Study indicates key credentials of practitioners need to be verified regularly

Oct 8 2009

An observational study conducted by Medversant Technologies, LLC, (www.medversant.com), the nation’s exclusive provider of AutoVerifi™ technology (U.S. Patent 7,529,682) that continuously monitors Web-based credentials verification solutions for hospitals, health plans, state Medicaid programs, and other healthcare settings, determined that of 29,845 healthcare practitioners with professed current medical licensure, 1.9 percent were practicing without a license and 18.7 percent were flagged with one or more “adverse findings” – including malpractice, expired license, and credentials falsification.

“These findings clearly indicate that key credentials of practitioners need to be verified continuously instead of simply reviewed every two to three years, as is customary in the industry,” advises Matthew Haddad, president and CEO of Medversant. “Continuous monitoring of credentials identifies high risk practitioners who might otherwise be missed in a traditional credentialing process and who pose serious risks to patient safety, compromise care delivery, and often expose healthcare enterprises to litigation.”

The study, “Medversant 2009 National Provider Adverse Findings Study,” which is available at www.medversant.com, surveyed a database that included physicians, dentists, podiatrists, chiropractors, physician assistants, nurse practitioners, and other ancillary personnel from 30 healthcare organizations with a state license number under which the practitioner professed to practice at the time of credentials verification. The study measured the number of practitioners:

• with one or more adverse findings
• practicing without a license
• with an adverse finding not reported by the Excluded Parties List System (EPLS) or the National Practitioner Data Bank (NPDB)

Key findings included:

• One or more adverse findings: 18.7 percent (5,577)
• Practicing without a license: 1.9 percent (558)
• Malpractice payment reports: 94.9 percent (2,520 of 2,655) of practitioners with an adverse NPDB finding had one or more malpractice payment reports; 9 percent>
• One or more adverse findings related to license to practice: 4.6 percent of practitioners reviewed had one or more adverse findings related to their license to practice. Of these practitioners, 554 practitioners were found to have a license status in their state of practice that rendered them unable to practice. Twenty practitioners professed to hold a license in their state of practice, but were never licensed according to the state licensing board. Overall, a total of 1.9 percent, of all practitioners, was found to be practicing without a valid license.
• Multiple adverse findings (when excluding the same action): 0.4 percent (131)
• Adverse findings not reported by the EPLS or NPDB: 5.2 percent (1,564)

Cohort groupings found that podiatrists showed the highest number of adverse findings – 26.8 percent, compared with physicians at 20.4 percent and dentists at 13.5 percent. The most common adverse finding across all practitioners was evidence of an NPDB report at 8.9 percent, followed by license action at 4.6 percent.

Additionally, 110 flags across 13 credentials were identified, with criteria based upon credentialing standards promulgated by the National Committee for Quality Assurance (NCQA), Utilization Review Accreditation Commission (URAC), the Joint Commission, and the Centers for Medicare & Medicaid Services (CMS).

The study further notes that, according to a report published by NPDB, (U.S. Department of Health and Human Services, 2006), practitioners with more than one malpractice payment report are responsible for more than half of malpractice payments made, and are one-third more likely to have other adverse findings than practitioners with a single malpractice payment report.

“Continuous Web-based monitoring may be the surest way to curtail the growth in preventable medical injuries and avoidable patient deaths,” concludes Haddad. “Medversant developed and patented its AutoVerifi™ technology as a best practice to identify these faulty practitioners in a timely manner through sources other than the NPDB, and in direct compliance with the NCQA standard.”