Your Guide to Mastering Professional and/or Peer References

Professional references (or peer recommendations) are an important step in the credentialing effort—they offer peers an opportunity to verify the clinical competency of a provider. They can provide valuable information that might otherwise be unavailable regarding an applicant. However, though they offer significant value, they are only effective when used appropriately and obtained from a suitable source.

We’ll cover the purpose of references, when and how they should be used, who is a suitable reference, and what should be included in a professional reference letter.

What is the purpose of a peer reference?

Peer recommendations provide detailed insight into a provider’s abilities, character, values, and skill level. It is one of the many ways that healthcare organizations can work to ensure they are able to provide the highest level of patient care. Accreditors and regulatory agencies all have varying requirements when it comes to peer references. The purpose of obtaining references is not only to verify a provider’s clinical competency, but to remain compliant with the standards of concerned organizations.

• Centers for Medicare and Medicaid Services (CMS) requires documentation of experience and supporting references of competence. The standards of all hospital accreditors will have similar requirements
• HFAP/Accreditation Commission for Healthcare standards require that both application and reapplication must include peer references obtained from at least one - but preferably from three - peers
• The Joint Commission requires that peer recommendations be obtained from a practitioner in the same professional discipline as the applicant. The peer must have personal knowledge of the applicant’s ability to practice
• DNV Healthcare Standards require two peer recommendations for initial appointment
• Center for Improvement in Healthcare Quality standards require favorable peer reference(s) to be confirmed for each provider at the time of initial appointment and reappointment

When and how are peer references used?

Individual states may have specific requirements for peer references contained in their hospital licensing regulations. That is why it is critical that you know what the hospital licensure requirements are in your state.

Depending on the organization, you may only need peer references for initial credentialing. Reapplicants may find that peer reviews via the organization’s routine review is enough, but that a clinical competence review is a requirement of recredentialing.

The number of professional references required depends on your hospital accreditor:

• HFAP/Accreditation Commission for Healthcare requires at least one - but preferably three for initial appointment, but does not require professional references on recredentialing
• The Joint Commission’s standards state peer recommendations must be obtained and taken into consideration when developing recommendations for appointment to or termination from the medical staff and for the initial granting, revision, or revocation of clinical privileges, with no specific number addressed
• DNV Healthcare requires two recommendations for an initial appointment
• Center for Improvement in Healthcare Quality requires favorable peer reference(s) - meaning you can have one or more – at initial appointment and recredentialing

Who can provide a suitable peer reference?

According to the Joint Commission, a peer reference is defined as “information submitted by a practitioner(s) in the same professional discipline as an applicant, reflecting his or her perception of the applicant's clinical practice, ability to work as part of a team, and ethical behavior; or the documented peer evaluation of practitioner-specific data collected from various sources for the purpose of evaluating current competence.”

Sources for peer recommendations may include:

• An organization performance improvement committee, the majority of whose members are the applicant’s peers
• A reference letter(s), written documentation, or documented telephone conversation(s) about the applicant from a peer(s) who is knowledgeable about the applicant’s professional performance and competence
• A department or major clinical service chairperson who is a peer
• The medical staff executive committee

Most regulatory and accreditation bodies have different requirements, as do individual states. That is why it’s vital to not only know what hospital licensure requirements are in your state, but for every accreditation body you work with.

What should be included in a professional reference letter?

Once again, each hospital will have varying requirements, but there should be a policy in place with regard to what should be included in a professional reference. We recommend:

• A series of standard questions to be used with all candidates
• Details on the number and kind of references (directed or volunteered) required
• A method for requesting, storing, and tracking references
• Details on the type of references accepted (written vs. oral)
• Guidelines on turnaround and follow-up times

We believe that having specific questions will help you evaluate candidates in all areas of competency and ensure you can compare candidates’ side by side. Your questions should ask about a candidate’s:

• Clinical judgment/knowledge of field
• Best fit in terms of practice environment
• Leadership skills and ability to work as part of a team
• Personality traits, reputation, and work ethic
• Oral and written communication skills
• Ability to adapt to new situations and handle stress
• Professional competence
• Malpractice history/judgments against them
• Would the reference accept this candidate on their staff today, and in what capacity

It is also recommended that professional references come directly from the source. If letters are accepted from the applicant, there is no guarantee the peer actually composed the letter. There are other requirements to consider, like if a recommendation has to come from a peer in the same clinical specialty, or what to do if no one in the same professional discipline can provide a professional reference. We have answers to all that and more.

In Summary

We don’t have to tell you twice; credentialing providers takes a lot of effort. The good news is, CredentialStream® allows applicants to list peer references during the online application process. Users can also add references to a provider's file under the references section, and can automate peer references as part of their primary source verification workflow process that will send peer references electronically through CredentialStream. For any questions, we’re here to help, simply reach out!