It’s been over a decade since the small earthquakes called OPPE and FPPE rumbled through med staff services. In 2007-2008, The Joint Commission’s rebranded regulatory focus on provider proficiency improvement—Ongoing Professional Practice Evaluation and Focused Professional Practice Evaluation—linked competency assessments to clinical privileges, placing the function squarely in medical staff professionals’ (MSPs) domain. The regs were supposed to set a new higher bar of accountability by med staff services administrations to help manage quality and safety among privileged practitioners.

It matters not whether your organization is a hospital or ambulatory facility that follows TJC, a health plan that adheres to NCQA, or a group practice following state law: It’s essential to tie providers’ competency to their current ability to maintain privileges or continue to practice within a given scope via regularly scheduled assessment. The safe delivery of quality patient care demands it and you can’t wait two years for a recredentialing process to let a practitioner know they could have done something better.

But aftershocks of OPPE/FPPE persist. For example, The Joint Commission offers something called “Standards BoosterPaks,” which are searchable documents intended to provide detailed info about a standard or topic with a high volume of inquiries or non-compliance. With all of the standards areas covered by TJC, they offer just 10 of these tools—and one is for OPPE/FPPE.

And interestingly, although OPPE rendered ongoing competency assessments as privilege-specific and the National Association Medical Staff Services (NAMSS) identifies the “Conduct, participation in, and maintenance of current clinical competency evaluations and peer review” as one of eight core function areas of MSPs, OPPE ranked just 16th out of 23 specified MSP duties on a 2017 NAMSS survey. (Peer review ranked 17th.)

In 10+ years, hospitals and healthcare organizations self-reportedly have made only a dent in becoming fully compliant with OPPE. Is it normal or troublesome that MSPs are still only on the periphery when it comes to helping to verify competency and foster improvement? And are those points related?

Read on to learn some basics about OPPE, a high-profile function that, should you choose to become involved, could set you up for career success and potential salary advancement in an industry with fast-evolving job requirements.

OPPE Basics
  • Practitioner performance evaluation for peer review and for quality improvement is a complex set of activities. OPPE is a part of the peer review process and generally provides the majority of the data needed to make reappointment decisions.
  • OPPE is not an adverse action and isn’t an investigation reportable to the NPDB.
  • It’s not punishment, and it’s not *subjective. (*However: Some dimensions of practitioner performance require providers to accept and use data that relies on the perceptions of patients and other healthcare clinicians and staff. More under “General Competencies” below.)
  • Effective OPPE aims to provide an objective program that relies on data and pre-determined thresholds (targets) and to engage providers in managing their own performance and being more accountable for the quality of their patient care, toward constant improvement.
  • OPPE targets are specialty specific, but at its basis can broadly use the Six General Competencies established by the Accreditation Council for Graduate Medical Education and the American Board of Medical Specialties:
    1. Patient Care
    2. Medical/Clinical Knowledge
    3. Interpersonal and Communication Skills
    4. Professionalism
    5. Systems-based Practice
    6. Practice-based Learning and Improvement
      *ACGME states that “assessment requires observations and judgments of performance in the workplace.”

Organizations with successful OPPE programs (i.e., their measures do measure what they are designed to measure, and practitioners are engaged in managing their own performance toward quality improvement) have shared lessons from their journey:

Lessons/Resources
  • Meeting regulatory compliance should not be the primary goal but should be a byproduct of striving for safe, high-quality care. The truth is that good compliance is good business for all parties.
  • Start small (crawl, walk, run) with measures that are easier to gauge, that aren’t controversial/don’t cross specialties, and that providers are more likely to trust the data on. Example sources for performance metrics are:
    • Agency for Healthcare Research and Quality
    • National Quality Forum
    • National Healthcare Quality Report
    • National Committee for Quality Assurance
    • CMS/The Joint Commission
    • Specialty-specific Professional Societies
  • OPPE and FPPE were not new a decade ago, as the concept of using data for monitoring and evaluation (and reappointment) was required by TJC for many years prior. Review what your organization is already doing and build from there.
  • When defining the measures that are important, engage medical staff leaders in the same specialty to guide the process.