What is Board Certification?

What is Board Certification?

To practice medicine, physicians have to be licensed by the state in which they're going to work. However, licenses don't guarantee that doctor has qualifications to practice a specific specialty, such as surgery or dermatology. One of the best ways to find out about doctor's qualifications is to know if he/she is Board certified and actively participates in activities to learn about the latest advances in patient care and medicine.

Board Certified physicians voluntarily meet requirements beyond licensing. These physicians show the expertise by obtaining Board Certification through the member Boards that all are part of the American Board of Medical Specialties or AMBS. Before a physician can be Board Certified, he/she has to complete:
•    a training leading to a DO or an MD degree from a medical school
•    four years of education in a university or college
•    five years of experience in a residency program

In the past, boards granted physicians with lifetime certificates, so once they were certified, they got it for life. However, nowadays physicians have time-limited certificates and require frequent recertification. The vast majority of boards require recertification after 5 years with some exceptions. Hospital requirements for certification usually vary, which is based on physician availability. There are areas with an abundance of physicians, thus hospitals require thorough verification of qualification and skill, but in underserved areas, hospitals may not ask for a board certification.

When certification is necessary, physicians should keep track on expiration dates of their certificates. Besides, hospitals' bylaws should clearly define the requirements for board certification and develop a process that will verify the certification. Sometimes, the medical staff requires the certification within a given timeframe or on the appointment, which means that physicians should keep track of their documents and assure they meet the standards. Hospitals usually send reminder letters prior to the expiration date of a current certificate. Whether recommendations are applied, they should be fair and consistent.

Board certification can be verified by collecting information from the board. There are also more convenient ways: board certification for ABMS is verified using the CertiFacts website, and many other certifications can be verified online.

However, hospital's governing body has to make sure that under no circumstances clinical privileges in the facility depend on only upon certification, membership or fellowship in a society or a specialty body. In other words, hospitals have to perform a thorough check of background information and qualifications of physicians even if they have a certification. A hospital can require a board certification when thinking of a DO/MD for membership. However, they should not rely on the fact that a DO/MD is or isn't board certified in making a final decision in membership. In addition to the board certification, hospitals should also verify other criteria such as character, training, judgment, and competence. After a thorough evaluation of all criteria, if these criteria are met except for certification, the hospital can decide to select or not to select a physician to the staff.

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What Is Negligence In Credentialing?

Negligence means a guilty conduct because it falls short of what a person would do to protect another person from a preventable harm or risk. If a healthcare facility could possibly foresee that a physician isn't qualified and the physician injures a patient, the hospital is separately liable for the negligent privileging and credentialing of the physician. Healthcare facilities are legally responsible under multiple theories. Some of them have been held responsible for the failure of the thoroughly screen a physician through the processes of credentialing and privileging, or for negligent credentialing. Negligent credentialing is recognized by at least 28 states. However, there are other theories under which hospitals are held responsible.
Liability theories
There are states where negligent credentialing falls under the corporate negligence doctrine or corporate liability. The main idea of the theory is that when patients enter a hospital they do so with a reasonable assumption that the hospital will try to cure them. Hospitals have the duty to make a lot of efforts to monitor and evaluate the treatment and care administrated and prescribed by the providers practicing in the facility. Hospitals are also responsible for granting privileges only to professional, competent physicians.
The governing body is responsible for making final decisions in credentialing and privileging matters. Although the Board Certification can also be partially responsible, since they verify physician's information regarding his/her experience and training, the ultimate decision-making power belongs to the governing body.
There are two doctrines that make hospitals responsible for hiring unqualified providers. Patients can't choose the practitioners, so it's a healthcare facility who should carefully decide who can be a member of the organization and who can't.
Elements of Negligence
Patients should understand that the fact a hospital didn't credential a physician adequately doesn't mean that the healthcare facility was negligent. For instance, if the hospital can't verify medical licenses for a competent and qualified physician within the requirements of the credentialing standards, this shouldn't be seen as negligence.
In order to establish negligence, one should analyze specific elements. For example, there should be a duty to exercise due care, and duty must be breached. There is also has to be an injury, and the breach of duty should be a reason of the injury. Besides, the patient bringing the charges has to prove that the injury caused him/her compensable damages.
As it was illustrated in a previous example, let's imagine that a physician injured a patient and it was proved that the injury was a result of negligence. If it was proved that the healthcare facility failed to verify the experience, qualification, and competence on initial appointment, and if it would have found that physician's licensure was suspended, only then it can be assumed that proper credentialing wouldn't lead to the injury. In this example, it's pretty easy to conclude that the breach of duty to properly credential that physician could have led to the injury of a patient.
Premier Credentialing Solutions, LLC has the best credentialing and licensing solutions for you and your business; We proudly offer Provider Enrollment & Physician Credentialing, Medicare – Provider Enrollment & Revalidation, Medical Licensure Services, and Full-Service Credentialing For Billers / Billing Companies. Call (800) 455-4773 for a free, no-obligation consultation.