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Credentialing
- 1. Module 4 Lecture Credentialing, Clinical Privileges,Accreditation and Health Care Policy
- 2. Credentialing Process of procuring,verifying and analyzing the eligibility and qualifications of the APRN provider to execute health care services (Joint Commission on Accreditation of Healthcare Organizations, 2002)
- 3. Credentialing Categories of dataneeded include: Personal and practice demographic information Education, training, work history State(s) licensure history Certifications DEA certifications Liability insurance and claims history
- 4. Credentialing Categories of datacont. History of sanctions/penalties Disclosure of physical, mental, substance, or criminal problems Attestation of information completeness and accuracy Authorizing statement to collect any information necessary for verification
- 5. Credentialing Two types ofverification of application data: 1. Primary: source of credentials 2. Secondary: sources other than credentialing agencies such as patient satisfaction statistics
- 6. Credentialing The credentialing processitself is timeconsuming and usually involves a committee composed of physicians.
- 7. Privileging This is usedby a facility or employing organization to monitor the clinical activities a provider is authorized to perform in that facility and is the process of authorizing a health care professional to perform specific diagnostic or therapeutic services within welldefined limits.
- 8. Credentialing and Privileging Thisprocess attempts to decrease the chances of liability for the facility and practitioner by ensuring that practitioners currently providing care are licensed, have been educated for the role they are working, and are safe and competent.
- 9. Factors That Affectthe Outcome of Privileging State Practice Acts* Agency Regulations License Education Training Experience Competence Health Status Judgment *most influential
- 10. Career Portfolio Practitioner The Contact Information “Practice-based Evidence” Credentials Component Section Attestation Page
- 11. Second Licensure National Councilof State Boards of Nursing proposes that it is appropriate for APNs to be legally regulated through a second license because their activities are complex, involve specialized competencies, independence and autonomy.
- 12. Licensure A license is apermission to commit some act that would otherwise be unlawful. Most restrictive method of credentialing Competency Protection assessment for the public
- 13. Registration Act of recordingor enrolling Review of credentials Title protection No implication of competency assessment Omnibus Budget Reconciliation Act of 1987 Registered title
- 14. Certification Authorizes Voluntary Title bearer to act in a specific way process protection Regulated credential versus proprietary designation
- 15. Recognition Confirmation that anact done by another person was authorized and that they have a certain status. Several boards of nursing use this to regulate APRNs practice.
- 16. Self-Regulation Voluntary Process Standardsof Practice Ethical Frameworks Values Safe-practice Guidelines Continuing Education
- 17.
- 18. National Certifying Organizations American Academyof Nurse Practitioners (AANP) American Association of Nurse Anesthetists Council on Certification American College of Nurse-Midwives Certification Council American Nurses Credentialing Center
- 19. National Certifying Boards National Certification Board of Pediatric Nurse Practitioners National Certification Corporation for the Obstetric, Gynecologic and Neonatal Nursing Specialties
- 20. National Council ofState Boards of Nursing Model Act Uniform Advanced Practice Registered Nurse Licensure/Authority to Practice Requirements.
- 21. State Regulatory Process Protect the public Administrative, powers Fourth legislative and judicial branch of government?? Promulgate rules, regulations, policies, procedures, and interpret laws
- 22. Major Duties ofBoards of Nursing o Control entry into the profession through examination and licensure o Monitor and discipline licensees who violate the scope and standards of practice o Monitor continuing education and/or competency of licensees to protect the public from unsafe or poor quality practice.
- 23. State Boards ofNursing Composition Meetings Mandatory State Reporting Regulations
- 24. Federal Regulations Medicare andMedicaid Centers for Medicare and Medicaid Medicare and Medicaid reimbursement Veterans Administration and Indian Health Services Commerce Clause of U.S. Constitution
- 25. Federal Regulations Telehealth Patient Protectionand Affordable Care Act Federal Register http://www.gpoaccess.gov/fr/index.html Code of Federal Regulations http://www.gpoaccess.gov/cfr/index.html
- 26. Pew Health Professions Commission Doesregulation promote effective health outcomes and protect public? Are regulatory bodies accountable? Does regulation respect consumers’ rights to choose own healthcare provider? Does regulation encourage a flexible, rational and cost effective healthcare system?
