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Credentialing With the Lights Out

By Dorothy Zelenik, CPCS, CPMSM

This feature first appeared in the January/February 2013 issue of Synergy.

It was the morning after Hurricane Sandy had hit and run. Lady Liberty, ever vigilant, had stood her ground as high winds and 15-foot swells wreaked havoc on the coastline, causing heavy flooding throughout New York and New Jersey. According to the latest radio broadcasts, the hurricane had pummeled NYU Langone Medical Center and 322 patients, including 20 newborns, were successfully evacuated during the storm and transferred to other facilities in the area. From all accounts, this heroic rescue mission was nothing short of a miracle. The hospital staff, along with firefighters, police officers, and other volunteers, gently carried patients down the darkened stairwells on “med sleds” while clutching the newborn infants close to their chests for safekeeping. At least six workers were needed to transport each baby out of the hospital. I also learned that Bellevue Hospital and the Veterans Affairs hospital — our close neighbors on First Avenue — also sustained major flooding and were forced to evacuate their patients and close their doors to the public.

Anxious to get a handle on the situation, I grabbed a flashlight and ventured down the eight flights in my apartment building. Our power was out and would be for some time. My neighbors and I quickly found out that the subways were flooded, bridges were out and the city was a complete mess, especially the shorelines. Walking through my familiar neighborhood became surreal as I passed uprooted trees, crushed cars and broken glass that littered the streets. I experienced tangled emotions about what might lie ahead. Expecting the unexpected, I shuffled along with curious onlookers like myself who banded together in an attempt to cross the busy streets of Manhattan without any functioning traffic lights — a death-defying act I was bound to repeat if I wanted to get home again. As I continued to walk the few blocks to Langone Medical Center, I had no idea of the superstorm that was brewing at work.

After finally reaching the command center, we learned that the fantastic news accounts of incredible courage and heroism were true, and every single patient indeed was transferred successfully to nearby hospitals with the attending physicians and nursing staff close by to continue patient care.

Now, to preface the story, our medical staff services team, along with most of the facilities in New York, were prepared for disaster credentialing and had our policies in place and ready for action. In short, if our hospital officially declares a disaster, we might expect an influx of medical volunteers who we would need to credential quickly. Most MSPs know the drill: The volunteer practitioners basically are required to complete a short application form; you verify their license; check their ID; pair them with a staff member for oversight; and assign the practitioners to help out until the crisis is officially over.

Yes, a disaster was officially declared, but in this case there was no influx of volunteers; just the opposite had happened. Our patients had been evacuated and our practitioners needed to follow their patients — and fast. With no privileges at the other facilities, we had to come up with a plan. We decided that we would work with the medical staff services at the other facilities by manually listing the names of the providers who needed privileges, pulling their credentials files, gathering their demographic information — licensure, copy of privileges, etc. — and sending the information to the neighboring hospitals involved to help expedite their credentialing process. Unfortunately, as we had neither power nor public transportation, our office was still in the dark and our team was physically unable to get to the medical center on day one of the aftermath.

With the help of a few volunteers with flashlights, we proceeded to the darkened file room across the street pulling the initial 78 credentials files we needed and carried them back to the command center where there was power generated for the workspace we needed, including emergency lighting and a working printer. Thankfully, the following day, a few members of our credentials team were able to make it in and we set to work on completing the 78 applications with the goal to deliver them personally to the facility where the physicians needed privileges, as there was no scanning, faxing or phones available to us.

As the week progressed, demands increased as other hospitals were added as possible alternatives for our patients who sought care. After a week of chaos, we finally regained electricity in our office. The next challenge was meeting the separate requirements of each and every medical staff office in the facilities with which we worked. If we thought our task was daunting, we could only imagine the volume of work the other facilities faced to keep up with the influx of new patients and new physicians needing credentialing, operating room time, technology training, etc. In a few short weeks, the number of our physicians and allied health practitioners who needed disaster credentialing reached more than 700. There were some days we could not credential them fast enough. Once our power was back, we knew that we needed to organize, work smarter and be consistent in our processes.

As more hospitals signed on to offer assistance, we made some suggestions to expedite their credentialing. In lieu of the laundry list of items requested, we offered a “physician profile” from our Cactus Credentialing Software system, which included the physician’s information needed for credentialing, such as:

• Demographic information
• Verified education
• Training
• Licensure
• Certificate numbers
• Malpractice insurance
• Expiration dates
• Delineation of privileges

The other facilities could use this information to verify their credentials and perform due diligence on their end to meet standards. This made our jobs a little easier, as we could run the reports directly from our PCs and negate pulling the files and searching for documents, copying, faxing and scanning. The intent was to send these items later after the immediate crisis was over.

“There is no education like adversity.” — Disraeli

During this experience, we learned many lessons. Emergency preparedness is the most important. I had a contact list of our active physicians as an attachment on my BlackBerry that became critical during the initial crises when we had no power. Thankfully, we had the capability to recharge cellphones and laptops at the command center. Some other recommendations to prepare for disaster credentialing include the following:

• Always have a backup plan for power outages.
• Prepare quarterly reports with physicians’ contact information, licensure, DEA, boards, NPI# and malpractice insurance that you email to yourself and your staff on a quarterly basis for easy access. It’s also smart to keep a paper backup copy.
• Keep a current binder of information in the MSO that includes the contact information as listed above and delineation of privileges for each active practitioner and update quarterly.
• Standardize your disaster credentialing process.

We recently had a regional meeting of New York State Association for Medical Staff Services (NYSAMSS) members to discuss our experiences on the giving and receiving end of disaster privileging, and we all agreed that standardization of the disaster credentialing process needs to be addressed on a statewide level. For example, what credentialing process do you follow when the disaster is not over in a few days, but goes on during weeks and possibly months of recovery? We decided to form an ad-hoc committee that plans to meet with our state agencies to discuss guidelines for long-term disaster credentialing and devise a feasible plan for New York state and, of course, the rest of the country, as no state is immune to these epic disasters.

As the New Year begins and our medical centers slowly come back to life, New Yorkers have so much to be thankful for. My heartfelt thanks goes out to our MSPs and volunteers at NYU Langone Medical Center for their extraordinary team effort and positive spirit during this crisis. They worked tirelessly to make sure our patients had a safe haven and that our physicians, nurse practitioners and physician assistants had privileges expedited at all the facilities to which they applied.

Kudos to our neighboring hospitals in New York and New Jersey for their generosity, patience, understanding and outpouring of support. MSPs from all over the state called every day to volunteer their services and offer workspace, especially when we had no power. Special thanks to the hospitals that continually opened their doors to us and managed the incredible volume of work that came their way. Every day we witnessed teamwork in action, as our patients sought care and our physicians and nurses needed privileges to provide that care. Credentialing really does have no other master than the patient. I will never forget it.

Another moment close to my heart was an act of kindness brought on by our state association. A few weeks after the storm, as the NYSAMSS Board meeting commenced in Albany, our members volunteered to make donations, personally shop for and deliver much needed supplies to the homeless victims of Hurricane Sandy on the badly battered Long Beach Island. Is it any wonder I am so proud to be associated with this phenomenal group of women professionals?

As I celebrate 10 years of service at NYU Langone Medical Center — the same 10 years as a resident New Yorker — and involvement with NYSAMSS, I can attest wholeheartedly that New York is an incredibly special place with generous, compassionate, resilient people. No matter what challenges we face, I have no doubt that we will emerge stronger, tougher and better in so many ways.