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tions.80 Every organization accredited by the

Applicants who complete the verifica-

Joint Commission must meet standard HR

tion process establish a permanent,

1.20, which requires a process in place "to

lifetime portfolio of primary source

ensure that a person's qualifications are con-

verified credentials [that] can be used

sistent with his or her job responsibilities."81

throughout the applicant's career for

Therefore, every hospital or other healthcare

state licensure, hospital privileges,

facility has policies and procedures that delin-

employment, and professional mem-

berships.84

eate each clinician's scope of practice. These

can be generic for groups of clinicians or writ-

Private specialty board certification is

ten specifically for individual clinicians. The

another voluntary form of credentialing and

hospital medical staff observes and docu-

quality certification more rigorous than state

ments a clinician's skills before approving the

licensing. Private specialty boards administer

clinician as competent to practice. Clinicians

exams to test physicians' competence in a par-

are supervised both concurrently and retro-

ticular area of medicine; physicians may

spectively as the basis for granting hospital

become board-certified in more than one spe-

privileges.

cialty. According to the American Board of

Managed care organizations, preferred

Medical Specialties, nearly 85 percent of U.S.

provider organizations, and other health plans

physicians are independently certified by spe-

are accredited by the National Committee for

cialty boards.85 In 2002, the 24 boards that are

Quality Assurance. The NCQA requires these

organizations to credential clinicians as well.82

members of the American Board of Medical

The demand for clinician-credentialing has

Specialties agreed to adopt common "Main-

grown to the point that a sophisticated indus-

tenance of Certification" standards. All boards

try now collects and verifies information

are required to be in compliance by 2010. This

about individual clinicians for hospitals and

new agreement not only requires a formal

other clients. Credentials verification organi-

examination and an assessment of clinical

zations (CVOs) verify clinicians' training and

skills in a supervised practice setting, but also

periodic reevaluation.86

experience, and periodically review claims and

In the United States and abroad (in the bur-

adverse judgments against health care profes-

geoning medical tourism industry), board cer-

sionals. In addition to verifying a clinicians'

tification guides hospitals and health plans in

professional education and training, CVOs

assessing physicians and is recognized by con-

verify whether a clinician has been certified to

sumers as an indicator of quality. Physicians

prescribe controlled substances by the federal

often advertise their specialty-board certifica-

Drug Enforcement Agency, the clinician's

tions, and patients often search for board-certi-

malpractice claims history, any Medicare or

fied physicians. The value of independent

Medicaid sanctions, and the clinician's work

board certification is suggested by a national

history. CVOs also monitor private actions

study that found that managed care organiza-

against medical professionals, including loss

tions are more likely to contract with board-

of hospital privileges or other sanctions. To

certified physicians than with non-board-certi-

guide facilities and organizations in choosing

fied physicians.87

a CVO, the NCQA--the same group that

Nongovernmental organizations also certify

accredits managed care, health maintenance

the quality of nonphysician clinicians. As noted

and preferred provider organizations--certi-

Nearly 85 percent

fies independent CVOs.83

above, the independent National Commission

of U.S. physicians

The private, nonprofit Federation of State

on Certification of Physician Assistants certifies

are independently

Medical Boards' Credentials Verification

physician assistants. Another private group, the

Service offers a permanent repository for

Accreditation Review Commission on Edu-

certified by

records for physicians and physician assistants:

cation for the Physician Assistant, accredits

specialty boards.

physician assistant programs. Many nurse prac-

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