Houston partner Robert Wolin authored an article for the August 15 edition of The Bureau of National Affairs (BNA) Health Care Fraud Report titled, "Real Time Physician Quality Monitoring Becoming Reality."
The article focuses on new developments in the credentialing process for medical practioners. According to Wolin, "Credentialing requires hospitals to collect, verify, and evaluate relevant data regarding the background and competence of medical practitioners on their staff or applying to become members of their staff."
Wolin continues: "When an adverse patient event occurs, the focus by regulators and the patient or their family is typically on (a) whether the hospital's credentialing decision regarding the physician's future behavior was reasonable based upon the information the hospital actually had in its possession and the information the hospital should have had, and (b) whether the hospital conducted a reasonable credentialing investigation at reasonable intervals of time . . . Health care organizations must undertake sufficient efforts to constitute the exercise reasonable care or competence."
The article goes on to describe a new service being offered by the National Practioner Data Bank (NPDB), which assists hospitals in easily obtaining data from multiple jurisdictions. "The NPDB has recently begun offering subscribers a prototype proactive practitioner disclosure service (PDS) to data bank subscribers. The PDS program provides on-going monitoring of NPDB files attached to health care practitioners enrolled by the health care entity in an effortless, cost-efficient way," according to Wolin.
Wolin concludes: "With the availability of services such as the NPDB PDS, it is likely that on-going real time monitoring of health care practitioner information may well become the de facto standard to determine whether a hospital has exercised reasonable care or competence in its credentialing decisions and medical staff retention, after the prototype program is converted to a generally available methodology. Consequently, hospitals should review their credentialing monitoring process to assure that it meets the evolving standard and should consider participating in the NPDB PDS prototype program."