How Good Are Australia’s Provider Identification and Credentialing Systems?

I came upon this headline the other day and I have to say I was amazed.

2% of Health Practitioners Are Not Licensed; 19% Have Issues with Credentials

Cheryl Clark, for HealthLeaders Media, October 9, 2009

Nearly 2% of health providers, including 1.6% of physicians and osteopaths, are practicing without a license and 18.7% have some cloud on their credentials, according to a new report from a company that checks licensing, credentialing, and malpractice litigation history.

The survey, published by Medversant of Los Angeles, used a patented tracking system to provide background checks on nearly 30,000 health practitioners for clients, such as state governments, hospitals, health plans, and nursing registries.

Matthew Haddad, president and CEO of Medversant, says the finding of so many practitioners who shouldn't be practicing is alarming, and points to a potential for widespread fraud.

"What's often the case is that when you have a provider billing who is not licensed, very often that patient is fictitious," he says. He adds that many state and federal agencies are interested in the finding in an effort to prevent paying bogus claims as well as safeguard quality of care.

The Medversant system checks for daily updates on licensees, which Haddad says is a vast improvement over the routine practice of checking once every two to three years, a requirement from The Joint Commission, healthcare accrediting organizations, government regulatory agencies, and the Center for Medicare and Medicaid Services.

The survey also revealed:

• Adverse findings were found in 20.4% of 20,243 physicians, 13.5% of 208 dentists, 25.8% of 585 podiatrists, 6.4% of chiropractors, 11.3% of 646 physician assistants, 9% of 1,621 nurse practitioners, and 8.7% of 5,475 allied health professionals.
• Expired, cancelled, delinquent, inactive, lapsed, not renewed, not registered, null and void, revoked, suspended, surrendered, terminated or voluntarily surrendered licenses were discovered among 5.1% of physicians assistants, 2.8% of nurse practitioners, 2.7% of allied health professionals, 2% of podiatrists, 1.6% of physicians and osteopaths, 1.4% of dentists, and .7 % of chiropractors.
• Among the 29,845 practitioners reviewed, 80 were either deceased or retired. "These practitioners, at the time of license verification, were listed in one or more health plan provider directories as a participating provider."

The company is marketing its services in an effort to help payers guarantee quality of care.

Lots more here:

http://www.healthleadersmedia.com/content/240267/topic/WS_HLM2_PHY/2-of-Health-Practitioners-Are-Not-Licensed-19-Have-Issues-with-Credentials.html

Now while I realise that Medversant has a strong commercial imperative to create the scariest picture possible, even if things are only 1/10 as bad here we have a problem Houston!

With a health workforce of about half a million (including 65,000 doctors in 2006 the latest figures available from the AIHW) even 0.2% winds us up with 130 docs who may not be what they seem and that is 130 too many in my view.

All we can hope is that those setting up the planned National Registration System are using the techniques Medversant talks of, and more, to track down the dodgy ones.

Recent experience in Qld and NSW shows just how problematic even one or two who are not up to scratch can be!

The risk of missing the odd rogue practitioner is emphasised by this report.

Call to simplify health care complaints

BRIAN ROBINS

October 12, 2009

A STATE parliamentary committee wants complaints against health care workers to be dealt with by a single body, as part of an overhaul of the handling of health complaints

Several different groups investigate complaints at present.

It has also recommended a health professionals registration act be introduced to give more ''transparency, consistency and fairness'' to complaints that are investigated, and that all existing separate registration acts covering health workers be repealed.

This would result in the formation of NSW health practitioner registration boards, similar to the Queensland Office of Health Practitioner Registration Boards, an independent statutory body.

As many as 11 different registration boards now handle complaints, along with the Health Care Complaints Commission.

These bodies include groups such as the Chiropractors Registration Board, the Dental Board, the Pharmacy Board and the Optical Dispensers Licensing Board.

Even though most health complaints are made about registered medical practitioners - about two-thirds of the complaints each year - nurses and dentists account for another 10 per cent each, and psychologists 5 per cent. About 1700 complaints a year are made against health care workers .

The overhaul recommendation follows an earlier State Government inquiry into complaints made against the former medical practitioner Graeme Reeves, which at the time called for the Health Care Complaints Act to be reviewed, specifically to focus on areas of unnecessary complexities.

More here:

http://www.smh.com.au/national/call-to-simplify-health-care-complaints-20091011-gse8.html

David.