[Federal Register Volume 67, Number 239 (Thursday, December 12, 2002)]
[Notices]
[Pages 76411-76412]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 02-31251]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Indian Health Service


Indian Health Service Medical Staff Credentials and Privileges 
Files

AGENCY: Indian Health Service, HHS.

ACTION: Request for public comment: 30-day proposed collection: Indian 
Health Service medical staff credentials and privileges files.

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SUMMARY: The Indian Health Service (IHS), as part of its continuing 
effort to reduce paperwork and respondent burden, conducts a pre-
clearance consultation program to provide the general public and 
Federal agencies with an opportunity to comment on proposed and/or 
continuing collections of information in accordance with the Paperwork 
Reduction Act of 1995 (44 U.S.C. 3506(c)(2)(A)). This program helps to 
ensure that requested data can be provided in the desired format, 
reporting burden (time and financial resources) is minimized, 
collection instruments are clearly understood, and the impact of 
collection requirements on respondents can be properly assessed. As 
required by section 3507(a)(1)(D) of the Act, the proposed information 
collection has been submitted to the Office of Management and Budget 
(OMB) for review and approval.
    The IHS received comments in response to the 60-day Federal 
Register notice (67 FR 50892) published on August 6, 2002. The public 
comments received in response to the notice and the agency responses 
are summarized and addressed below.
    Comment: One comment questioned the accuracy of the public burden 
estimate for this collection of information by indicating the burden 
estimate seemed to be too low.
    Agency response: The burden estimate was checked by having 
additional clinical staff review and complete the application formats. 
This consultation was conducted within the Department of Health and 
Human Services with the Federal Credentialing Program, and with several 
Department of Defense (DoD) hospital medical staff members. They 
confirmed the accuracy of the burden hour estimates for formats used in 
this information collection activity and the burden for the Application 
to Medical staff was increased accordingly. They made no specific 
recommendations to change any of the application formats or process.
    Comments: One comment suggested we consider the time burden spent 
by agency staff on this activity.
    Agency response: The time spent by agency staff to handle and 
process this data collection is not considered in the ``public'' burden 
estimate. However, the agency is examining methods to reduce the time 
it takes agency staff to process this required data.
    Comment: One comment suggested IHS centralize or regionalize the 
credentialing process and make it a web-based format.
    Agency response: Agency staff responsible for oversight of the 
medical staff credentials and privileges application process are 
currently collaborating with the Veterans Health Administration and DoD 
health program staff to make cost-appropriate advances and improvements 
in the credentials process and to automated appropriate portions of the 
credentials and privileges process. At present, automation of this 
process and use of a data repository like the Federal Credentialing 
Program or other complex relational databases is prohibitively 
expensive for the IHS. It is hoped that the collaboration will result 
in the automation and/or centralization/regionalization of some aspects 
of the agency's credentialing process and thereby reduce the public 
burden to provide the data and the agency staff time needed to process 
the data.
    Comment: One comment suggested IHS implement a nationwide corporate 
credentialing service with staff trained in the credentialing process.
    Agency response: The collaboration discussed above will address 
this suggestion.
    Comment: One comment suggested the credentialing process include a 
``criminal background check''.
    Agency response: The criminal background check is not a part of the 
IHS credentialing process. However, Public Law 101-630, the Indian 
Child Protection and Family Violence Protection Act, requires that all 
IHS employees, including the medical staff, with potential direct or 
unobserved contact with kids be checked for any history of criminal 
acts against children. In addition, the Division of Commissioned 
Personnel, United States Public Health Service, conducts a criminal 
background check as part of its Childcare National Agency Check with 
Written Inquiries (CNACI) system on all new appointees.
    The purpose of this notice is to allow an additional 30 days for 
public comment to be submitted directly to OMB.

Proposed Collection

    Title: 09-17-0009, ``Indian Health Service Medical Staff 
Credentials and Privileges Files.'' Type of Information Collection 
Request: Extension of a currently approved information collection, 09-
17-0009, ``Indian Health Service Medical Staff Credentials and 
Privileges Files.'' Form Number: Instructions and information 
collection formats are contained in IHS Circular No. 95-16, 
``Credentials and Privileges Review Process for the Medical Staff.'' 
Need and Use of Information Collection: The IHS operates health care 
facilitates that provide health care services to American Indians and 
Alaska Natives. To provide these services, the IHS employs (directly 
and under contract) several categories of health care providers 
including: physicians (M.D. and D.O.), dentists, psychologists, 
optometrists, podiatrists, audiologists, physician assistants, 
certified registered nurse anesthetists, nurse practitioners, and 
certified nurse midwives. IHS policy specifically requires physicians 
and dentists to be members of the health care facility medical staff 
where they practice. Health care providers become medical staff 
members, depending on the local health care facility's capabilities and 
medical staff bylaws. There are three types of IHS medical staff 
applicants: (1) Health care providers applying for direct employment 
with IHS (2) contract health care providers who will not seek to become 
IHS employees; and (3) employed IHS health care providers who seek to 
transfer between IHS health care facilities.
    National health care standards developed by the Health Care 
Financing Administration and by the Joint Commission on Accreditation 
of Healthcare Organizations (JCAHO) require health care facilities to 
review, evaluate and verify the credentials, training and experience of 
medical staff applicants prior to granting medical staff privileges. To 
meet these standards, IHS health care facilities require each medical 
staff applicant to provide information concerning their education, 
training, licensure, and work experience and any adverse disciplinary 
actions taken against them. This information is then verified with 
references supplied by the applicant and may include: former employers, 
educational institutions, licensure and certification boards, the 
American Medical Association, the Federation of State

