Purpose of Credentialing Health Care Providers

Credentialing serves to protect patient safety, reduce medical mistakes and enhance the quality of delivered services. Health care providers are of two types: personnel and organizations. Institutional providers of medical care services undergo accreditation (organization) and/or certification (specialized programs) by the Joint Commission. Health care practitioners are licensed by state or federal governments; all licensees meet standard requirements for education, training and experience necessary to practice their professions in a responsible and ethical manner.

Necessity for Licensure

• Medical professionals---doctors, nurses and various kinds of therapists---require specialized knowledge and skills, before they are licensed by the state or federal government to practice their professions. Handling life and death matters requires a specialized body of knowledge and experience not available to the general public. The general population does not have the knowledge nor expertise to know if the medical professional who is treating them is qualified, nor if the diagnostic and treatment options offered are valid, beneficial, reasonable or, at the worst, useless and/or dangerous. Licensing medical professionals gives the public a certain degree of protection from quacks, scam artists and incompetent practitioners.

Institutional Accreditation and Certification Process

• For institutional providers, "The Joint Commission reviews organizations' activities in response to sentinel events in its accreditation process, including all full accreditation surveys and random unannounced surveys and, as appropriate, for-cause surveys." Site inspections by Joint Commission personnel have historically been included in the accreditation process. Practice plans, such as managed care organizations, are evaluated by the National Committee for Quality Assurance (NCQA).

Credentialing Versus Privileging

• Credentialling precedes privileging. Credentialling is the verification of education (including continuing medical education) and licensing requirements. Privileging includes credentialling. In order to practice within institutions and organizations, such as hospitals, medical professionals must be granted "privileges." A private physician may treat his patients only within institutions, which have granted "privileges" to the physician. Prior to granting privileges, a hospital must investigate and verify the physician's licensure, background and experience to ensure, as examples, that the physician's privileges were not withdrawn "for cause" at another institution, the physician's license to practice medicine has not been revoked, and the physician has not been convicted of a crime, which would adversely affect the physician's practice.

Protecting the Public

• Privileging is a sensitive process, done privately and shielded from public scrutiny. Privacy of the privileging process benefits both innocent, competent physicians and the general public by ensuring better objectivity and independence while avoiding artificial manipulation of the process to satisfy personal interests.

Public Ratings of Providers

• Public pressure for knowledge about physicians and providers whose performances are less than stellar has created the demand for release of information so that the public can compare providers. Such public ratings are flawed and potentially harmful. These ratings are akin to comparing apples to meat because the public lacks full knowledge of the facts and circumstances, and because scientific principles are omitted from these calculations. Such ratings are anecdotal and skewed, rather than scientific, realistic or reasonable. The public's demand for automatic answers corrupts what governments and other independent organizations establish to protect the public from itself.