A recent survey by IntelliSoft asked credentialing and enrollment specialists for tasks they struggle with. Wrangling references came up, specifically:

  • Encouraging providers to maintain relationships with references, especially in telemedicine, where references may have several hundred requests to complete
  • Avoiding reference forms from being returned incomplete
  • Getting candid info especially when significant time lapsed

It’s agreed that references are among the best ways to get the true picture of a candidate’s clinical acumen and professional behavior, since the info comes from residency or fellowship program directors or department chiefs who saw the individual in action. In other words, you want to reach those people who’ve had current and direct exposure to the applicant’s practice. But references are a challenge for anyone in the industry and let’s face it: There must be an easier way, especially when it comes to telemedicine and locum tenens practitioners.

Enter evergreen (or forevermore) references and evaluations.

Think of evergreens as reciprocal: You have to give to get so there’s a bit of goodwill involved. Evergreens are both a way to ensure your organization is able to disclose reference information to other organizations as an evaluation when a practitioner leaves your organization, and a way for you to get the succinct info you need from other practitioners who join yours. In the end, they’ll make things easier for you and help others in your industry.

Think of evergreens as dual purpose: An evergreen combines on one form an affiliation verification (usually completed by the MSP or admin) and a clinical evaluation/reference (provided by the department chair/section chief, or supervisor). Reference requests using evergreen forms can speed the process in a big way, eliminating the waiting game for responses at the remote site. Clinicians responsible for completing the evaluations will be glad to learn that they or their successors won’t have to respond to multiple reference requests or to try to recall years from now how a provider who has since moved on from your org performed while he/she was there.

For the affiliation verification, include:

  • Dates the provider was associated with your organization
  • The clinical privileges held
  • Department of the practitioner and (if appropriate) staff category
  • Statement that provider met all requirements for their staff membership/category (clinical and behavioral) and had no clinical performance concerns (if appropriate)
  • Example case logs or other utilization history

For the clinical evaluation section, include:

  • The clinical evaluation by the department chair
  • Answers to the questions your organization uses on its clinical evaluation forms (e.g., you might use the six general competences)
  • Chair’s/supervisors signature and date of the evaluation
  • Dated statement by the department chair noting that the eval is valid at that date only for practitioner’s tenure/affiliation at your organization

Once completed, a best practice is to run a query of the provider’s activity for the past two years and store the results with the evergreen reference. You should also include with the packet the most current privilege form based on the applicant’s specialty. In addition, consider including a recent photograph of the applicant with a professional reference request at the time of appointment so the reference can verify the applicant by image.

A warning: Circumstances exist where evergreens aren’t desirable—including if a provider had poor performance, underwent disciplinary actions or investigations, or has pending issues around performance or behavior. It’s important for your organization to have a formal policy regarding references and evaluations, especially for cases such as these to avoid legal trouble. As a result, ensure that medical staff leaders and legal counsel are involved in setting policy that applies to everyone.

Revisit your policy IF…

You’re doing more work than needed at reappointment: First, let’s establish that we’re focused only on obtaining references at the time of initial appointment or expansion of privileges. References at reappointment are warranted for practitioners who are low- and no-volume and/or the organization lacks sufficient evidence of current clinical competence. But if a provider is clinically active at your organization at the time of reappointment, do you really need outside references?

You’re doing more work than needed for locums: Figuring that the average locums provider has worked in 20+ organizations, checking references would quickly swamp you if trying to adhere to a policy that states you must get references for all healthcare-related employment and appointment history.  This is prime example begging for a discussion and potential policy change. How about proposing checking the last 5 locations?

You’re doing more work than needed for peer references: Peer references can often attest to current clinical competency for privileges requested but should only be needed on top of supervisory references when you’re lacking info about clinical activity at your organization (i.e., at reappointment or renewal of privileges). On a related note, what’s the point in trading letters of good standing at sites within the same system in cases where there’s sufficient clinical activity at reappointment?

You never touch the phone when getting references: While not every reference check requires a call, any item that raises a flag should send you to the phone for follow-up. Consider the issue’s nature and then determine who best should make the call—MSP or physician, as some cases of clinical or behavioral issues are better discussed physician to physician.