MSSNY POSITION STATEMENTS
235.000: Physician Credentialing/Recredentialing
235.995 Granting of Provisional Credentialing Status to New York Physicians by MCOs: In view of the time consuming and burdensome credentialing process and its corresponding affect on new physicians’ efforts to earn a livelihood as they gain valuable patient care experience, MSSNY will take immediate steps to petition the New York State Legislature, the Superintendent of Insurance, the Commissioner of Health and the National Committee on Quality Assurance to require managed care organizations to grant “provisional” credentialing status to new properly trained and medically qualified physicians while their actual credentialing processes are underway. The aforementioned “provisional” status remained in force until the entire credentialing process has been successfully competed. (Council 2/4/98)
235.996 Hospital Mergers Resulting in Physician Exclusions: MSSNY will work with appropriate agencies to ensure that where one or more hospitals are merged, a physician credentialed to perform services at any one of the merging hospitals shall be entitled to receive equivalent credentials at any of the other merging hospitals, provided that such physician meets the qualifications for credentialing at such other hospital. (HOD 99-77)
235.997 Physician Credentialing: MSSNY adopts as policy the position that the NCQA is not the appropriate organization to determine criteria for physician credentialing and will ask the AMA to adopt a similar policy and seek to develop its own national physician credentialing criteria through AMAP. (HOD 97-87)
235.998 Physician Recredentialing: MSSNY supports the concept of the Department of Education doing a special survey of a small group of physicians licensed in the State of New York at the time of their next re-registration provided that the Society will have input into the creation of such a survey. The survey will solicit information on their education, continuing medical education activities, disciplinary actions, etc. Results of the survey may be used to expand its future use to include all New York State physicians.
MSSNY supports: (1) The development of an “indicator system” to identify “problem physicians”; (2) The development of more sophisticated methods of determining what the problems really are; and; (3) The organization of appropriate remedial actions.
MSSNY understands that the State Board for Medicine has already started the first phase. Phases 2 and 3 are more complex and will require collaboration among several groups. MSSNY recommends the careful development and testing of “practice parameters” to assist physicians in clinical decision-making but opposes any attempts, at this time, to use them for “re-credentialing purposes.” MSSNY urges better recognition and stronger support efforts to bring together under one umbrella, all parties in the Continuing Medical Education-Quality Assurance fields for better coordination of efforts, collaboration where appropriate, development of policy, and instigation of pilot projects including the issue of re-credentialing. The Continuing Medical Education Council of the State of New York, Inc. is designed to serve this purpose. MSSNY agrees with the Federation of State Medical Boards (FSMB) that “it is not possible in practical terms to determine the competence or fitness of the mass of physicians in any way that will not burden the system with unacceptable costs and physicians with unacceptable interruptions.” (Council 1/30/92)
235.999 NYS Advisory Committee on Physician Recredentialing Report - MSSNY’s Non-Support of: The Report of the New York State Advisory Committee on Physician Re-credentialing entitled “Phase One: General Principles, Proposed Process, Recommendations” was released in January of 1988. MSSNY does not endorse this report or its recommendations. Historically, quality assurance (optimal patient care) and physician competency have been the foundations upon which the policies and positions of the MSSNY have been developed. Over the past decade, the assurance of quality and maintaining of competence, a responsibility, which rightly belongs within the purview of the profession (all professions), has been gradually assumed to a large extent by agencies external to the profession. Perhaps well intentioned, the regulatory mechanisms developed by these external agencies have had a deleterious effect on the delivery of medical care but have had little impact on physician clinical performance.
MSSNY agrees with the statement, made on several occasions in the report, that the re-credentialing process broadly outlined in the report “is not designed to measure medical competence.” Indeed the report does little more than discuss those well-known methods used to evaluate those various, individual components which taken collectively are used to define knowledge and cognitive skills, not performance. We agree with the report that there does not exist a single methodology for measuring competency and agree that employment of a combination of methodologies to measure competency would be logistically and economically unrealistic. The evaluation of competence in the health professions has not yet reached maturity. Measurement of changes in practice as a consequence of additional education, assessment of the validity of examinations and the determination of goals for competence are all necessary parts of the ongoing development of competence evaluation. As stated in the beginning of this statement, MSSNY is committed to quality assurance and maintaining competence of health professionals. However, we do not need further government intrusion to do what already is being done. Accordingly, the MSSNY subscribes to the following recommendations of the “Health Policy Agenda for the American People”:
(1) Health professionals are individually responsible for maintaining their competence and for participating in continuing education; all health professionals should be engaged in self-selected programs of continuing education. In the absence of other financial support, individual health professionals should be responsible for the cost of their own continuing education. (2) Professional schools and health professions organizations should develop additional continuing education self-assessment programs, should prepare guides to continuing education programs to be taken by practitioners throughout their careers and should make efforts to ensure that acceptable programs of continuing education are available to practitioners. (3) Health professions organizations and faculty of programs of health professions education should develop standards for competence. Such standards should be reviewed and revised periodically. (4) When reliable and cost-effective means of assessing continuing competence are developed, they should be required for continued practice. This should be done without government interference or control.