Credentials and Risk Management

What is the importance of keeping the physicians duly credentialed?

Reduced risk: the experience and knowledge obtained by obtaining a credential can reduce the risk of a healthcare operation. On the other hand, as a competitive advantage, more physicians with validated credentials means a better reputation and guarantee of the quality of services. Recently, according to Beker’s Hospital Review, an Ohio physician was accused of performing cardiovascular procedures before having the proper credentials.

According to Beker’s report, «The physician performed these procedures at Chillicothe, Ohio-based Adena Regional Medical Center in March 2022, the report said. TAVR procedures require two credentialed physicians to complete the surgery in order for a hospital to bill for it, according to CMS guidelines. An anonymous source within the organization told WCMH that one of the two physicians was not credentialed when they began performing the procedure but obtained the credentials shortly after.»

The hospital denied the allegations under the argument that the team of cardiovascular physicians had the credentials to perform the procedures and were accordingly privileged by the hospital. It also argued that «according to CMS, the performing of the TAVR procedure requires that a hospital have two cardiothoracic surgeons with >100 CABG and valve experience (at the time, Adena Health had three); an interventional cardiologist with privileges to perform left heart procedures; training on the device, as well as experience. Adena Health met the requirements for CMS and had physicians with the appropriate privileges involved in the cases.»

Beker’s Review reported that one anonymous source confirmed the response is true, and they do not believe any patient was harmed, but that source has concerns about patient safety. «My concern is not one of one specific case, but more of a process that needs to be in place to ensure the safety of all patients for all types of procedures,» the source told WCMH. «And if we skip parts of the process, we can put people at risk.