February 1, 2017

Common Credentialing Advisory Group Meeting

• Welcome and Introductions• Implementation Progress• Fee Development Update• Oregon Practitioner Credentialing Application

(OPCA) Recommendations• Advisory Committee on Physician Credentialing

Information (ACPCI) Membership• Public Comment

Agenda

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New Membership (Process)

• Three resigning members– Kelli Fussell (Fmr Salem Hospital)– Becky Jensen (Fmr Kaiser)– Joan Sonnenburg (Fmr Mercy Medical Center)

• Process for replenishing membership– Asked for replacement recommendations from resigning

members (received rec from one). Recommendation evaluated and endorsed by OHA staff and CCAG Co-chairs

– Solicited applications for hospital representatives through OAHHS for two open positions

– All three new members approved appointed by OHA Director

New Membership

• Danielle Coates – Medical Staff Office Manager, Tuality Healthcare

• Mary Pohlman – Manager, Credentials, Kaiser Permanente

• Cristi L. Skye – Medical Staff Liaison, Asante Rogue Reginal Medical Center

Implementation Progress

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Implementation Progress

• Continuing vendor contract finalization–Final negotiations–Internal approvals–Kick-off meeting

• Continuing other implementation work:– Implementation schedule finalization – Change Management planning– Program rules drafting– Credentialing policy discussions

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Fee Development Update

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Fee Development Progress

• Conducted a value analysis with Subject Matter Expert Workgroup

• Met with a subset of CCAG members to go over value analysis and draft fee model

• Conducted a webcast with the OAHHS on value analysis and draft fee model

• Working on next step in fee development process:– Final negotiated price needed to inform fee structure– Health System identification being defined– Working with credentialing organizations on comprehensive analyses

of program and fee impacts

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OCCP Value

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Practitioner Benefits• Centralized solution to enter credentialing information• Automated one-time initial application; updates thereafter• Minimized recredentialing process and less reverification • Reduced overall workflow; especially if have numerous COs• Increased revenue possibilities due to quicker credentialing

Credentialing Organization Benefits• Centralized solution of verified credentialing information• Automated notifications for changes to Practitioner records• Minimized application mailing and processing • Reduced overall workflow and 3rd party verification costs• Increased revenue possibilities due to quicker credentialing• Enhanced patient safety assurance due to centralization

Value Considerations

Considerations helpful to understand OCCP value:• Practitioner burdens in the credentialing process will be minimized• Savings may be achieved via reduced application processing and

verification costs, but will be replaced by fees• COs will continue to have their own system and staff costs• COs using a Credentials Verification Organization may replace

some of those services with OCCP services • Some CO standards are more stringent than accreditation intentions

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Hospital Credentialing Considerations• Hospitals primarily:

– Conduct credentialing according to Joint Commission standards;– Conduct a privileging process more involved than credentialing that

includes evaluation of an individual’s clinical qualifications and/or performance and is primarily done through peer evaluation;

– Have stricter credentialing policies above and beyond accrediting entity credentialing standards (e.g., more extensive work history verifications, requirements to ensure recent verifications, etc.);

– Adhere to a two-year recredentialing cycle; and– Credential practitioners, but also act as designees for practitioners

assisting them in completing the credentialing process

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Credentialing process HCP current workflowHCP post OCCP

workflow

Submitting initial applicationsSubmittal to each

new COOne time initial

submittal to OCCP

Submitting supporting documentation Submittal to each CO Submittal to OCCP

Submitting CO specific documentationSubmittal to each

requesting COSubmittal to each

requesting CO

Ensure application completeness Coordination with

each COCoordination with

OCCP

Submitting recredentialing applications Submittal to each COAttest to OCCP every 120 days

Practitioner Value

Notes:• While the recredentialing process will continue to exist, the recredentialing

application will no longer be necessary as COs will be able to access the OCCP system to retrieve a current Oregon Practitioner Credentialing Application with updated attestations/verifications for the practitioners in which they have access.

• Practitioners credentialed with one or fewer COs willbe excluded from 120 day attestation requirement.

