent possible
symplr's OPPE module is the only quality software on the market that provides role-based reporting. This allows you to assign a supervisory/collaborating role in the EHR for the physician, and pull codes under that role to know whether the nonphysician/APP performed the procedure.
symplr’s decades of experience in working with hospitals and healthcare systems nationwide have provided a clear vantage point in helping organizations meet practice evaluation requirements. The following are essential steps in creating and maintaining a successful OPPE process for your APPs:
Check your bylaws language regarding nonphysicians' OPPE.
All standards require your APP OPPE process to be delineated in your bylaws and include the following:
- Time frames
- Intended framework
- Measure(s) to be used
- Data collection method(s)
- Criterial/triggers for initiating a performance-improvement plan
Document the OPPE process for APPs in your bylaws as well as policies and procedures.
Be specific about which nonphysicians undergo the OPPE process, how often, who is accountable for reviews, how information is documented. Specify which departments or functions contribute to the overall process. Surveyors want to ensure processes are well documented and that established plans are adhered to.
Choose meaningful measures that accurately reflect APP performance.
Taking the time to determine important measures related to your providers may be time consuming on the front end, but once complete, the results are worth it. Notably, organizations that have the buy-in from physicians on performance-improvement focused evaluation show greater results. Likewise, involve APPs in the selection of the measures for their performance.
Don’t rely solely on data-driven measures.
Sponsoring or supervising physicians (where applicable) account for much of the performance data included in the APP’s OPPE, making the use of a narrative in the report both appropriate and essential. The chart review required for maintaining privileges can serve to provide much of the information needed by the sponsor to complete the OPPE.
Consider adding APPs to medical staff committees that address performance improvement.
The Centers for Medicare & Medicaid Services has long recognized nonphysicians as members of the organized medical staff. However, many health systems lag in granting them medical staff committees seats. APPs possess invaluable knowledge of clinical issues, and their inclusion brings new points of view on safety and quality issues. For the APPs, the committee participation provides additional performance data in the professionalism category.
Include the six core competencies.
Patient Care: Do your patient satisfaction surveys reference the APP? Are there any compliments or complaints?
Medical/Clinical Knowledge: Has the Peer Review Committee reviewed the APP? What does a review of the chosen patient assessment and/or treatment(s) say about the competency of the APP?
Practice-Based Learning and Improvements: Does a chart review indicate a working knowledge of current scientifically based treatment choices? Is the APP involved in ongoing educational opportunities?
Interpersonal and Communication Skills: Like the Patient Care core competency, you can address these skills through compliments and complaints from staff and patients. How does the APP function in a team setting? Do they take feedback and direction well?
Systems-Based Practice: These skills can be ascertained from a chart review and study of the treatment choices and care plans created for patients treated. Is the practitioner able to see past an individual episode of care and evaluate the family, the community, the other bodily systems, and their contribution to the current state of the patient?
Professionalism: Assess this area by evaluating the overall impression made by this practitioner in all other competency areas. It’s the sum of all other parts reviewed.
Go beyond the six core competencies.
While all OPPEs should address the six core competencies, an evaluation should also include a minimum of two “hospital-specific” and two “department-specific” measures. These can be the same for both APPs and physicians to simplify the processes.
Make things easier for reviewers.
Although the main OPPE review for APPs will likely be manual and narrative, it doesn’t have to be cumbersome. When documenting answers to competency questions, simply have the Sponsor check “MET” or “NOT MET” with a column to check whether a performance improvement plan was, or should be, initiated. This type of format allows the medical staff to satisfy two standards—Sponsor Review of Charts and OPPE Report Submission—that often cause issues during compliance surveys.
In the eyes of patients today, there’s a blurring line between care received from a physician and an APP. That same line is blurring among those who write and enforce the quality requirements by which healthcare organizations and practitioners are judged—and reimbursed. Although the work required to create and manage effective OPPE programs for APPs can be challenging, the results are unquestionably positive: improved patient care and an opportunity to help every practitioner be the best they can be.
Need help with OPPE data collection or applying it to improve nonphysician provider performance?