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Credentialing, Peer Review, Disciplinary & Fair Hearing

The quality of a healthcare facility depends in large part on the caliber of healthcare professionals who treat patients there. A healthcare facility's practices, procedures and processes in identifying, credentialing, privileging, disciplining, and terminating healthcare professionals are critical not only to be able to provide quality care to its patients, but also to the healthcare facility's operations, reputation in the community, and viability as a provider.

Credentialing, wherein a healthcare facility analyzes the education, training, licensure and other experience and qualifications of physicians and other licensed healthcare professionals in order to determine whether the professionals are competent to practice at the facility, is a critical piece of any healthcare facility's operations. Needless to say, a good credentialing and privileging process can significantly improve patient safety and the quality of care. It is critical not only to implement a thorough and legally-compliant credentialing process, but to periodically review the credentialing process for any changes in applicable laws, industry recommendations, or best practices. Whether you are establishing a new credentialing and privileging process, need to update your process, or have concerns with respect to the credentialing of a particular healthcare professional, it is important to have experienced counsel available to advise you.

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Like credentialing, peer review is an essential part of quality improvement objectives. Peer review ensures quality standards are being met by through an evaluation of physician performance by colleagues. A key element in any peer review process is fairness. Fair hearing requirements ensure that due process rights are satisfied by providing notice and a fair hearing, in accordance with applicable law and medical staff bylaws, prior to a limitation or revocation of the healthcare professional's privileges or other disciplinary action. The Healthcare Quality Improvement Act provides immunity for fair hearings, provided that they comply with the requirements set forth in the Act. Accordingly, it is essential that a healthcare facility ensures that any fair hearing process is legally and constitutionally compliant by, among other things, providing the affected healthcare professional with notice of the allegations, adequate notice and an opportunity to prevent and rebut evidence, removing any potential conflicts of interest, and ensuring that the review panel has a sufficient number of qualified reviewers to properly assess the matter. It is also vital that all procedural safeguards set forth in the medical staff bylaws are followed and that the recommendation of the review panel is appropriate based upon the circumstances of the matter. Because of the complexities of fair hearings, and the immunity available only if fair hearings are properly conducted, it is essential to have knowledgeable and experienced counsel oversee and guide the peer review and fair hearing process.

MacDonald Illig has counseled healthcare facilities and providers of various sizes and types in matters related to credentialing, privileging, peer review, fair hearing, and other quality and disciplinary matters. Allow our attorneys to partner with you to ensure your practices, procedures and processes are not only legally compliant, but designed to enable you to achieve the highest quality of care possible for your facility.