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Credentialing servicesCO

currentOCCP

workflowCO post

OCCPProviding and managing a credentialing database X X XSending/generating applications X X -Reviewing applications for completeness X X -Requesting additional/missing info – practitioner follow up X X -Verifying licenses X X -Verifying board certifications X X -Verify all education and training X X -Requesting and reviewing residency letters X - XVerifying all hospital affiliations X X -Verifying work history up to ten years X X -Collecting three peer references X X -Verifying three peer references X - XReviewing of Medicare Opt-Out List X X -Querying OIG for exclusion X X -Collecting liability coverage face sheet X X -Running NPDB/HIPDB queries X - XTracking returned verifications X X -Managing status update inquiries and rosters X - X

Credentialing Organization Services

Note: Some COs (e.g., hospitals and ASCs) may not see savings due to credentialing policies being stricter than accrediting entity intent.

CVO Example• CVO representing IPAs, ASCs, and hospitals provided cost detail• Average cost charge of processing one initial application according

to Joint Commission standards = $148.63 • Based on CVO estimates of staff time by service element, the

OCCP could reduce initial application processing costs by $60.• Results in a 37% reduction in costs to process an initial application

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Credentialing servicesMinute

EstimatesCost @

$45/HourSending/generating applications 5 $ 3.75 Reviewing applications for completeness 30 $ 22.50 Requesting additional/missing info 5 $ 3.75 Verifying licenses 5 $ 3.75 Verifying board certifications 5 $ 3.75 Verify all education and training 5 $ 3.75 Verifying all hospital affiliations 5 $ 3.75 Reviewing of Medicare Opt-Out List 5 $ 3.75 Querying OIG for exclusion 5 $ 3.75 Tracking returned verifications 10 $ 7.50 Totals 80 $ 60.00

Large health plan example

• Large Health Plan ≈11,500 credentialed practitioners in panel• Current total costs of $35 for initial applications and $19 for

recredentialing applications, with 2,000 initial applications and 3,000 recredentialing applications processed each year on average– Annual direct credentialing costs: $127,000

• Organization falls into Tier 9 (10,000 – 15,000 practitioners)– Fee Model: Annual subscription fee of $110,000

• Difference– Fee Model: $17,000 per year

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Large health plan example, continued…

• Hard to say exactly what the difference is between current and post OCCP implementation costs since credentialing organization staff and systems will likely be retained to perform credentialing operations outside of the OCCP’s scope.

• At the same time, this plan reported that they expected to see a 90% decrease in the amount of verification work, a 33% decrease in application processing times, and a 20% decrease in staff time needed to perform follow up to complete applications or gather supporting documentation once the OCCP is up and running.

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Oregon Practitioner Credentialing Application (OPCA) Recommendations

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OPCA Recommendations

• ACPCI met and approved or denied solicited OPCA change suggestions on October 26, 2016

• December 2016 – ACPCI recommendations emailed to CCAG members for their feedback

• Discussions and recommendations from today will be considered when finalizing the paper-version of the form. Final recommendations will go to the OHA Director or Director’s Designee for approval

• The latest version of the OPCA form will be the basis for the practitioner information gathered within the Medversant solution

• .OHA staff will be working with Harris/Medversant on issues related to automating the OPCA in the next few months

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ACPCIReviews/suggests changes

OHA staff brings ACPCI recommendations to the

OHA Director and the CCAG

CCAG reviews and advises the OHA on the ACPCI

recommendations

OHA staff finalizes and forwards recommendations

to the OHA Director

OHA Director reviews and approves or denies final

recommendationsOHA Rules Coordinator

initiates rulemaking process

Secretary of State publishes notice of rulemaking

Denial

Approval

If OHA Director denial related to CCAG changes

If OHA Director denial related to ACPCI changes

OHA conducts public hearing and considers testimony

OHA adopts and files final rules with Secretary of State

OHA notifies the ACPCI and CCAG of adopted rule

OHA distributes new applications and

updates the ACPCI website

ADVISORY COMMITTEE FOR PHYSICIAN CREDENTIALING INFORMATION (ACPCI)PROCESS FLOWCHART FOR AMENDING THE OREGON PRACTITIONER CREDENTIALING/RECREDENTIALING APPLICATIONS(Revised October 2016)

If necessary to add or

change rules19

Suggestion #1Page 4 Section VIII “Undergraduate Education and Section IX Graduate Education”Suggest including box for start date in addition to graduation date in these two sections.

Re: Suggestion #1 (CCAG #3A)Suggest listing the start date in these sections above the graduation date so it’s not confusing to practitioners.

