Credentialing and Privileging Process part 3, FPPE, OPPE, and Peer Review

Credentialing, Privileging, and Professional Practice Evaluation (FPPE and OPPE)

updated 8.26.2016

Keywords:  credentialing, privileging, FPPE, OPPE, quality assurance, peer review, LIP

Related posts:  Credentialing and Privileging section
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In credentialing and privileging Licensed Independent Practitioners (LIP), The Joint Commission (TJC) established the following quality assurance processes, “Focused Professional Practice Evaluation (FPPE)” and “Ongoing Professional Practice Evaluation (OPPE)”[i].  FPPE is the process a new hospital hire goes through the first year or so of practice.  This is commonly a more detailed and thorough vetting and review process than OPPE.  After the FPPE is complete and the practitioner is no longer “new”, commonly OPPE is used as a professional review and quality assurance measure. [Note that FPPE is always used for a new hospital hire.  It may also be used again (on an established hire) if a practitioner is flagged as performing substandard care.]  

FPPE and OPPE basic guidelines are set by TJC.  Every hospital has specific institution-specific versions of FPPE and OPPE for any provider that falls into the Licensed Independent Practitioner (LIP) category of provider-type.  These institution-specific guidelines follow TJC standards.  [TJC Standards Search page[ii]]  OPPE may include any of the following, as determined by the institution:  periodic chart review, direct observation, monitoring of diagnostic treatment and techniques, possible discussions with consulting providers, nursing personnel, and administrative personnel[iii]

Peer Record Review (periodic chart review by a peer or peers) is a common practice for quality assurance and falls under the requirements that fulfill both FPPE (new hospital hire) and OPPE (established hospital employee).

If you are interested in commenting on a TJC standard: 

“The Joint Commission provides a Standards Online Submission Form as one of the means of soliciting questions about the standards.”  TJC invites providers to use the form and send them your questions and thoughts about the standards in their “how to comment on a standard” webpage: and directed to the TJC Standards Interpretation Group through the online standards question form.

Remember, when TJC looks at creating a standard, they judge it by the following criteria:

• Does it have a strong evidence-base?
• Does it have a strong relationship to patient outcomes/clinical care?
• Does it support a health care organization’s goal of patient safety and quality of care?
• Does it have benefits that outweigh the costs?
• Does it support a health care priority which impacts quality and safety?

References  

• The Joint Commission’s FAQ search page on Standards[iv] 
• TJC Leadership Blog, “OPPE and FPPE:  tools to help make privileging decisions” by Robert Wise, MD, dated August 21^st, 2013.   
• TJC Leadership Blog, “Using OPPE as a performance measurement tool” by Paul Ziaya, MD, dated Feb 5^th, 2014.  
• TJC Leadership Blog post, “Physician experience with standards: An opportunity for understanding and improvement”, by Robert A. Wise, MD, dated Nov. 6^th, 2013.  

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[i] In 2004 The Joint Commission (TJC) renamed “Peer Review” as “Focused Review of Practitioner Performance” and since 2007, it has been known as “Focused Professional Practice Evaluation (FPPE)” and “Ongoing Professional Practice Evaluation (OPPE)”. 

[ii] From Standards page, search keyword “OPPE”.  Under “Hospital and Hospital Clinics” category, then OPPE-Intent.  “The intent of OPPE allows the Hospital/Critical Access Hospital to identify professional practice trends that impact the quality of care and patient safety as it relates to privileges granted to the Licensed Independent Practitioners.”

[iii] From Standards page, keyword “OPPE”.  Under the “Hospital and Hospital Clinics” category, then OPPE-data collection guides

[iv] From Standards page, keyword “FPPE”.  Under the “Hospital and Hospital Clinics” category, note the following links for FPPE:

Components of Design Process

Monitoring Timeline

*Intent*

New Privileges

Pre-defined Process

*4 Required Components*

Peer Review

Links for OPPE:

Low volume practitioners—data use from another organization

Medical/cognitive specialties

*data collection guides*

*Intent*