Credentialing and Privileging Provider Profiling

Excerpt

Provider profiling involves systematically compiling and analyzing information related to the healthcare provider to define their characteristics in certain areas, including knowledge, professionalism, communication, procedural competency, and patient outcomes. Profiles are continually expanded and analyzed as a provider progresses beyond initial certification to ongoing practice throughout medical staff membership. Institutional medical staff committees reference the provider's existing profile when deciding on credentialing, privileging, advancement, promotion, acceptance to advanced training, and employment. Credentialing assesses if a provider meets institutional requirements for staff inclusion, such as training, board certification, and malpractice event history. In contrast, privileging evaluates a provider's behavior, skills, and procedures within their practice scope at the institution. In the initial credentialing and privileging phase, provider profiling entails collecting and analyzing comprehensive multifactorial data points used to assess the provider's potential clinical competence, professionalism, and adherence to the core competencies expected of a future medical staff member.