Any issues/objections on this aesthetic change?

Suggestion #2Page 7 Section XVI “Hospital and Other Health Care Facility Affiliations”

Suggest adding field for “Professional Liability Carrier” to each affiliation.• Note: this field is already collected for each entry in the “Professional

Practice/Work History” section, and in more detail in the “Professional Liability Insurance” section

Suggestion #2 (Opposition)Page 7 Section XVI “Hospital and Other Health Care Facility Affiliations”

Suggest adding field for “Professional Liability Carrier” to each affiliation.

One ACPCI member opposed this change, raising concern that practitioners may not know which liability carrier is associated with each of their affiliations.

CCAG #3A: Jen Waite agreed with this opposition: “in many cases, the hospital’s malpractice insurance policy covers the practitioner while they provide services within that facility and the practitioner has no idea who the carrier is or what the policy details are…”

Suggestion #3"What providers have expressed needing is a way to know which sections are applicable to their specific profession. A sheet that would list the sections most applicable to their profession—this would be helpful to providers that are needing to fill out the form for the first time and need some guidance.“

ACPCI agreed current “Does Not Apply” checkboxes at the top of sections currently allows certain practitioners to bypass sections that aren’t applicable to them.

Guidance documents by practitioner types may be a useful tool

Suggest changing text on Page 1 instructions to read:

Suggestion #6BPage 6 Section XIV “Health Care Licensure, Registrations, Certificates & ID Numbers”

Suggest changing “Individual NPI Number” field text to “Entity Type 1 (Individual) NPI Number”. This would clarify that the form doesn’t want Entity Type 2 (organization) NPI numbers.

Suggestion #6B (Opposition-CCAG #2)Page 6 Section XIV “Health Care Licensure, Registrations, Certificates & ID Numbers”

Suggest changing “Individual NPI Number” field text to “Entity Type 1 (Individual) NPI Number”. This would clarify that the form doesn’t want Entity Type 2 (organization) NPI numbers.

CCAG #2: Deb Bartel suggests that an additional field be added for Entity Type 2 (organization) NPI numbers. Current version does not have any field for Type 2 NPI numbers where a practitioner or office staff can enter the Group NPI.

Suggestion CCAG #1APage 11 Section XXI “Attestation Questions”

Suggest rewording attestation question G from “Have you ever voluntarily or involuntarily left or been discharged from medical school or subsequent training programs”

TO“Have you ever voluntarily or involuntarily left or been discharged from the education program leading to your current licensure or any subsequent training program?”

This way the question does not only apply to physicians but to all disciplines of health care practitioners that may be completing the OPCA

Suggestion CCAG #1BOPCA Glossary

Both the OMB and AANE (American Association of Nurse Anesthetists) are listed in the glossary but they don’t seem to be referenced anywhere in the applications themselves.

Suggest all licensing Boards associated with the credentialing process be listed in the glossary (this list is large)

OROMB and AANE and any other Boards that are not referenced in the OPCA be removed from the glossary.

Advisory Committee on Physician Credentialing Information (ACPCI)

Membership

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ACPCI Membership

• ACPCI develops the uniform applications used by credentialing organizations to credential and recredentialing practitioners within the State of Oregon.

• Committee consists of 9 members appointed by the OHA Director– 3 health care practitioners of practitioners’ organizations representatives– 3 hospital representatives– 3 health care services contractor representations (payors)

• Currently, need to fill 3 of 9 positions– 1 practitioner organization representative– 1 hospital representative– 1 health care services representative

Current Membership

Licensed Practitioners or Practitioner

Organization RepsHospital Reps Health Care Services

Contractor Reps

Mark A. BonannoOregon Medical Association

Danielle CoatesTuality Healthcare(CCAG member)

Leah J. AsayTrillium Community Health Plan

Victor B. Richenstein, MDNWMHA Board Member

Valery Kriz (New Chair)Providence Portland Medical Center

Mary PohlmanKaiser Permanente(CCAG member)

New Member Needed New Member Needed New Member Needed

Volunteers/Suggestions/Recommendations?

Public Comment Period

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Next meeting: April 5, 2017

Lincoln Building, Suite 775 Transformation Training Room421 SW Oak StreetPortland, OR 97204

More information can be found at:www.oregon.gov/oha/OHIT/occp

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