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NAMSS Teams With 2 Major Groups to Deliver ICS Revisions

By Teddy Durgin

A decade ago, the National Association of Medical Staff Services (NAMSS) released the Ideal Credentialing Standards (ICS) to provide healthcare organizations with best-practice guidelines for initial practitioner credentialing. The ICS was subsequently revised in 2019 and now again in 2024. NAMSS named a task force to work on the latest revisions that was chaired by Diane Meldi, MBA, CPCS, CPMSM, FMSP. This task force teamed with the Dr. Lorna Breen Heroes Foundation and the American Medical Association (AMA).

Meldi, NAMSS Government Relations Liaison and senior consultant for the Mercy Health System, says, “The biggest change for 2024 are the health status questions on the practitioner’s application and the peer reference questions. NAMSS started communicating with the Dr. Lorna Breen Heroes Foundation in 2022 and with the AMA in 2023. All parties involved have endorsed the new language.”

J. Corey Feist, JD, MBA, CEO and co-founder of the Dr. Lorna Breen Heroes’ Foundation, was eager to get involved. “We needed to remove questions about prior mental health diagnoses and treatment,” he says. “That’s a big, big deal! We are very pleased that NAMSS has now joined a chorus of voices of regulatory or quasi-regulatory organizations who are also saying, ‘Eliminate any questions of prior mental diagnosis or treatment around your licensing and credentialing questions and others.’”

Why is this so important? Feist was quick to answer: “The mental health state of workers has gotten worse. And yet they are penalized — or at least there is the perception of a penalty for seeking treatment — that creates a patient safety issue, and it creates a workforce issue. These questions that they’ve had to answer harken back to a day in which stigma around mental health care is accepted. And now we have the Americans With Disabilities Act, which makes it very clear that asking anything other than questions around your current impairment is inappropriate.”

American Medical Association (AMA) President Jesse M. Ehrenfeld, MD, MPH, concurs, adding, “The AMA deeply appreciates and commends NAMSS for its national leadership and its commitment to supporting physicians’ health and wellness by removing those stigmatizing questions that are irrelevant. We need to make sure that when a physician needs help, he or she seeks it. They need not be concerned about losing their license, losing their ability to practice, because they are getting the help they need. Many physicians and physicians in training don’t seek out treatment for mental health or addiction issues because they’re concerned about the potential negative impact that getting treatment could have on their future career or burdening their colleagues with extra work.”

The ICS identifies 13 essential criteria for credentialing an initial-practitioner applicant and provides red flag and primary-source examples for each criterion. This year’s updated guidance includes vetted language that organizations can use to inquire about a practitioner’s health status, along with guidance for internet background checks and social media searches.

For Feist, the stakes are personal. His foundation was created in 2020 and is named after his sister-in-law, who was a physician in New York City who died by suicide after obtaining mental health treatment just one time. “She identified that this was going to immediately have an impact on her ability to be a physician,” he recalls. “She took her life shortly thereafter. We have heard from many, many others who have either attempted suicide or were a family member to those who died by suicide after expressing concerns for the ramifications of getting treatment or having a prior treatment.”

Meldi, too, has firsthand experience that has informed her work on the revisions. She says, “Through my many years as an MSP, I have seen practitioner suicide [and] medical careers destroyed by mental illness or drug addiction. If a practitioner can seek treatment without the concern of answering the previous health questions which differ throughout the country, I am encouraged that there will be more focus on practitioner wellness in the future and hopefully the past trends of suicide will be greatly reduced.”

Challenges, of course, remain. All three interviewees agreed that the 2024 ICS revision is but an essential first step. Ehrenfeld says, “Implementing systemwide structural changes to support physicians’ health is the critical next step. We stand ready to work with every hospital, every health system, and every practice to support their updating of credentialing applications to make sure they’re supporting all healthcare professionals’ health and well-being.”

He adds, “We’ve worked with more than a dozen state boards to change licensing applications and remove these kinds of questions. This has only been effective because there’s been such a great partnership with many stakeholders to urge these changes.”

Feist is equally committed with a positive eye toward the future. He points out, “The good news is these changes that we’re talking about that are in the 2024 standards can be implemented in as short as 48 hours. There is a lot of work to be done, but the work can be done quickly.”

Meldi notes that the ICS has already had over 3,000 downloads of the document. In addition, an already-full webinar with NAMSS, AMA, and the Dr. Lorna Breen Heroes Foundation will be held on March 25. It will focus on the ICS document and also how health systems can move forward to remove this questionnaire barrier and protect the well-being of the healthcare workforce.

Feist concludes, “No question, this will improve the entire landscape for the mental health of our healthcare workforce. We are anticipating the loss of 900,000 nurses to the profession in the next 10 years. We are also anticipating significant growth in the elderly population over that same period of time. We must create an environment where the workforce can thrive, stay in their jobs, and have healthcare themselves so they can take care of the population. These are humans who are deserving of the same access to mental health care when they need it as anyone else, free from negative consequences. This is going to change the culture, this is going to reduce the stigma, and this is going to improve the access of healthcare professionals to obtain the same mental health treatment that you and I can get.”