Credentialing and Privileging – The Cornerstone of Provider Status

By David Witmer posted 09-18-2016 14:14


prescribing.jpgThis issue of AJHP is a theme issue featuring numerous papers on provider status. I applaud the Journal for featuring more theme issues such as this one that bring us more in-depth focus on important topics facing our profession. What struck me most as I read these papers is that a common theme in all of them was the foundation of some process to credential and privileging pharmacists based on the patient care roles they perform.

In their paper, Elevating pharmacists’ scope of practice through a health-system clinical privileging process , Jordan, et al describe privileging programs at several institutions including Truman Medical Centers, Johns Hopkins Hospital, and The Ohio State University Wexner Medical Center. While there are many differences in these models all utilize privileging to expand the patient care role of pharmacists and increase patients’ access to pharmacists. It is also noteworthy that the authors highlight the fact that the process require more than simply maintaining external credentials such as board certification but also requires implementation of professional practice review.

Ourth and colleagues from the VA describe pharmacists prescribing in their paper Clinical pharmacist prescribing activities in the Veterans Health Administration. Although VA has long utilized the terminology “scope of practice” (SOP) for pharmacists, the process emulates a credentialing and privligeing model that has empowered pharmacists. The VA credentialing process includes a comprehensive review of skills, training, education, and licensure and pharmacists with SOPs and the process for SOP development and oversights the same as that for Licensed Independent Professionals (LIPs). Peer review is also a central tenant to their model.

Woolf et al, describe pharmacists prescribing in their paper Pharmacist prescribing within an integrated health system in Washington. Their paper describes required education, training and certification and again highlights the requirement for quality improvement measures.

In Collaborative practice model for management of pain in patients with cancer, Hammer and colleagues describe the array of qualifications that may be considered during credentialing.

“Although the process at each hospital may differ, credentialing could require submission of any combination of the following qualifications: education history, pharmacist licensure, NPI number, DEA number, postgraduate training or fellowships, professional work history, board certifications, three professional references, curriculum vitae, faculty appointment, proof of professional liability coverage, and a national certified background check.” Importantly, it’s not simply degree and board certification that are considered, but an evaluation of work history, education and training, and demonstrated practice experience.”

Todd and colleagues describe in more detail an array of credentials leading to qualifications in their paper Pharmacist prescribing practices in a clinical pharmacy cardiac risk service. In addition to degree, residency or board certification they describe, supervised clinical practice, completion of certificate programs and targeted continuing education as pathways to obtain privileges.

All of these papers emphasize the importance of credentialing and privileging as a cornerstone to the successful implementation of provider status. I’ve discussed credentialing and privileging in past blogs (Credentialing and Privileging - The Time Has Come). The success of provider status hinges on the recognition that pharmacists, like other providers, must demonstrate that they are prepared to provide competent care to the patients they serve. A license allows one to practice but is not sufficient to demonstrate knowledge and expertise in complex therapeutic decision making. Some therapeutic areas or patient populations require greater expertise than obtained during school.

These papers also demonstrate that pharmacy must be flexible in its approach to credentialing and privileging if we are to evolve our profession and achieve the vision of the Practice Advancement Initiative (PAI). We cannot expect that residency or board certification can be the sole pathways to obtaining privileges. This would exclude too many talented and dedicated pharmacists who are necessary to achieving the vision. It is not reasonable to expect that pharmacists who have practiced for decades will complete a residency and board certification is limited to only a few very broad areas that have developed to point of formal recognition. There is a difference between certification and specialization and the profession needs both.

Recognizing the need for more certificate training programs ASHP has begun to invest in the development these programs. Three programs have been launched this year, a Teaching Certificate for Pharmacists, a Pharmacy Informatics Certificate and a Sterile Product Preparation Training and Certificate Program. Members can expect offerings in more areas in the coming years in anticipation of the successful attainment of provider status.

As I’ve said before, pharmacy should also monitor closely medicine’s certification wars. Medicine’s model of board certification, long thought to the gold standard by many pharmacists, has been increasingly under fire. Physicians are increasingly frustrated with burdensome requirements for maintenance of certification among other things. More recently the American Osteopathic Association faces a class action lawsuit related to requirements for membership in order to obtain board certification.  Pharmacy should be careful to avoid such pitfalls.

To successfully implement our future vision pharmacy must evolve its own model of credentialing and privileging. This model should recognize the need for flexibility and integration of existing pharmacists who entered practice with an array of academic degrees and before residency training was so common. Pharmacy’s model should build on the experience of medicine and nursing but should recognize the uniqueness of pharmacy and not attempt to simply duplicate medicine’s extensive subspecialty model. Success will not be achieved overnight, but will take time, persistence and a healthy dose of experimentation. The authors in this issue of AJHP demonstrate that pharmacy has now begun to this journey. I encourage everyone to read this issue and consider the how the lessons from these innovators can be applied in your practice site.

#Certification #credentialing #BoardMembers #NewPractitioners #boardcertification #ASHPStaff #AJHP #ProviderStatus #priviledging #HouseofDelegates #ClinicalSpecialistsandScientists



10-15-2016 06:24

Roger, Thanks for your thoughtful reply. I could not agree more. We need to build a foundation now so that the profession is prepared to capitalize. WHEN provider status is obtained. Other providers must be credentialed and privileged and pharmacy will be no different. Now is the time to prepare for our future vision.

10-14-2016 10:52

David does a good job making a case for the  importance of Credentialing and Privileging.  They are essential elements for health system readiness for provider status and this should be a call for action.  It's not "if" we will get provider status but "when".  Health system leaders should pursue and understand of steps need to implement these processes so they can set things in motion now before actual provider status comes about.  For most organizations this means having strategic discussions with medical staff leadership those that manage MD credentialing (usually Medical Staff Services).  First you have to sell both on the "why" pharmacists need to be credentialed and then work collaboratively with them to implement the processes.  Even thought most health systems can take advantage of delegated credentialing with payers, it can still be a 6mo to 12 mo process so the time to begin is now.

The privileging part is equally important..  In Washington State, pharmacists have been recognized as providers for decades but only recently did laws require that insurance companies pay for services provided.  As the payers began to add pharmacists to provider networks they began to inquire how we ensure the quality of the services we provide and specifically how specific pharmacists are determined if they are competent to provide those services.  In preparation for these discussions, health system leaders need to design processes that set the standards, assess performance and provide development when needed.  As David described, many times we can borrow learning's from our physician colleagues but often we need to start with an internal validation process much like many of those described in the theme issue of the Journal.  The time to act on this is now.

Roger .