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The Ins and Outs of Healthcare Credentialing: Ensuring Quality Care and Patient Safety


As a patient, you deserve high-quality medical care from competent professionals. However, research indicates that physician errors can have devastating consequences. The numbers of medical errors in the United States are alarming. Recent studies suggest that medical mistakes may account for as many as 251,000 deaths annually, making them the third leading cause of death. Credentialing and privileging are essential processes that help mitigate these risks by ensuring healthcare providers meet rigorous standards and prioritize patient safety and well-being.


What is Credentialing?

Credentialing is the systematic process of verifying a medical provider's qualifications, education, training, and experience. This includes:


  • Verifying medical degrees and certifications

  • Confirming licensure and registration

  • Evaluating work history and experience

  • Assessing professional references

  • Reviewing malpractice history


What is Privileging?

Privileging grants authorized medical providers permission to perform specific procedures and treatments within a healthcare facility. This process:


  • Evaluates a provider's competence in specific areas

  • Assesses their ability to meet facility standards

  • Defines scope of practice and procedures


Why are Credentialing and Privileging Important?

Credentialing and privileging of medical providers are crucial processes that ensure patients receive high-quality care from competent professionals. Here are some key points highlighting their importance:


  • Ensures Patient Safety: Credentialing verifies a medical professional's qualifications, education, and experience, reducing potential medical errors and ensuring patients receive care from qualified individuals.

  • Maintains Healthcare Standards: Credentialing establishes consistent levels of patient care by ensuring practitioners meet rigorous criteria in education, training, and expertise.

  • Fosters Patient Confidence: Credentialing and privileging instill trust among patients, recognizing healthcare providers' skills and expertise.

  • Ensures Compliance with Regulations: Credentialing helps healthcare facilities adhere to regulatory requirements and standards.



How to Determine a Medical Provider's Credentials

  1. State Medical Boards: Verify licensure and registration.

  2. American Board of Specialties: Confirm certification and education.

  3. Healthcare Facility Verification: Patient-Reported Outcomes.

  4. Online Reviews and Ratings: Research patient experiences.

By understanding credentialing and privileging, you can make informed decisions about your healthcare. Remember, it's your right to ask about your provider's qualifications.


Additional Resources:



Medical errors pose significant risks, but credentialing and privileging can help. These processes verify healthcare providers' qualifications and grant permissions for specific procedures. By understanding credentialing and privileging, patients can ensure they receive high-quality care from competent professionals, prioritizing safety and well-being.



References:


James, J. T. (2013). A new, evidence-based estimate of patient harms associated with hospital care. Journal of Patient Safety, 9(3), 122-128.


Kohn, L. T., Corrigan, J. M., & Donaldson, M. S. (2000). To err is human: Building a safer health system. National Academy Press


Makary, M. A., & Daniel, M. (2016). Medical error—the third leading cause of death in the US. BMJ, 353, i2139. doi: 10.1136/bmj.i2139


StatPearls. (2022). Credentialing and privileging. In NCBI Bookshelf. Retrieved from Credentialing - StatPearls - NCBI Bookshelf (nih.gov)


Assessed and Endorsed by the MedReport Medical Review Board

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