Credentialing and privileging and how does that fit in with telehealth. So, as I said earlier, credentialing and privileging credentialing is essentially like checking your background, checking your information, reviewing your qualifications before you are granted privileges to provide services within an institution usually a hospital or a clinic. Now where that becomes problematic sometimes for maybe smaller institutions or smaller hospitals who perhaps don't have like a lot of money to do this process, do the full credentialing review process. And that becomes very problematic for them, especially if they are in rural areas and they're trying to get certain specialty services to their patients and they need to try to get those types of specialists to provide those services. Perhaps they're not in a place where they can attract them physically to like move there to provide their services. So what they've done in the past is utilized telehealth to provide those services to their communities. However, if they have to go through the full credentialing process that might become problematic, it may not be worth their while to go through the full credentialing process because maybe they just have a small segment of the population that needs those services. So what has happened then to sort of like address this conundrum, especially for those smaller institutions, smaller hospital, smaller clinics that don't have a lot of resources to devote to this, but still have a need, but maybe like not a significant enough need to like justify going through the full credentialing process, which can be very expensive and time consuming. The federal government came up with an alternative channel of like doing the credentialing process where telehealth is concerned. So, as I said, the credentialing process, it can be long and intensive and expensive. So if you're again a smaller institution, you may not have the resources to go through all that if you are perhaps only needing those services for a very small segment of your community. But the the federal government came up this solution a couple of years ago, and it's an alternative. It's an alternative way of doing credentialing. So hospitals and clinics are not forced to go take this route if they don't want to, they can go through the full credentialing process. This was just offered as an alternative for institutions that they were running into this issue. And what that alternative is that under the federal regulations and conditions of participation. And what that means is conditions of participation. It means that hospitals can receive Medicare and Medicaid money, basically money from the feds, if they agree to to certain conditions of participation and receiving that money. And one of those things is they change that regarding credential telehealth providers where they have said, if you are a hospital and you're agreed to these conditions participation what you can do for telehealth providers in this credentialing process is that you can go ahead and use the credentialing review materials and all the work that the telehealth providers home institution did to originally credential that provider, you can use that for your own institution. So instead of you basically little hospital starting from scratch with your matching process, you can rely on what was done originally to credential that telehealth provider, their home institution. However, you need to do certain things before you can do that. And basically is there needs to be an agreement between the two parties that you're doing this. There needs to be like reporting of adverse incidents with that telehealth provider in your institution back to his home institute, his or her home institution or their home institution. And also the site that is receiving those telehealth services. You're probably going to have to change your bylaws to say that you're adopting this process. So that's where that whole bylaw question comes through. It's like this kind of seems a little bit out there bylaws was concerned this talk, because we're talking about credentialing and licensure is because with this sort of expedited process, with credentials, this alternative process, with credentials and how to do it. There is an element of you may as an institution need to change your bylaws to say that you're going to adopt this alternative means or method of like doing credentialing within your institution. And then there are other requirements as well. I just listed a couple examples, but basically what this is is again, it's optional. So hospitals don't have to do it this way if they don't want to they can go through the full credentialing process. But the federal government has essentially said, we're giving you an alternative route, if you are under time and many crunch, resources crunch, you can do it this way. You can rely on the telehealth providers, home institutions credentialing review of what they did for that provider, but you have to take certain steps in order for that to happen. And these are a couple of the steps, these are the applicable regulations for for the hospital. So, I've listed them there. The Joint Commission for those who don't know, they usually like to do things for community health clinics. They mirrored essentially the federal CMS regulations as well, those federal regulations. So that's basically there for different institutions, rule of thumb, hospitals for CMS and then sort of more clinics are for the joint commission. Generally that's not in every single case, I don't think. But basically the two sort of what is required and how you do this kind of do mirror each other there. So, but those are the actual like resources and where you can find that actual language. So hopefully right now after this talk, you understand the difference between licensure and credentialing and what that means and also what privileging means. And you understand how these compacts work and like how they impact the licensure issue. And also what are some steps that hospitals can take to help them with that credentialing process when they're talking about a telehealth provider, the faster way that they can do it an alternative way and one that's not mandated. So it's just like another option to address that credentialing issue if that is being an issue for your institution. And another way to like do it, that may be faster and a little bit less expensive for you. So I hope you found this talk useful and we hope to see more of future discussions. Thank you.
