Massachusetts Health & Hospital Association

First in the Nation: Massachusetts Healthcare Community Commits to Eliminating Invasive, Stigmatizing Questions from the Credentialing Processes

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Every local hospital, health system, and local health plan is a part of this effort to support clinicians’ mental health and wellbeing

BURLINGTON, MA – December 11, 2023 – In a nation-leading step for caregiver wellbeing, Massachusetts is the first state in which every hospital, health system, and local health plan has committed to eliminating potentially stigmatizing or invasive questions from their credentialing processes. This is part of the healthcare community’s broader strategy to support clinician wellbeing and reduce stigma within the ranks of the profession, and to help connect workers with the mental health resources they need.

Each year, thousands of local physicians and healthcare professionals go through the credentialing process to ensure they are in good standing to deliver safe patient care. However, the forms used within this process have often included outdated, unnecessary questions about clinicians’ mental health history and past drug use. Caregivers have been discouraged from seeking behavioral health services because they know they will encounter these overly broad questions and fear their livelihoods will be threatened as a result of answering honestly.

The Massachusetts Health & Hospital Association’s Board of Trustees unanimously approved this effort to reform the credentialing process, and the association is working with individual members to bring their policies up to best practice. The initiative also is championed in partnership with the Massachusetts Medical Society, local health plans (which have their own credentialing forms that clinicians must compete), and leading national healthcare organizations. The commonwealth is the first state to mount such a comprehensive commitment across providers, insurance companies, and advocates.

In a major victory, the National Committee for Quality Assurance (NCQA), which accredits health plans nationwide, will no longer require that the plans ask clinicians about their prior drug use. The change is the result of extensive internal review, coalition building, and advocacy from MHA and its partners. The NCQA’s modification will allow the commonwealth to update its common credentialing application, known as the Integrated Massachusetts Application (IMA), with full endorsement from local health plans. This change will also affect 38 Massachusetts hospitals that use the IMA form for their own credentialing practices.

The initiative comes at an especially intense time for the healthcare system and its caregivers. As has been well documented, clinicians in every role are reporting troubling rates of stress, fatigue, and burnout. Healthcare leaders continue to prioritize new and creative ways to support their employees – including behavioral health support.

“We are proud that, once again, our provider organizations are meeting the moment and rallying around the wellbeing of their caregivers,” said Dr. Steven Defossez, vice president of clinical integration at MHA. “While we will never know which clinicians will now choose to seek support, we are confident that they and their patients will be far better off as a result of this united initiative. We will celebrate the impact that this effort will have, while knowing it is just one more step along the way to mitigate burnout and eliminate stigma from the healthcare profession. We hope that Massachusetts’ credentialing practices can serve as a model for healthcare systems across the nation.”

“These changes signify a major reduction of stigma-fueled barriers that render physicians reluctant to seek appropriate care for their own mental health concerns, including those commonly known to drive and exacerbate burnout like depression and anxiety,” said Massachusetts Medical Society president Dr. Barbara S. Spivak, whose organization in 2018 advocated successfully for the elimination and modification of intrusive and overly broad questions regarding mental health issues on physician licensure applications. “This supportive approach will encourage physicians to take care of themselves, so they are better equipped to deliver safe, quality, and equitable patient care. The epidemic of physician burnout remains a focus of the Medical Society, and we will continue to push for meaningful reduction of administrative burdens and improved workplace culture and flexibilities so that we can build a robust, diverse, and sustainable physician workforce capable of meeting patient needs across the commonwealth.”

“MAHP and our member plans believe that every individual should have access to high-quality, affordable, and equitable healthcare, including mental health and substance use disorder treatment,” said Liz Leahy, senior vice president of advocacy and engagement at the Massachusetts Association of Health Plans. “It is our hope that NCQA’s elimination of this outdated question, formerly required as part of health plans’ provider credentialing processes, will reduce stigma for providers and patients alike. Ensuring patient access to robust, high-quality provider networks means ensuring our provider partners are able to seek the care they need without fear of discrimination.”

“Blue Cross Blue Shield of Massachusetts works hard every day to ensure that our members get the healthcare they need when they need it,” said Michael Caljouw, BCBSMA’s vice president, state government and regulatory affairs.  “We are proud of our work collaborating with our clinician partners to eliminate this particular question and will continue to review similar opportunities to remove other barriers that no longer make sense.” 

The removal of potentially invasive and stigmatizing language from credentialing forms is supported by leading national healthcare organizations, including the American Medical Association, the Dr. Lorna Breen Heroes’ Foundation, The Joint Commission, the National Academy of Medicine, the U.S. Surgeon General Health Worker Burnout Advisory, the Institute for Healthcare Improvement, the Federation of State Physician Health Programs, and The Federation of State Medical Boards.

The Dr. Lorna Breen Heroes’ Foundation commends the leadership of the Massachusetts Health & Hospital Association, Massachusetts Medical Society, and local health plans for prioritizing the mental health and well-being of all healthcare professionals,” said CEO & Co-Founder Corey Feist. “The Dr. Lorna Breen Heroes’ Foundation is helping to transform the culture to one where seeking mental health care is viewed as a sign of strength. Through our ALL IN: Wellbeing First Champions Challenge, we have seen remarkable progress across the country by licensing boards and hospitals in using our toolkit to eliminate overly invasive questions about prior mental health of clinicians, which serve to reinforce the structural stigma against getting mental health treatment as well as serve as the primary driver of suicide of health workers. We look forward to awarding Champions Challenge badges across Massachusetts as a visible reminder to clinicians that they are free to obtain mental health treatment without fear of professional repercussions.”

“The American Medical Association commends the Massachusetts Health & Hospital Association, Massachusetts Medical Society and all those in the commonwealth who have made the commitment to support physicians’ health and wellness by removing stigmatizing questions about past treatment or diagnosis of a mental illness or substance use disorder on credentialing applications and peer review forms,” said AMA President Jesse M. Ehrenfeld, MD, MPH. “We urge all other state hospital associations to make the same commitment and join a growing number of leading state and national organizations that recognize the urgent need to make these changes.”