Key Learnings from the 2023 National Credentialing Forum

This year’s National Credentialing Forum took place in February, and VerityStream by HealthStream was delighted to be included in the group of invitees. The forum is attended by the foremost industry experts in credentialing and enrollment. This year’s attendees included the following organizations:

• American Board of Medical Specialties (ABMS)
• American Medical Association (AMA)
• American Osteopathic Association (AOA)
• Council for Affordable Quality Healthcare, Inc (CAQH)
• Det Norske Veritas (DNV)
• Educational Commission for Foreign Medical Graduates (ECFMG)
• Federation of State Medical Boards (FSMB)
• National Commission on Certification of Physician Assistants (NCCPA)
• American Academy of Physician Assistants (AAPA)
• National Committee for Quality Assurance (NCQA)
• National Association Medical Staff Services (NAMSS)
• National Practitioner Data Bank (NPDB)
• The Joint Commission (TJC)
• Utilization Review Accreditation Commission (URAC)
• And other organizations and individuals who are deep into credentialing – either because they work in this area and/or they provide services to the credentialing industry.

The meeting was insightful and informative and included collaborative discussions on challenges impacting the industry. Read below for our main takeaways.

American Board of Medical Specialties (ABMS)

• New standards are still in development - the long lead time is attributed to the sheer size of the project that incorporates Professional Standing and Opportunity, merging of Lifelong Learning and Assessment, Improve Health and HealthCare, and Professionalism
• Certifications are issued by each of the 24 boards assessing initial and ongoing knowledge and clinical judgment, which exceed baseline requirements for medical state licensure.

American Medical Association (AMA)

• Priorities are to eliminate obstacles that impact patient care, organized medical staff, and physician wellness
• Eliminate redundancy with a focus on application: pre-populate application with software
• Resources available for the organized medical staff include: toolkit on response to emergencies with lessons learned from Covid public health emergency (PHE), toolkit on gender disparity, and update to physician guide to bylaws
• Implement strategies to promote physician well-being in response to recent survey results

American Osteopathic Association (AOA)

• Recently-launched Customer Advantage Program to enhance member services
• Website redesign is planned for later this year that will include a new look to the AOA profile report
• Soft launch to approve API technology to streamline processes is planned for this year

Council for Affordable Quality Healthcare, Inc (CAQH)

• 2023 transformation of technology is planned that will include an update to the ProView platform that has 2.4 million users
• Working with NCQA to improve provider directory confirmation process
• Expanding collaboration with AMA and ADA
• Focusing on Medicaid revalidation in 2023

Det Norske Veritas (DNV)

• Completing a review of hospital standards addressing performance process measures that will relax the requirements for Advanced Practice Professionals
• Have observed that hospitals have not embraced the CMS telehealth waivers
• Implications associated with the upcoming lift of the Public Health Emergency (PHE) effective May 11, 2023 to be considered that include:
  • Acute hospital care at home
  • New provider type of Rural Hospital: regulations for CMS created, regulatory accreditations have not been fully established

Educational Commission for Foreign Medical Graduates (ECFMG)

• Upcoming release of new platform, MyIntealth, to provide streamlined access to services and a common user experience is planned for Q2 2023
• Plans for 2024 to report on recognized accredited programs using the world directory of medical schools

Federation of State Medical Boards (FSMB)

• Passport-like tool for the purpose of primary source verification for physicians
• Physician wallet-based project that allows physicians to load data via smartphone into the medical board
• Massachusetts licensure board has implemented an automated process that has demonstrated timeframe improvement to average of 20 days from 60-80 days
• 85% of physican assistant (PA) licensure fall under the state medical boards whereas the others have a PA licensure board

National Commission on Certification of Physician Assistants (NCCPA) & American Academy of Physician Associates (AAPA)

