Massachusetts providers, payers axing mental health, prior drug use credentialing questions

Massachusetts healthcare organizations announced this week that every hospital, health system and local health plan in the state is removing “stigmatizing or invasive” mental health questions from physician credentialing processes, a commitment they said is a first for the nation.

The push to remove such questions has been championed by the American Medical Association (AMA), the U.S. Surgeon General, the National Academy of Medicine and several other major groups who say it intimidates clinicians from seeking needed mental health support.

As of late October, 26 state medical boards (including Massachusetts in 2018) had changed the language of their licensure applications to remove broad, “intrusive” questions related to physicians’ mental health, according to the Dr. Lorna Breen Heroes’ Foundation, an advocate for the change and others focused on clinician mental health.

On Monday, the Bay State took the effort a step further when the Massachusetts Health & Hospital Association (MHA) announced that its Board of Trustees had unanimously approved reforms to the credentialing process. The association said it is working with individual member organizations “to bring their policies up to best practice.”

Also partnering on the push is the Massachusetts Medical Society; the Massachusetts Association of Health Plans and Blue Shield of Massachusetts, whose local health plans each have credentialing forms for clinicians; and other major healthcare groups from outside the state.

“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,” MHA Vice President of Clinical Integration Steven Defossez, M.D., said in a statement. “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.”

Of particular note, the Massachusetts groups' announcement highlighted a recent update from the National Committee for Quality Assurance to no longer require health plans to ask clinicians about prior drug use. This change “will allow the commonwealth to update its common credentialing application, known as the Integrated Massachusetts Application (IMA), with full endorsement from local health plans,” and extend to the 38 Massachusetts hospitals that also use the IMA, they said.

“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,” Liz Leahy, senior vice president of advocacy and engagement at the Massachusetts Association of Health Plans, said in a statement. “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.”

Recent years have seen an increasing number of healthcare workers report feelings of burnout and similar stressors, per federal data. Advocates for clinician mental health are quick to point to systemic factors like credentialing questionnaires as a potential target for industry groups and policymakers seeking to avert workforce departures and a national shortage of 37,000 to 124,000 physicians over the next decade.

In a statement included with the Massachusetts organizations’ announcement, AMA President Jesse Ehrenfeld, M.D., said his group commends the commitment and painted it as a hopeful starting point for the rest of the country.

“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,” he said.