Medical staff credentialing at Tuba City Regional Health Care Center

When you or a loved one must go to a busy medical center for care, and you don't necessarily have a regular family physician, how do you know that the health care provider who sees and attends to you is qualified? This article will discuss how a provider joins the staff of Tuba City Regional Health Care Center (TCRHCC). This process is called credentialing.

Credentialing is one of the key activities undertaken by the Board of Directors and leadership of TCRHCC. The importance of credentialing goes beyond demonstrating compliance to accreditation standards or regulations.

A timely, complete and well-documented credentialing process helps to fulfill the mission of the hospital. Credentialing is what allows you - our community - to be assured appropriate and safe care. By coming to TCRHCC you receive care from providers whose experience and ability to deliver quality health care has been confirmed. As a part of our commitment to the community, we ensure that the men and women who provide care for our community members are qualified and skilled professionals.

Credentialing is a comprehensive review of the training, education, licensure and experience of every provider who applies to join the medical staff. This review determines if someone who wants to join the medical staff meets our qualifications. And not just our qualifications, but those of our national accrediting organization.

So that you will better understand our credentialing process, we've answered some common questions that have been raised.

Q. Does everyone who works at TCRHCC go through the credentialing process?

A. No, not everyone is credentialed. Only members of the medical staff are credentialed. Those who are credentialed include all physicians, dentists, optometrists, psychologists, physician assistants, nurse anesthetists, nurse midwives, nurse practitioners, physical therapists, occupational therapists and speech pathologists. Other providers of care go through a different process in being hired to have their licenses or certifications verified, and to have references checked.

Q. What information do you check when you credential someone who wants to be a TCRHCC provider?

A. We check all of the following - license or certification, education and training, experience, malpractice history, health status, and ability to work with others.

Q. Couldn't someone just say they have a license or that they provide good care and then get on staff?

A. No! We don't just ask someone for information; we verify every item from what's called a primary source. This includes:

• Contacting state licensing agencies to verify all licenses, including licenses that have expired. Sometimes we have to check 15 licenses for doctors who work in many states.

• Contacting schools to verify clinical education and training.

• Requesting information from references, including where the person is currently working. We provide a special form that is to be completed.

• Checking a national listing, The National Practitioner Data Bank and Office of Inspector General Exclusion list, to see if there have been any malpractice issues or if the provider has been warned by Medicare for improper billing practices.

• Requesting health information from the applicant's physician.

Q. Is credentialing done only for full time employees of TCRHCC?

A. No. This process is in place for every provider whether they are full-time or part-time, and whether they are employees or contractors. In fact, credentialing is done for every provider of every specialty involved in seeing and taking care of our patients.

Q. Does a provider ever start seeing patients before their information is verified?

A. No. All information must be verified and reviewed by several people and groups before they become a member of the medical staff.

Q. What happens if you find out that there is a problem with someone who wants to join the medical staff?

A. We always contact appropriate agencies and individuals to investigate the problem. We carefully determine whether the problem might negatively affect one of our patients. If it would, we don't credential the provider and they do not join TCRHCC's medical staff. The most frequent issue we find is that someone no longer has a license in a certain state because they no longer work there. We make sure they do have a license in another state that is current.

Q. After you do all of the verification, what happens next?

A. All of the verification is done by TCRHCC employees who have been trained in the credentialing process. Once they are finished collecting all of the documents, the file is reviewed by a physician in charge of a department. The file then goes to a group of providers - the Credentials Committee - who make sure all of the candidate's required information is in place and that there are no issues with the file. The file then goes to the Medical Executive Committee. No one can become a member of the medical staff without the review and approval of the Board of Directors. The Board reviews each candidate, and at times asks for more information before they make a decision.

Q. Does credentialing end after a provider is on the medical staff?

A. Credentialing is an ongoing process. Each time a license expires it is verified again. Each member of the medical staff must reapply every two years to remain a member of the medical staff.

Q. Is credentialing required by any regulation?

A. Absolutely. Credentialing is required by The Joint Commission (TJC), an independent, not-for-profit organization that is the nation's predominant standards-setting and accrediting body in health care. TJC visits and surveys TCRHCC every three years for hospital accreditation, and during the most recent April 2007 survey, TCRHCC was found to be fully compliant with standards and regulations. Credentialing is also required by the Centers for Medicare and Medicaid Services.

Q. Can anyone who is credentialed take care of me, no matter what illness I have or surgery I need?

A. No, in addition to credentialing, each provider has a list of illnesses they can treat or surgeries they can perform. These lists are called privileges. Of course in an emergency situation, any provider would do whatever they could to help save a life.

TCRHCC is proud of the members of the medical staff serving the community, and stands behind these credentialing standards.

Tuba City Regional Health Care Corporation, located in Tuba City, consists of a 73-bed acute care referral hospital and integrated health system. It provides a broad range of outpatient specialized care services in addition to inpatient care. The patient population includes Navajo, Hopi and San Juan Southern Paiute. Its mission is to provide accessible, quality, culturally sensitive health care.

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