Disclosures. Learning Objectives. Definitions. Initial Credentialing and Privileging. Who are the Medical Staff? 3/3/2015

Transcription

1 Disclosures Advanced Practice Credentialing, Privileging, Onboarding and Professional Practice Evaluation for the PNP Speakers have no financial relationships to disclose. Speakers will not discuss off label use and/or investigational use of any drug or device in the presentation. Michelle M. Wilson, MS, CPNP-AC, PPCNP-BC Lead Nurse Practitioner, Pre-Surgery Preparation Center Chair, Advanced Practice Provider Credentials Sub-Committee Julie Tsirambidis, MSN, FNP-BC, PNP-PC Director, Advanced Practice Center Nurse Practitioner, Akron Children s Hospital Pediatrics Learning Objectives Describe the process of advanced practice credentialing, privileging, onboarding and professional practice evaluation. List the benefits of developing an advanced practice structure that is inclusive of a credentialing committee and medical staff membership with a professional practice evaluation committee. Discuss ways to measure provider competency in the context of FPPE and OPPE process including peer review. Definitions Credentialingis the process of verifying education, licensure and certification. Privilegingis the process of granting the authority to perform specific aspects of patient care. Onboardingis the process of organizational socialization. Professional practice evaluation is a screening tool used to evaluate practitioners who have been granted privileges. Who are the Medical Staff? APRNs (CNP, CRNA, CNS, CNM) Physicians PAs Psychologists Podiatrists Dentists Optometrists PharmD Clinical Scientists (PhD) Initial Credentialing and Privileging Much paperwork! Lead APPs mentor through the process Applicant meets with Lead Medical Staff Coordinator Credentialing Specialist Master s or DNP degree National board certification Collaborative agreement CTP & DEA 1

2 Delineations 10 different APP delineations: PNP, FNP, *NNP, Adult NP, CNS, *CRNA, *PA-surgical, PAmedical, Women's Health NP, & PMH NP Core and special non-core privileges Initial appointment, reappointment or additional privilege/location request Qualifications & limitations The Process Data gathering, collecting, verifying Presenting applicant at Credentials Sub- Committee (workgroup) 2 APP s review the APP applicant files Recommendations made Formal presentation at Credentials Committee Common Issues New grads Lack of relevant experience Poor planning in filling the need Lack of understanding of APRN formal training No documentation to support privilege request No current practice Medical Staff Membership APRNs and PAs at Akron Children s Hospital are credentialed and privileged as active members of the Medical Staff, with voting membership. Pay similar dues as other medical staff peers They carry provider billing numbers with Medicaid, Medicare, and commercial payers and are able to professional bill their services according to the payers fee schedule. Serve on various medical staff and hospital wide committees Participate in shared governance and reporting to MSEC through an APP Council. 2

3 What is the APP Center? The Advanced Practice Provider Center at Akron Children s Hospital supports the role of Advanced Practice Registered Nurses (CRNA/CNP/CNS) and Physician Assistants (PA-C). Advanced Practice Structure The Center serves to provide expert resources on practice, licensing, compliance, credentialing, continuing education, training and development to advanced practice services throughout the organization. APP Council Chair -Julie Tsirambidis, MSN, CNP The Advanced Practice Provider Council is a medical staff sub-committee of the Medical Staff Executive Committee (MSEC). The APP Council also serves as a Shared Governance Group and Council as part of a Magnet Designated organization. Duties: The APP Council reviews standards for APRN and PA providers and practice. The APP Council operates to decrease barriers to practice, and increase access and service to the delivery of health care of patients. It also provides the forum for the committees to exchange, create, and improve areas of clinical practice, continuing medical education efforts, community outreach, address state and national health policy, credentialing issues, and hospital initiatives. The APP Council recommends, revises, create policies, procedures, processes and forms to support APRN and PA practice at Akron Children s Hospital. Composition: The APP Council consists of a Chairperson: The APP Center Director will serve as the APP Council Chair, who is a member of the MSEC Committee and will report the operations of the APP Council. The Lead APP providers all of all divisions, The Chairs of each APP Council committee*, Three additional APP members at large (From divisions located within DOP including one APP located at an off-site Campus and from ACHP practices), Two medical staff physicians with vote, The CMO serves as a non-voting ad-hoc member, The CNO serves as an non-voting ad-hoc member, Additional ad-hoc members can be appointed by the APP Council chair without approval APP Credentials Committee/Health Policy APP Council Treasurer Clinical Practice, Education, & Research Annual APP Conference Committee (Fall & Spring) Professional Development Quality APP Outreach/Visibility Onboarding Committee Advanced Practice Provider Credentials Committee APP Council Chair Michelle Wilson, MSN, CNP This committee is a subcommittee of the med staff credentials committee dedicated to the review of the APP medical staff applicant (includes APRN and PA providers) for membership, change in privileging, or reappointment issues. Responsible for the Quality Monitoring oversight and Standard Care Arrangements and Supervisory Agreements yearly in collaboration with the Medical Staff Office. See full bylaw in med staff policies. Meets monthly Advanced Practice Providers Quality Committee APP Council Chair Marlene Hardy-Gomez, MSN, CNP This committee is part of the APP Council Function is to oversee the quality assurance process and oversight in conjunction with the APP Credentials group and to create processes as needed Chair sits on Med PI committee Ongoing APP Quality Committee Chair will review and update necessary changes to the practice specific orientation plans with Lead APPs Work in collaboration with Med PI Team Ability to advocate Hear our voice Visibility Expert resources Design Benefits Leadership and learning opportunities Inclusive rather than exclusive Forward motion 3

