Course Description:

Since the early 1990s, hospitals have been required to report certain adverse actions taken against physicians to the National Practitioner Data Bank. Also, hospitals must file a National Practitioner Data Bank report on any physician’s surrender of privileges if an investigation is underway, when no action has been taken by the hospital medical staff. This has always been a Data Bank reporting requirement, intended to discourage plea bargains which allowed physicians to avoid being reported if they agreed to waive hearing rights. Under changes made to the Data Bank Guidebook in 2015 and again in 2018, expanded descriptions of “investigation” and “surrender” stretch what is to be considered a reportable surrender of privileges. Any interruption in a physician’s practice, including leaves of absence, may trigger reporting if an investigation is underway.

OPPE and FPPE and other peer review can be affected, as are physicians’ ability to make practice decisions without inadvertently tripping Data Bank reporting triggers. Since most medical staff policies and bylaws in hospitals today do not reflect these changes, medical staff bylaws and policies need to be reworked under the recent changes to the National Practitioner Data Bank Guidebook. When medical staffs and hospitals fail to do so, legal protections for medical staff leaders and hospitals could be lost. Because there has been little focus on these changes, credentialing staff are unlikely to be familiar with the changes and physicians will be surprised by reports generated under the new Guidebook.  

Medical staff policies and procedures that do not correct for bias make for bigger problems than mere bad optics. Bad faith credentialing loses opportunities for hospitals, harms overall staff morale and jeopardizes both physicians reputations and patient care. Prejudiced peer review means huge damages in court. Bad faith peer review is a moral hazard.

Given the many opportunities for liability exposure, hospitals, medical staffs, physicians and other providers must be familiar with the restrictions the law places on peer review. There is relief available: federal and state laws extend immunity and confidentiality to protect both the subject of peer review and those who are conducting peer review. But those protections must be earned, and the qualifications are not necessarily obvious. Peer review mistakes, such as discriminatory practices or procedural shortfalls, are costly for all involved.

This webinar will review basic medical staff processes that need to be corrected to comply with state and federal law and regulation, and Joint Commission accreditation standards.

Learning Objectives:

• Review federal legal requirements for fairness in peer review
• Identify areas where peer review abuse happens
• Provide examples of discriminatory peer review
• Explain guardrails to use to protect peer reviewers
• Help individuals measure whether their peer review processes are unfair
• Explore the peer review reporting quirks of the National Practitioner Data Bank
• Provide ways to comply And avoid unnecessary reporting
• List resources for peer review guidance
• Take questions and discuss answers

Areas Covered in the Session:

• What to look out for in bylaws, policies, rules and regulations
• How to protect professionals reviewing and under review
• Compliance with federal laws banning discrimination
• Look for provider protections in medical staff documents
• What practices qualify peer review for legal protection
• What practices strip peer review of legal protection
• How to build a medical staff organization that does peer review the right way
• What National Practitioner Data Bank issues affect peer review design
• Joint Commission/accreditation elements to build into fair peer review

Suggested Attendees:

• Hospital Administrators
• Compliance Officers
• Medical Staff Leaders
• Medical Staff Office Managers
• Chief Medical Officers
• Health Care Attorneys
• Medical Staff President/ Chief of Staff
• Bylaws Committee
• Credentialing Committee
• Vice President of Medical Affairs
• Director of Medical Staff
• Medical Staff Attorney
• Hospital Counsel
• Credentialing Specialist
• Human Resources Professionals