Northwell changes credentialing to accommodate mental health

Healthcare providers are not immune to the growing mental health crisis, and that's why New Hyde Park, N.Y.-based Northwell Health has overhauled its credentialing process.

"We have a moral obligation to address the long-standing crisis of burnout, exhaustion and moral distress across the health community," U.S. Surgeon General Vivek Murthy, MD, said in a May 23 advisory. "We owe health workers far more than our gratitude. We owe them an urgent debt of action."

President Joe Biden signed the Dr. Lorna Breen Health Care Provider Protection Act into law March 18, and Northwell leaders quickly got to work. The act, which is named after a New York City emergency medicine physician and former Northwell resident who took her own life in the height of the pandemic, is aimed at improving mental and behavioral health among healthcare providers.

Northwell updated its credentialing questions from a format that singles out mental and behavioral issues to one that does not.

Previously, Northwell's credentialing forms asked:

Do you have a physical, mental or emotional condition or substance abuse problem that could affect your ability to exercise safely and competently the clinical privileges requested?

Leaders at Northwell updated it to read:

1) Do you have a current condition or are you taking medication that would affect your ability to practice or provide safe patient care for the privileges you are requesting? Yes/No

2)    If the answer to No. 1 is Yes: Do you require a reasonable accommodation to exercise your requested privileges safely and competently?

         If yes, please identify the accommodation that is needed and its duration. 

"Sometimes people don't seek help because they're worried about their license and hospital privileges," Northwell Senior Vice President of Medical Affairs and Deputy Chief Medical Officer Annabella Salvador-Kelly, MD, told Becker's.

While the question's original form created a chilling effect on providers seeking the treatment they need, it also likely resulted in some lying about relevant conditions that could affect their ability to practice.

"There are some states that ask, 'Have you ever …' not even whether the condition is current," Dr. Salvador-Kelly said. "If somebody who had postpartum depression for a month after they gave birth, and who sought treatment for that one month, but has been perfectly fine ever since? That's nobody's business and not any different than somebody who gets medication for diabetes."

For those worried about whether such a change would jeopardize their accreditation, Dr. Salvador-Kelly said The Joint Commission now discourages organizations from asking about history of mental health conditions or treatments. It also recommends limiting questions to conditions that currently impair job performance.

"It's something all health systems could do," she said. "The cost is basically free, but the message it sends to team members is invaluable."

It's an opportunity ASCs can make use of, too, Northwell Vice President and Chief Quality Officer for Ambulatory Services Nancy Beran, MD, told Becker's.

"If you're a freestanding ASC, I think you have to look at the legislation [in your area], but because of what [Dr. Salvador-Kelly] was saying, if you're Joint Commission, you can still change your language," Dr. Beran said.

Northwell was able to implement the updated question to all credentialing and hospital privilege forms in all their departments in about two months, Dr. Salvador-Kelly said.

"Single hospitals or even smaller health systems probably can get it done even faster," Northwell Vice President of Occupational Medicine, Epidemiology and Prevention Jacqueline Moline, MD, told Becker's. "The switch could be done within a week easily at a single hospital."

"Our goal is to say, hey, you might not have looked at those questions in 10 or 20 years," Dr. Salvador-Kelly said. "Now's the time to do it."

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