4 APP Onboarding & Orientation Program APP 90 Day Checklist to Practice created and reviewed annually by the APP Council Originates with APP Recruiter HR Moves on to the Medical Staff office, Lead APP, and Divisional Directors or delegates Part of the FPPE process APP Onboarding Program APP Boot Camp Lecture Series Created and Reviewed Annually by the APP Center The APP Boot Camp is a year-long series of lectures and events specifically designed for clinical growth, networking, and professional development of our Advanced Practice Professionals. It is a high level on boarding program as part of the FPPE process and not intended to replace practice specific orientation, which is completed within practice specialty as part of the FPPE Document moving to online Quarterly networking APP meetings continue APP Specialty Specific Orientation Division Specific Standardized template Annually the Lead APP responsible for reviewing content Lead APP submits the orientation plan to APP Center and medical staff office for new providers Currently in place: NICU, PICU, Hospitalist Medicine, Orthopedics, Plastic Surgery, Burn Surgery, General Surgery, Neurology/ND, Cardiology, Anesthesia, Pre-Op Surgery/PSP center, Primary Care, Endocrinology, Palliative Medicine, Neurosurgery, Heme/Onc What is FPPE/OPPE? Focused Professional Practice Evaluation Ongoing Professional Practice Evaluation FPPE What is Focused Professional Practice Evaluation? This is a set of credentialing and privileging standards required by the Joint Commission. Requires evaluation of practitioner competency at the time of hire A plan for a FPPE should be forwarded to the Medical Staff Office during application for appointment Peer review process that provides meaningful feedback about the provider s practice, as well as interpersonal relationships FPPE more New Joint Commission standards in 2008 that required institutions to ensure the following: Review of all new providers in the institution after they are credentialed for special procedures Providers maintain ongoing competency for the procedures that they are credentialed for A process is in place for a focused review of a provider should an event trigger the need for such a review The re-credentialing process includes a documentation component that articulates that the provider has maintained competency for the procedures 4

5 FPPE more What constitutes a FPPE? The FPPE is a review of the provider s practice that involves an evidenced based verification of a provider s knowledge, skills, and behavior. When does a FPPE occur What triggers a FPPE? Following the credentialing of a new provider (~6 months) in the institution to ensure that the provider is doing well & performing the procedures for which he/she is credentialed Following a significant patient event involving the provider, as a result of a critical patient complaint, or at the request of the practice site based on ongoing practice concerns Our FPPE Policy The Medical Staff Office is responsible for providing submitted completed FPPE s to the Credentials Committee for approval of the completion of this review period The CC will evaluate the data provided & any concerns will be noted in the minutes On direction of CC Chair, Medical Staff office will assist in correspondence to the Department Chair/Director regarding any potential concerns. Concerns addressed as per the Hospital Peer Review Policy OPPE What is Ongoing Professional Practice Evaluation? Process by which organizations look at the practice of the individual providers on an ongoing basis and screen how well they are doing The ongoing process of evaluating clinical competency in an effort to identify performance improvement needs on a timelier basis Our OPPE Policy OPPE conducted for all practitioners granted clinical privileges using multiple sources of performance data Interval not to exceed every nine (9) months Review of privileges evaluated at reappointment Criteria used: Review of assessment, treatment, clinical procedures, medication management, consults, tests of patients, as well as review of performance thresholds specific to specialty and as defined by the department, division chair/director OPPE Submitted to Quality Department Recommendations from an OPPE: No further action, need for additional info, Trigger for a FPPE, relinquish existing certain privileges Copies kept in confidential QM Files in Quality Department with summary of outcome in the MSS Office and provider file Ohio Law & Rule for QM for APRN OAC Comply with CE requirements for state and national licensure Review & sign SCA annually Verify licensure of each collaborating physician via the OSMB or employer Participate in a Quality Assurance Process which includes: Annual chart review with semi-annual prescribing pattern review Discussion of results of chart reviews, between a collaborating physician or a designated member of a quality assurance committee of the organization and the APRN. Process for patient evaluation of care (patient survey) Documentation of participation in an ongoing, systematic quality assurance process at organization shall satisfy the requirements of OAC (D) What do we do at our organization? Until 2015, we underwent a parallel and duplicative process! 5

