Synergy - May/June 2014 - 16

managed care connections

The articles in Managed Care Connections address readers' concerns
on many topics related to managed care organizations (MCOs), and they
are written by managed care professionals and other sources that affiliate
with MCOs. Interested in contributing to this section? Contact SYNERGY
Managing Editor, Kelly Rehan, at krehan@namss.org for details.

Ann Klinger, CPCS, has been
the Credentialing Supervisor
with Providence Health Plans
since 2013. Prior to that, she
was at Tuality Community
Hospital in Hillsboro, Ore., as
the Medical Staff Coordinator
performing credentialing and
recredentialing duties both on
the hospital side as well as for
the hospital's PHO. Klinger has
twice served as the President of
the Oregon Association Medical
Staff Services (OAMSS) as well
as the organization's Newsletter
Editor. She is currently the
OAMSS Board special projects
coordinator.

Balancing Respect for
Aging Physicians and
Patient Care
By Ann Klinger, CPCS

I

have spent more than 16 years working in
the credentialing industry, both on the
hospital side and the managed care arena.
One of the most difficult tasks I have
encountered on the managed care side is
the issue of credentialing aging physicians
and ensuring the providers approved for our
insurance products are able to provide
high-quality care to our patients.

physician shortage as providers retire, and
we have fewer medical school graduates.
I do not believe health plans are looking
to force a provider into retirement. At
the same time, plans must act in the best
interest of their patients. How can we help
the provider to continue practicing, while at
the same time provide a safe environment
for patients?

From my research, I find quite a few
hospitals have implemented a physician
assessment program for providers reaching
a certain age, such as 70 years old. I
have also encountered many articles
regarding the topic of aging physicians;
some express concern over their potential
decline in cognitive abilities. Our state
of Oregon's licensing board has been
approached regarding aging physicians
in terms of how they are looking at
implementing requirements for assessments
of aging physicians. We were informed the
medical board will support organizations
implementing these types of programs, but
they currently will not be implementing or
requiring assessments on aging providers as
part of the licensing process.

What should the Credentials Committee
do when they are presented with the
recredentialing application of an 80-year-old
surgeon who, after many years of practice,
has a substantial malpractice settlement?
Should the provider be required to undergo
a cognitive examination or a form of
competency assessment? Or should the
Credentials Committee place the provider
into ongoing monitoring and review the file
if another malpractice settlement occurs? At
this time, there is no consensus developed
on the insurance side to approach the
challenge of aging physicians.

During my discussions with the Credentials
Committee, Medical Director, and
credentialing staff, we find the struggle is
trying to balance how not to take away an
aging provider's livelihood while ensuring
that they remain a contributing member
of the medical community. The other end
of the spectrum is how we handle the
16

/

SYNERGY MAY/JUNE 2014

In accordance with NCQA regulations (CR6
- Ongoing Monitoring), "the organization
develops and implements policies and
procedures for ongoing monitoring of
practitioner sanctions, complaints and
quality issues between recredentialing
cycles and takes appropriate action against
practitioners when it identifies occurrences
of poor quality." As noted in the case above,
how do you protect the patients and work
with the surgeon to realize they should
not be taking on such difficult surgical
Synergy - May/June 2014

Table of Contents for the Digital Edition of Synergy - May/June 2014
