Author: Joe Morris, Writer, HealthStream
This blog post is based on a webinar - Automate Collection of Provider Procedure Data to Ensure Patient Safety
When provider procedure data makes the news, healthcare professionals who are directly involved — or even on the periphery — sit up and take notice.
So recently, when a Modern Healthcare article reported that less than a quarter of hospitals that voluntarily completed the LeapFrog Groups' 2019 Hospital survey fully met the standard for all eight high-risk procedures (selected by a LeapFrog panel of patient-safety experts that found a strong correlation between patient outcomes and the number of times the procedure was performed), it got a lot of attention, says Vicki L. Searcy, Vice President, Consulting Services, VerityStream.
“This is not just related to how many times a specific provider did something; it's related to the amount of times that an organization does something,” Searcy says. “The report also identifies whether hospitals actively have processes in place to screen surgeries to make sure that they're necessary before they are actually performed, to make sure that surgeries aren't being done when they're not necessary to inflate the numbers,” she adds. “Some of the highlights from the 2019 report include: No. 1, the majority of hospitals are still electively performing high-risk procedures without — in their opinion — the adequate ongoing experience to do so.”
So, how does this affect the granting of clinical privileges? What’s the relationship between procedure data and privileges?
“First of all, there is a process for, and steps in, privileging, the first being that an organization decides if certain procedures or patient care activity should even be conducted at all,” Searcy says. “If an organization would determine if they're going to engage in one of those eight procedures, or not, that is the first step in privileging. Then it would need to develop criteria for what types of providers can perform those procedures, and then the third step is applying the criteria to requests for the privilege.
Monitoring privileges for safety and adherence to guidelines
“The fourth step is really the continual monitoring of those procedures to make sure, No. 1, providers are exercising the privileges that they've been granted and not exceeding what they've been granted; and secondly, what are the outcomes so that we can continuously monitor the effectiveness of what is being done,” Searcy says. “It is what you do when you renew or reappoint somebody's clinical privileges as you’re evaluating should they continue to have these privileges based upon the data that shows outcomes.”
As a part of the process, these initial areas of competency are evaluated:
- Training
- Skills
- Behavior
- Experience
That’s followed by ongoing competency evaluations that include:
- Evaluating a provider's current performance in your organization or in other organizations where a provider is clinically active
- Performance includes factors such as professionalism, interpersonal and communication skills
- Data about the exercise of clinical privileges — what privileges is somebody exercising?
“Competency is determined based upon two different types of information, the first being recent experience and the other element being the acceptability of measured outcomes of that experience,” she explains. “When the provider exercised the privileges, meaning performed the procedure, how did it come out? What was the outcome? Were there problems? You’ve got to have data that's going to tell you the answers to both of those questions.”
The right approach helps gather necessary data
That’s why, when designing a privileging approach, it's critical to group or cluster privileges and procedures that require similar knowledge and skills, Searcy says.
“I know when we talk about clinical activity requirements there's a lot of questions that come up about when you should set a clinical activity requirement,” she points out. “You should establish those requirements when it's important to have sufficient case activity to evaluate. But not all specialties, such as those that are more consultative in nature, have clinical activity requirements. In those cases, you're primarily looking for evidence of ongoing clinical practice.”
That said, even if a provider doesn't meet a clinical activity requirement it doesn't have to mean automatic relinquishment of those privileges. It does, however, mean that caution and stepped-up monitoring should occur.
“You might have some system of oversight or proctoring for situations where the clinical activity requirement hasn't been achieved, and the provider wants to retain the privileges so that you can allow continuation of the privileges with some level of oversight for a period of time,” she says. “Because there may be valid reasons why someone was unable to meet a clinical activity requirement, you want to allow them the ability to keep on practicing. However, when you get surveyed, the continuation of granting privileges that are not exercised over and repeatedly is not going to make your privileging process look good to a surveyor.” Bottom line is that privileging is meant to protect patients – that is the primary reason why there is a concern related to competency. We can’t allow providers to have privileges that we don’t know that they are competent to provide.
Clinical activity, performance reports offer actionable insights
Credentialing software can support the need to track and report volumes, as well as indicator-based performance evaluation. For example, Performance Privileges is a feature of VerityStream’s Privilege solution, and it sets out to answer the question of, “How many?” toward that end of determining competency based on volume, says Sarah Cassidy, Solution Executive, Privilege and Evaluate, VerityStream.
For instance, to mitigate an organization’s risk, you can bring to the forefront providers who are falling out of minimum volume requirements. If someone isn’t performing enough of a procedure for you to be able to aptly measure competency, you'll be alerted and empowered to take appropriate action, Cassidy says.
Then the occurrence of providers who might be performing procedures that they aren't currently granted can be flagged. These procedure volume reports feature the ability to compare individual provider volumes to those of their peers, as well as drillable data points. When I say drillable, I mean down to the encounter level, she adds.
“The ability to see the details behind each procedure performed is important because that really informs data validation processes and informs discussions when presenting this data to clinicians,” she explains. “Providers and clinical reviewers alike have access to these reports via a provider-facing portal, and then these reports can be used in making either self-guided improvements or in informing critical decisions around renewing privileges, perhaps assigning oversight requirements or possibly even revoking privileges in severe circumstances.”