6 Why centralize the APP Quality Assurance Process and FPPE & OPPE Process? Not consistent Current Landscape fragmented and redundant HR Evaldone annually separate of clinical evaluation SCA renewals done by APP Credentials Committee with medical staff office assistance QM Forms individual provider s responsibility FPPEs not consistently tracked and forms are not easily identified We meet OPPE criteria based on Ohio law but we are not all speaking the same language, our forms are utilized for FPPE & OPPE purposes Proposed process will streamline process and allow for identification of improvements to practice & meaningful data FPPE & OPPE design for APPs FPPE/OPPE Work Group as part of the Quality APP Council Committee National and State benchmarks with outside APP organizations Templates reviewed Reviewed our policy on FPPE and OPPE review Looked at divisions who are doing this well Drafts for generic and practice specific areas designed Our Decision? Integrate the entire FPPE and OPPE process via a newly designed committee called PPEC (professional practice evaluation committee) Consists of physicians, APPs, quality office, CMO, President of Medical Staff, Credentials Committee Chair, Director APC, and more One quality process for ALL medical staff providers APP designed templates were utilized as the organization s FPPE & OPPE standard templates Proposed FPPE Model Following each Board meeting, the MSSO will list those medical staff members (Physicians, Psychologists, and APPs) We utilized a MIDAS electronic system for our FPPE and OPPE now Remember: FPPE start date begins with first patient contact The FPPE contents are broad enough to encompass the domains required and the Ohio law for APRN and PA providers The FPPE policy states that the division chair or delegate is responsible for ensuring this quality meeting occurs (A Lead APP may be involved) The PPEC oversees the completion of the work The focused evaluation will be considered completed when the FPPE documents have been submitted electronically to the quality office A summary sheet will be kept in each provider s credentialing folder in the MSS Office PPEC will maintain this date and APP credentials and CC can obtain access to those who are still delinquent in completion The CTP externship and provisional period are reviewing during the FPPE period, and if found inadequate, then a more detailed review may be requested of the provider (An online education module outlining the provider s responsibility during this time period is available on CareLearningand is part of the 2015 onboarding boot camp) The SCA will have the new quality language discussed (ORC states for APRNs- the SCA will outline the externship requirements) The practitioner will be notified of the status of his/her review whether it is complete or continued Significant findings are reported to the Med PI Committee OPPE at our institution Q: Who must complete an OPPE? A: All Credentialed medical staff providers in the organization Will be done every 9 months Annual HR Evaluation for APPs remains in placed for now OPPE will be done in Midas and signed off by Division Director Reminder Quality Chart/Rx Reviews as previously outlined will no longer exist These chart review templates still exist and may be used by the division if requested 5-10 charts reviewed-# based on division policy However, only the checkbox of completion or non completion is marked inside MIDAS 6

7 Summary Quality Requirements Done via our FPPE Process, and via the OPPE thereafter.. See FPPE/OPPE presentation for APPs APRN Chapter : Documentation of participation in an ongoing, systematic quality assurance process at an institution, organization, or agency shall satisfy the requirements of paragraph (D) of this rule (see (D) (1-3) Prescriptive externship oversight is outlined in the APRN s SCA ( during the externship period of prescribing, the APRN will adhere to the FPPE process and guidelines as outlined in the medical staff policy OAC PA Chapter : Quality Assurance Process in alignment with our new FPPE/OPPE process PA Prescriptive provisional period requires oversight of practice by supervising physician during the initial period as outlined in Chapter FPPE Model regarding privileges Core privileges only upon entry into the institution Credentialed for special non-core procedures after identified time frame or ability to demonstrate competency at time of initial credentialing The identified time frame will vary by service area-depends on orientation time period, case logs, etc There will need to be documentation of the direct supervised procedures through which the individual provider obtains signatures by physician/app Procedural logs completed Application for non core privilege if not on current list FPPE within 6 months Review by Lead APP and/or Division/Medical Director MIDAS document has checkboxes-the following items can be scanned for additional reference or housed in Quality Office in hard files Additional chart reviews Boot Camp Completion 90 Day Checklist to Practice HR requirements Orientation Competencies Documentation of procedures FPPE Template Example 7

8 Thank You Medical Staff Alignment! Physician, Podiatry, Psychologist, APRN, PA, Clinical Scientist, PharmD Coming together is a beginning. Keeping together is progress. Working together is success. -Henry Ford Questions? References Hittle, K. (2010). Understanding certification, licensure and credentialing: a guide for the new nurse practitioner. Journal of Pediatric Health Care, 24(3), Hravnak, M. (2009). Credentialing and privileging for advanced practice nurses. AACN Advanced Critical Care, 20(1), Kleinpell, R. M., Hravnak, M., Hinch, B. & Llewellyn, J. (2008). Developing an advanced practice nursing credentialing model for acute care facilities. Nursing Administration Quarterly, 32(4), Ohio Board of Nursing. (2014). OAC Quality assurance standards. Retrieved from Smolenski, M. C. (2005). Credentialing, certification and competence. Journal of the American Academy of Nurse Practitioners, 17(6), The Joint Commission. (2010). Credentialing and privileging your hospital medical staff-examples for improving compliance (2 nd ed). Oakbrook, Illinois: Joint Commission Resources,