Joseph Zanga, MD, FAAPChief of Pediatrics

Columbus Children’s HospitalColumbus, Georgia

Professor of Pediatrics - Mercer University School of Medicine

706 571 1220

Credentialing Simplified

The

WHY and HOW

Columbus, Georgia

Columbus, Georgia

Columbus, Georgia

Area: 220.8 sq. miles (571.9 km²)

Population: 202,824 (2013)

Second largest city (not metro) in Georgia

Midtown Medical Center

The Why

Midtown Medical Center

• Columbus Children’s Hospital and the Community:

• 35 primary care pediatricians

• Pediatric Emergency Center (PEC)

• Regional perinatal center – 40 bassinettes

• 21 Inpatient beds

• 5 bed PICU

• 5 bed stepdown/observation unit

We Have at the Hospital and in the Community:

• Neonatologists (3)• Allergist/immunologist• Cardiologist• Critical Care• Endocrinologist• Gastroenterologist• Hematologist/Oncologist• Neurologist• Ophthalmologist• Orthopedist• Psychiatrist• Physiatrist

But We Still Needed

Services for:

PediatricNephrology

Urology

Child Maltreatment

Dermatology

And someone in every other service for which we had only one specialist

So We Wanted

Backup in:Cardiology

Critical Care

ENT

Gastroenterology

Hepatology

PM&R

Psychiatry

However No One Wanted To Complete Our 47 Page Credentialing Packet and Provide All The Accompanying Documentation Required (24 Separate Items – plus $100)

The How

Official Publication of Joint Commission Requirements Final

Telemedicine Revisions • Element of Performance for LD.04.03.09 A 23. For

hospitals that use Joint Commission accreditation for deemed status purposes:

• The originating site makes certain through the written agreement that all distant-site telemedicine providers’ credentialing and privileging processes meet, at a minimum, the Medicare Conditions of Participation at 42 CFR 482.12(a)(1) through (a)(9) and 482.22(a)(1) through (a)(4).

• If the originating site chooses to use the credentialing and privileging decision of the distant-site telemedicine provider, then the following requirements apply:

• The governing body of the distant site is responsible for having a process that is consistent with the credentialing and privileging requirements in the “Medical Staff” (MS) chapter (For more information, see Standards MS.06.01.01 through MS.06.01.13).

• The governing body of the originating site grants privileges to a distant-site licensed independent practitioner based on the originating site’s medical staff recommendations, which rely on information provided by the distant site.

There is Another Section

APPLICABLE TO CRITICAL

ACCESS HOSPITALS

Medical Staff (MS) Standard

MS.13.01.01 For originating sites only: Licensed independent practitioners who are responsible for the care, treatment, and services of the patient via telemedicine link are subject to the credentialing and privileging processes of the originating site.

Element of Performance for MS.13.01.01

The Next Step

MMC Staff By-Laws

Telemedicine: Medical practice is defined as any contact that results in a written or documented medical opinion and affects the medical diagnosis or medical treatment of a patient.

Telemedicine is the practice medicine through the use of electronic communication or other communication technologies to provide or support clinical care at a distance.

The Joint Commission and the American Telemedicine Association define telemedicine as the use of medical information exchanged from one site to another via electronic communications for the health and education of the patient or healthcare provider and for the purpose of improving patient care, treatment and services

• 3.2.1.1 If the applicant is a telemedicine Practitioner located in a different State the applicant must also possess current, unlimited, unrestricted, active licensure in that State as well as in Georgia.

Telemedicine Privileges

Practitioners who wish to provide

telemedicine services, as defined in these

Bylaws… shall be required to apply for and

be granted clinical privileges for these

services as provided in these Bylaws

The Medical Staff shall define…which clinical

services are appropriately delivered through a

telemedicine medium…

The following credentialing procedures shall

be followed:

• 5.2.11.1 When a telemedicine provider is providing services from a different State, licensure and/or other requirements that may be imposed by a State will be verified for both the State where the Hospital is located and the State where the Practitioner is located.

• 5.2.11.2 Specific to telemedicine providers, due to extraordinary high number of healthcare affiliations, queries will be limited to the top five high volume affiliations and any healthcare organization from which the Practitioner was reassigned during the last five years.

With All That In Place

• Application received in Medical Staff Office

• If complete is referred to Pediatric Credentials Committee

• If approved:

Is referred to Medical Staff Credentialing

Committee

Then is referred to Medical Executive Committee

• Final approval is by the Board of Directors

Remember

No One Wanted To Complete Our 47 Page Credentialing Packet and Provide All The Accompanying Documentation Required (24 Separate Items - plus $100)

Credentialing By Proxy

• Copy of Health Care Facility (JACHO) approved delineation of privileges form for provider

• Provider Summary Page (to include educational background information)

• Certificate of Malpractice Insurance

• State License Verification

• DEA Verification

• Board Certification Verification

• CV

So Now We Have

15 Telemedicine Physician Consultants on Call

Heavy Cardiology Concentration

Still need:

Dermatology

Infectious Disease

Rheumatology

??

One Further Need

Funds

Any Questions

Thank You