- 27. Pew Commission Does regulationallow effective working relationships among healthcare providers? Does regulation promote equity among providers of equal skill? Does regulation facilitate professional and geographic mobility of competent providers?
- 28. Robert Wood Johnson Foundation& IOM Report Remove scope of practice barriers Expand opportunities for nurses to lead collaborative improvement efforts Implement nurse residency programs Increase proportion of nurses with BSN by 80% by 2020 Double the number of nurses with doctorates
- 29. Robert Wood Johnson& IOM Ensure that nurses engage in lifelong learning Prepare and enable nurses to lead change to advance health Build an infrastructure for collection and analysis of inter-professional healthcare workforce data (IOM, 2010)
- 30. Multistate Regulation Uniform Requirementsfor Licensure/Authority to Practice Issues for the future: DNP and APRN regulation by NCSBN
- 31. Issues? Your text listsseveral issues that will be facing nursing as the workforce ages and the country ages. We will address those in the last module.
Editor's Notes
- #2 {"27":"Additional questions included: Does regulation allow effective working relationships among healthcare providers? Does regulation promote equity among providers of equal skill? Does regulation facilitate professional and geographic mobility of competent providers?\n","16":"Self-Regulation is a voluntary process and involves the desire of members of the professional community to set professional standards of practice, code of ethics, values, safe-practice guidelines and continuing education requirements. Even though professional organizations can develop standards they cannot enforce them by law.\n","5":"There are basically two types of verification of application data; either it is primary or the original source or it is secondary and these would be sources other than credentialing agencies.\n","22":"The State Boards of Nursing have three major duties: control entry into the profession, monitor and discipline licensees who violate the scope and standards of practice; and monitor continuing education and/or competency of licensee to protec the public from unsafe or poor quality practice.\n","11":"The National Council of State Boards of Nursing proposed that it is appropriate for APRNs to be legally regulated through a second license because their activities are complex, involve specialized competencies: independence and autonomy.\n","28":"A consensus report by the Robert Wood Johnson Foundation and the Institute of Medicine was issued in 2010 and was called The Future of Nursing: Leading Change, Advancing Health. The eight recommendations are seen on your power point slide. They are to remove the scope of practice barriers, to expand the opportunities for nurses to lead collaborative improvement efforts, to implement nurse residency programs, to increase proportion of nurses with BSN by 80% by 2020 and to double the number of nurses with doctorates.\n","17":"Most boards of nursing require the advanced practice nurse to be certified in order to practice. State boards of nursing may require this but they must make sure that the exam has met certain psychometric standards and able to measure entry-level practice. A job analysis is done that defines job related knowledge, skills and abilities. \n","6":"The credentialing process itself is time-consuming and usually involves a committee composed of physicians.\n","23":"Generally boards of nursing are composed of licensed nurses and consumer members. In most states the governor appoints the members but in some they are elected. The meetings are usually open due to “sunshine” laws that permit the public to observe or participate in the discussions. Boards may go into executive session when necessary. Meeting agendas and minutes are usually posted 30 days prior to the meeting. Participants in the meetings may include board members and staff, legal counsel and other invited guests. In making decisions board members must consider implications for public welfare, national standards of care, impact of the decision on the state as a whole and the legal defensibility of the decision. First and foremost, the board must act only within its legal jurisdiction. All actions of the board are a matter of public record. Licensees may be placed on the mailing list for the newsletter if one is not automatically received. The most critical role of the board of nursing is assuring public safety. Licensed nurses also have a moral and ethical duty to report unsafe and incompetent practice to the board of nursing. There is a system of due process for complaints against licensees. The licensed nurse is responsible for knowing the laws and regulations that govern the practice of nursing in the state of licensure and adhering to the legal. Ethical, and professional standards of care. A nurse who has a multistate licensure is responsible for knowing the laws of the state in which the practice occurs in addition to the home state of licensure. Ignorance of the law is not excuse. Some states have regular designated commissions or committees that are responsible for review and approval of regulations, other states send theirs to the general assembly or to committees in the legislature. Certain things have to be done if there is a change in a regulation. Public notices need to be sent, opportunity to submit written comments or testimony including oral testimony and publication of the final regulation in a register or state bulletin. In some states a fiscal impact statement is required. In some