• 170,00 certified PAs the beginning of 2022 with increase of 11,000 PAs per year
• 2022 is first year the total number of PAs practicing in hospital settings is greater than those that practice in outpatient settings
• Upon completion of education, one can take the Physician Assistant National Certifying Examination (PANCE) and upon passing they are issued a NCCPA certification and can use the PA-C designation
• 2023 Pas will have two options to complete recertification every ten (10) years: traditional PANRE or new PANRE-LA.
• In 2023, 75% or 45,000 PAs of those eligible are participating in PANRE-LA
• Legislative Updates
• 21 states and District of Columbia PAs practice without supervision and instead collaborate with physician or without required relationship with a physician
• No states have changed the name of PA to Licensed Physician Associates, but there are two states where legislature is in process
• Plan is for a licensure compact to be launched when seven states have legislated to change the licensure board name to Licensed Physician Associate

National Committee for Quality Assurance (NCQA)

• New web-based and interactive tool for file review for health plan credentialing accreditation
• Health Equity Accreditation surveys are underway

National Association Medical Staff Services (NAMSS)

• New MSP self-assessment tool is now available
• “Credentialing by Proxy” podcast and other educational resources available
• Plan to open online platform for non-NAMSS members seeking CPCS and/or CPMSM certification
• NAMSS currently has 5,800 members
• Rollout of NAMSS PASS Electronic Connectivity Program (ECP) helping health care entities (HCE) and vendors connect their credentialing-related software systems to the NAMSS PASS database

National Practitioner Data Bank (NPDB)

• Security is a main focus with potential plans to use multi-factor authentication
• Noted that the Health Care Quality Improvement Act (HCQIA) does not reference cycle time although there is reference to 2 years and privilege
• Reported annual total of 6 million continuous query verses 5.5 million on-demand queries with the on-demand is attributed to health plan queries.

The Joint Commission (TJC)

• Launch of Equity Accreditation and associated requirements
• Early stages of environmentally focused initiatives with plans to reduce carbon emissions, including electricity, gas, and use of disposables
• Practitioner well-being and addressing the nursing shortage
• Standards simplification, including which elements can be removed in lieu of Public Health Emergency (PHE)
• Discussion of implementation of 360 nursing survey into the evaluative process
• Telehealth goals to discuss digitally enabled care
• Hospital at Home is an accreditation that is dependent on if and/or when CMS provides regulations
• A topic that was top of mind for most organizations was TJC’s extension of credentialing reappointment/reappraisal from two to three years. As entities develop their transition plans, the main considerations discussed were centered on:
• Implications of the current program regarding peer review and the management of ongoing practitioner performance monitoring
• Governance documents, bylaws, and privilege forms as they pertain to reappointment
• Noted that CMS has a two-year requirement to review surgical privileges Financial implications and whether current fees typically collected at reappointment may be able to be collected outside the reappointment cycle time
• Discussion of having the reappointment cycle be completed by specialty

Utilization Review Accreditation Commission (URAC)

• V8.1 standards have been released
• Ongoing work on dental health plan and network standards
• Working on health equity accreditation

General Credentialing Legal Updates and Considerations



• Some states require reappointment every 24 months, some states are open to change, while others are not
• The Public Health Emergency ends May 11, 2023 and implications for the blanket waiver and regulatory body flexibilities
• Effect of price transparency on quality with the No Surprises Act
• Implications that customer decisions will be based on price without quality/outcome data
• Considerations of customer use of Physician Compare/SNF Compare/Population Health data to make their decision for care and services
• Minimum clinical activity required for provider wellness
• Note: Physician wellness related to Stark Law and anti-kickback statute amendments are referenced in the Omnibus Bill signed into law December 2023

Summary

While most of these organizations have differing goals to some degree, there were a few consistent themes that stood out to us. Aside from the TJC reappointment extension, which we addressed in our latest webinar, many organizations are focused on updating and improving their standards so they can be more efficient, and productive, and ensure patients receive the best in care. We also see many of these organizations taking steps to foster physicians' health and well-being, while also proactively finding ways to address the nursing shortage. And finally, all organizations are taking steps to utilize technology that empowers them to credential and enroll practitioners more accurately and with fewer delays.

This commitment to the practitioner experience, process improvement and patient care is inspiring, and we at VerityStream by HealthStream fully embrace it. We look forward to the ongoing work and commitment of the National Credentialing Forum in 2024. Have questions? Get in touch.