Licensing and medical board members: The rise of personal liability
Licensing and medical boards contribute to the management and quality assurance of healthcare quality. From service quality supervision to consumer education, disciplinary hearings to licensing decisions, licensing boards act as part of the framework of oversight that increases patient safety and preserves professional standards and quality. Under certain circumstances, members of licensing boards may be exposed to liability as a result of their position.
Board members may be considered participants in a conspiracy to restrain trade if they adopt anticompetitive policies that are outside the scope of the board's authority as defined by the statute governing that profession. Under such circumstances, board members may be personally liable under the antitrust laws. Even board members who are not licensed to practice (and therefore not competitors) can be held to the same degree of culpability as the licensee members. This is especially significant in states where no statutory limits have been placed on a government (or quasi-government) employee's liability for antitrust violations.
Board member liability issues in action
As an example of the personal liability that licensing and medical board members now face for their professional actions, consider Gary F. Edwards v. Lawrence M. Gerstein, et al. This case resulted in a jury in Missouri ruling in favor of a licensee in his civil suit against individual state licensing board members. The board members were found to have been negligent in their handling of a disciplinary hearing against the licensee and were therefore deemed personally liable. The final amount awarded to the licensee was $6.3 million, to be taken from the personal assets of board members, not the board's organizational funds.
Shortly after this ruling, another liability headline hit the news as the Supreme Court of Washington allowed another licensee to continue with a civil rights suit against board inspectors (Michael S. Jones v. The State of Washington, et al.). Yet again, the courts determined that individual licensing board members or inspectors can be held personally liable for acts committed in the performance of their official duties as part of the board.
Mitigating risk through automation
License Boards that are characterized by paper processes and manual review may expose board members to liability. Adverse decisions may be made based on erroneous or outdated information, or information related to the decision may be lost or misplaced. Board members may be placing a great deal of trust in error-prone procedures.
Electronic licensing platforms offer centralization of data into a single, secure provider record, through which provider data accuracy is maintained and provider history is preserved. For more discerning licensing and medical boards, some portals additionally utilize patented technology to perform continuous, automated data verification against trusted primary source databases, thereby providing real-time validation 24/7 and immediate notification of discrepancies or other provider issues that may affect licensure. Through constant monitoring, boards have continuous proof of verification results and ongoing monitoring statistics. With the strong defense of an objective, transparent, technology-driven licensing process, liability can be reduced.
How to choose the automated licensing solution for your board
To avoid liability and protect board members, the transition to automated licensing seems inevitable. To help streamline this process, here are some guidelines to remember when searching for a simple and cost-effective solution for your board:
1. Aim for automation. Application collection, data verification and constant monitoring must be immediate and user friendly. Make sure that the solution you choose allows you to electronically automate as many of these functions as possible to keep costs and resource strain low.
2. Streamline the provider process. Manual licensing models are quite demanding on providers who must hand write and mail applications every renewal cycle. Reduce your providers' administrative burden by choosing a partner with a Web-based data collection portal that allows providers to utilize a secure, online application with rules-based logic to ensure that applicants only answer questions applicable to their specialty, practice location, etc. Additionally, make sure the portal offers your providers a one-stop licensing experience by allowing immediate upload of scanned supporting documents and HIPAA-compliant electronic signature capabilities for application completion.
3. Demand accessibility. 24/7 accessibility has become a modern requirement of any technology solution. To achieve maximum process efficiency, make sure that you utilize a Web-based solution that allows a transparent view of provider data and licensing processes to board members from start to finish. This is most easily achieved if your technology partner houses information in a single, electronic relational data warehouse and compiles a single, secure provider record to avoid data duplication.
4. Ensure integration. With data sharing increasingly required across national and state databases, choose the technology solution that allows flexible integration with any internal or external system.
5. Maintain data accuracy. To protect the public, your organization must guarantee that a licensee's credentials are valid and compliant at all times. Look for a solution that offers you real-time data accuracy through constant, automatic data verification and electronic alerts when provider data changes.
6. Simplify analysis and reporting. To understand your data and perform enterprise-wide data analysis for credentialing, claims management, provider relations, etc., make sure the electronic licensing solution your board utilizes generates online reports, statuses and other information through an ad hoc reporting system.
7. Choose an experienced partner. If you opt to use a vendor's outsourced services, make sure that they have experience implementing statewide solutions and that they have a strong knowledge of licensing processes and your agency's unique needs.
With these guidelines in mind, your board is sure to find the automated licensing solution that will offer optimum efficiency and cost savings.
The pillars of licensing change
It has become obvious that change is on the horizon for licensing and medical boards' processes, procedures and technologies. There needs to be a holistic view of the licensing continuum which features Web-based provider communication platforms to ensure accuracy and completeness, automated and continuous primary source verification of all provider data, Web services integration between all stakeholders and a change of course in looking at licensing as a key component of quality care.
About the author
Matthew Haddad is president and CEO of Medversant Technologies. Haddad is an attorney and member of the state bars of California, New York and Massachusetts. He is also a patent holder of Medversant's AutoVerifi technology (US Patent No. 7,529,682). To learn more about Medversant Technologies, go to www.medversant.com.