states the rule promulgation process requires oversight by a commission of legislators whose role it is to ensure that the regulatory agency institutes the rules has the authority to do so and that the rule does not conflict with other disciplines. Who could put in rules governing nursing? Medicine, pharmacy, counselors, therapists, and other health professionals. Numerous conflicts occur over scope of practice, definitions of practice, right to reimbursement, and requirements for supervision and collaboration. \n","12":"A license is a permission to commit some act that would otherwise be unlawful. It is the most restrictive method of credentialing. It implies a competency assessment of the professional at some point of entry into the profession. Licensure offers the public the most protection by restricting the use of the title and the scope of practice to the licensed professional . The administering agency holds the licensee accountable for practicing according to the legal, ethical, and professional standards of care defined for the profession.\n","1":"This module will discuss credentialing, clinical privileges, accreditation and health care policy\n","29":"The rest of the recommendations were to ensure that nurses were engaged in lifelong learning, to prepare and enable nurses to lead change to advance health, to build an infrastructure for collection and analysis of inter-professional healthcare workforce data. \n","18":"There are several national certifying boards. They are the American Academy of Nurse Practitioners, American Association of Nurse Anesthetists Council on Certification, American College of Nurse-Midwives Certification Council, American Nurses Credentialing Center\n","7":"Privileging is used by a facility or employing organization to monitor the clinical activities a provider is authorized to perform in that facility and is the process of authorizing a health care professional to perform specific diagnostic or therapeutic services within well-defined limits. This is usually limited for APRNs in the hospital environment.\n","24":"Many factors have contributed to the federal government taking a more active role in the regulation of the health professions. One of thee was Medicare and Medicaid. The federal initiatives that have grown out of this are centered around cost containment and consumer protection. With the “graying” of America and costs of Medicare going up there are predictions of bankruptcy if substantive changes are not made. One of the most significant changes was in July 2001 when the Centers for Medicare and Medicaid was created to replace the former Health Care Financing Administration. The practice of APRNs has also been influenced by changes in the Medicare reimbursement policy. In 1997, legislation was passed in Congress calling for Medicare reimbursement of APRNs regardless of setting. They were able to get reimbursed for Part B, normally the domain of physicians. APRNs would now be able to see new and returning Medicare patients. They would be reimbursed 80% of the lesser actual charge or 85% of the fee schedule amount for the physician. The states have now been given the authority to manage Medicaid programs and management of the welfare program. The Veterans Administration and the Indian Health Services are regulated by the federal government. Nurses employed in these services must be licensed in at least one state and are subject to their state’s laws and the standards of care and policies established by the federal laws. Federal laws take precedence over state laws. The Commerce Clause of the U.S. Constitution limits the ability of states to erect barriers to interstate trade. So the federal government can preempt state licensing laws in the practice of the professions across state boundaries. \n","13":"Registration is the act of recording or enrolling someone after they provide a review of their credentials. Unlike licensure it offers title protection so someone could not be registered and still practice. With registration there is no implication of competency assessment. As a result of the Omnibus Budget Reconciliation Act of 1987 there is a requirement for unlicensed personnel who work in nursing homes to be on a registry. The registered nurse title is historically significant for the title protection so it has remained as part of the title.\n","2":"Credentialing is the process of procuring, verifying and analyzing the eligibility and qualifications of the APRN provider to execute health care services. Regulation of the health professions is achieved through various methods of credentialing. The method selected is determined by the state government and is based on at least two variables: 1) the potential for harm to the public if safe and acceptable standards of practice are not met and 2) the degree of autonomy and accountability for decision making by the professional. The least restrictive form of regulation should be selected. Four methods of credentialing are used in the United States.\n","30":"Technology has transformed the healthcare delivery system thereby challenging the state-by-state regulatory and licensing system. The internet affords the patient access to hundreds of diseases and telehealth crosses state lines. There are a variety of methods by which APRNs are regulated and there is a need to look at multistate regulatory systems. There has been some discussion about the National Council of State Boards of Nursing regulating nursing practice. Then it would be consistent. Added to that is the doctor of nursing practice degree and the call by the American Association of Colleges of Nursing calling for nurse practitioners to be doctorally prepared by 2015. \n","19":"Other certifying boards include the National Certification Board of Pediatric Nurse Practitioners and the National Certification Corporation for the Obstetric, Gynecologic and Neonatal Nursing Specialties.