[[Page 76412]]

Medical Boards, the National Practitioner Data Bank, and the applicants 
themselves.
    In addition to the initial granting of medical staff membership and 
clinical privileges, JCAHO standards require that a review of the 
medical staff be conducted not less than every two years. This review 
evaluates the current competence of the medical staff and verifies 
whether they are maintaining their licensure and the certification 
requirements of their specialty.
    The medical staff credentials and privileges records are maintained 
at the health care facility where the health care provider is a medical 
staff member. The establishment of these records at IHS health care 
facilities is not optional; such records must be established and 
maintained at all health care facilities in the United States that are 
accredited by JCAHO. This information collection activity is used to 
evaluate individual health care providers applying for medical staff 
privileges at Indian Health Service (IHS) health care facilities.
    Affected Public: Individuals, Businesses or other for-profit, Not-
for-profit institutions and State, local or Tribal Government.
    Type of Respondents: Health care providers requesting medical staff 
privileges at IHS health facilities.
    The table below provides the following: Types of data collection 
instruments, estimated number of respondents, number of responses per 
respondent, annual number of responses, average burden hour per 
response, and total annual burden hour.

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                                                                                                        Total
                                 Estimated    Responses      Annual       Average burden hour per       annual
  Data collection instrument     number of       per       number of             response*              burden
                                respondents   respondent   responses                                    hours
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Application to Medical Staff..          600            1          600  1.00 (60 mins)..............        600.0
Reference letter..............        1,800            1        1,800  0.33 (20 mins)..............        600.0
Reappointment request.........          644            1          644  1.00 (60 mins)..............        644.0
Medical Privileges............          387            1          387  1.00 (60 mins)..............        387.0
Ob-Gyn Privileges.............           25            1           25  1.00 (60 mins)..............         25.0
Surgical Privileges...........           23            1           23  1.00 (60 mins)..............         23.0
Psychiatric Privileges........           18            1           18  1.00 (60 mins)..............         18.0
Anesthesia Privileges.........           16            1           16  1.00 (60 mins)..............         16.0
Dental Privileges.............          128            1          128  0.33 (20 mins)..............         42.2
Optometric Privileges.........           21            1           21  0.33 (20 mins)..............          6.9
Psychology Privileges.........           23            1           23  0.17 (10 mins)..............          4.0
Audiology Privileges..........            6            1            6  0.08 (5 mins)...............          0.5
Podiatric Privileges..........            6            1            6  0.08 (5 mins)...............          0.5
Radiology Privileges..........            9            1            9  0.33 (20 mins)..............          3.0
Pathology Privileges..........            3            1            3  0.33 (20 mins)..............          1.0
                               --------------
      Total...................        3,709  ...........  ...........  ............................     2,371.0
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*For ease of understanding, burden hours are also provided in actual minutes.

    There are no Capital Cost, Operating Costs and/or Maintenance Costs 
to report.
    Request for Comments: Your written comments and/or suggestions are 
invited on one or more of the following points: (a) Whether the 
information collection activity is necessary to carry out an agency 
function; (b) whether the agency processes the information collected in 
a useful and timely fashion; (c) the accuracy of public burden estimate 
(the estimated amount of time needed for individual respondents to 
provide the requested information); (d) whether the methodology and 
assumptions used to determine the estimate are logical; (e) ways to 
enhance the quality, utility, and clarity of the information being 
collected; and (f) ways to minimize the public burden through the use 
of automated, electronic, mechanical, or other technological collection 
techniques or other forms of information technology.
    Direct Comments to OMB: Send your written comments and suggestion 
regarding the proposed information collection contained in this notice, 
especially regarding the estimated public burden and associated 
response time, to: Office of Management and Budget, Office of 
Regulatory Affairs, New Executive Office Building, Room 10235, 
Washington, DC 20503, Attention: Allison Eydt, Desk Officer for IHS.
    Send requests for more information on the proposed collection or to 
obtain a copy of the data collection instrument(s) and instructions to: 
Mr. Lace Hadohkwen, Sr., M.P.H., IHS Reports Clearance Officer, 12300 
Twinbrook Parkway, Suite 450, Rockville, MD 20852, 1601, call non-toll 
free (301) 443-1116, send via facsimile to (301) 443-2316, or send your 
E-mail requests, comments, and return address to: [email protected].

FOR FURTHER INFORMATION CONTACT: Directly pertaining to the proposed 
data collection instruments and/or the process, please contact 
Katherine Ciacco Palatianos, MD, 801 Thompson Avenue, Suite 320, 
Rockville, Md 20852-1627, Telephone (303) 443-1479.
    Comment Due Date: Your comments regarding this information 
collection are best assured of having their full effect if received 
within 30-days of the date of this publication.

    Dated: December 3, 2002.
Robert G. McSwain,
Acting Interim Director.
[FR Doc. 02-31251 Filed 12-11-02; 8:45 am]
BILLING CODE 4160-16-M