\n","8":"Credentialing and privileging attempts to limit the chances for liability for the facility and practitioner by ensuring that practitioners currently providing care are licensed, have been educated for the role they are working and are safe and competent.\n","25":"The impact of technology on the delivery of healthcare allows providers to care for patients in remote environments and across geopolitical boundaries defined by traditional state-by-state licensure. The Patient Protection and Affordable Care Act allows increased funding for a primary care workforce, grants for funding nurse-managed health centers through the Department of Health and Human Services, clarification of the funding of advanced nursing education to include accredited midwifery education, expansion of the Nurse Loan Repayment and Scholarship Programs to provide loan repayment for students who serve in faculty positions in accredited nursing programs for at least 2 years and increases in the Nurse Faculty Loan Program. APRNs are also allowed to be accountable care organizations. The law also authorizes HHS to establish a grant program for states or designated entities to establish community-based interprofessional teams to support primary care practices, increases Medicare payments for primary care practitioners, and increases reimbursement rates for certified nurse midwives. The success of this legislation is threatened and the final outcome is uncertain. Promulgating federal regulations is established by the Administrative Procedures Act. A notice of the proposed rule is published in the rule section of the Federal Register. The second step involves careful consideration of public comment by the agency and amendment to the regulation. An emergency regulation is enacted if the public welfare is immediately adversely affected. They run about 90 days and either are removed or have to go through the steps to become permanent. The Federal Register is the bulletin board or newspaper of the federal government. It may be accessed online at the web address in your power point slide. The Code of Federal Regulations is a compilation of all final regulations issued by the executive branch of the federal government. It can be accessed at the web site on your slide.\n","14":"A certificate is a document certifying the bearer’s status or authorization to act in a specific way. It is a voluntary process that may require completion of required education or competency assessment. Certification, like registration is a means of title protection. If regulated by the law versus proprietary organizations then it is mandatory for that individual to be able to practice. For example, in Tennessee nurse practitioners have to be certified to practice..\n","3":"Categories of data needed for credentialing include personal and practice demographic information, education, training, work history, state licensure history, certifications, DEA certifications, liability insurance and claims history.\n","20":"In 2000 the NCSBN passed the Uniform Advanced Practice Registered Nurse Licensure/Authority to Practice Requirements. These requirements included 1) unencumbered RN license, 2) graduation from a graduate-level advanced practice program that is certified by a national accrediting body 3) current certification by a national accrediting body in the advanced practice specialty appropriate to educational preparation, and 4) maintenance of certification or evidence of maintenance of competence. \n","9":"Factors that affect the outcome of privileging include state practice acts, agency regulations, license, education, training, experience, competence, health status, judgment.\n","26":"The Pew Health Professions Commission published a sweeping report that began to change thinking about existing regulations. The commission suggested that the states consider the regulatory process in light of the following questions. Does regulation promote effective health outcomes and protect the public? Are regulatory bodies accountable? Does regulation respect consumers’ rights to choose own healthcare provider? Does regulation encourage a flexible, rational and cost effective healthcare system?\n","15":"Recognition is confirmation that an act done by another person is authorized and that they have certain status. It is also a means of regulating the registered nurse practice. Criteria for recognition is defined in the practice act and may include requirements for certification.\n","4":"Other things that might be needed include history of sanctions/penalties, disclosure of physical, mental, substance or criminal records. Attestation of information completeness and accuracy and an authorizing statement to collect any information necessary for verification might be needed as well.\n","21":"The state is given the right to protect its citizens and therefore it has the power to regulate the professions. It has administrative, legislative and judicial powers – so is it the fourth branch of the government? State Boards of Nursing promulgate rules, regulations, policies, procedures and interpret laws. \n","10":"A career portfolio could contain practitioner contact information, practice based evidence, credentials component section and an attestation page.\n"}