As healthcare organizations grow, it becomes harder to maintain consistent, high-quality care across teams, locations, and specialties. To support safe practice, accrediting bodies such as The Joint Commission require hospitals and many healthcare facilities to use two evaluation processes: FPPE (Focused Professional Practice Evaluation) and OPPE (Ongoing Professional Practice Evaluation).

These processes help organizations confirm that every clinician—whether a physician, nurse practitioner (NP), or physician assistant (PA)—is practicing safely and competently. They are a key part of credentialing and privileging, and they are essential for maintaining accreditation and participation in Medicare and Medicaid programs.

This guide explains OPPE and FPPE in clear terms, why they matter, and how organizations can manage them more easily.

What Is FPPE?

FPPE is a short-term evaluation used to confirm that a clinician is able to perform certain clinical tasks safely.

FPPE is required when:

• A clinician is new to the organization
• A clinician is requesting new or expanded privileges
• There are concerns about performance that need review

FPPE can include chart review, direct observation, or peer feedback. Once the organization confirms that the clinician can perform the privilege safely, FPPE ends.

What Is OPPE?

OPPE (Ongoing Professional Practice Evaluation) is a continuous review process. Instead of waiting for a two-year reappointment cycle, OPPE gives organizations regular updates on how clinicians are performing.

OPPE usually includes:

• Quality and safety indicators
• Patient care outcomes
• Documentation quality
• Timeliness and responsiveness
• Compliance with policies and procedures

The goal is to identify both good and bad trends early, and support clinicians before problems grow.

Why Accrediting Bodies Require OPPE and FPPE

The Joint Commission

The Joint Commission introduced OPPE and FPPE requirements to ensure that organizations have a consistent, structured way to evaluate clinical performance. These requirements are part of the Medical Staff standards for credentialing and privileging.

If an organization does not have OPPE and FPPE processes in place—or cannot show proof during survey, it can lose accreditation, face corrective action plans, or risk reimbursement interruptions for Medicare and Medicaid

This is why hospitals take OPPE and FPPE so seriously: accreditation is directly tied to operations, funding, and patient trust.

Other Accrediting Bodies

While The Joint Commission is the most widely known, other bodies have similar requirements, including:

• DNV Healthcare
• The Healthcare Facilities Accreditation Program (HFAP)
• Center for Improvement in Healthcare Quality (CIHQ)

Each organization may phrase the requirements differently, but the expectations are the same: facilities must evaluate clinical competency in a structured, ongoing way.

Why OPPE and FPPE Matter Today

As the healthcare workforce changes, these evaluation processes have become even more important. Organizations now rely heavily on multi-disciplinary teams that include advanced practice providers (APPs), including NPs and PAs, who practice across different states, specialties, and care settings.

OPPE and FPPE help address key challenges:

1. Multi-State Provider Teams

State rules differ widely, especially for APP collaboration, supervision, and prescribing. OPPE and FPPE establish a consistent internal standard, even when regulations vary.

2. Growth of Telehealth and Hybrid Care

Remote care makes traditional oversight harder. Ongoing evaluation helps organizations maintain quality even when teams are distributed.

3. Rising Regulatory and Payer Scrutiny

Auditors and payers expect to see clear, complete documentation of clinician competency. Missing OPPE/FPPE records can create risk during audits.

4. Workforce Shortages

With shrinking physician supply and growing patient demand, organizations must activate large APP teams quickly and safely. Structured evaluation supports faster onboarding and better quality control.

Key Components of an Effective FPPE Process

A modern FPPE program includes:

• Clear criteria for when FPPE is triggered
• Defined evaluation periods and success metrics
• Direct observation, chart review, or peer assessment
• Documentation of outcomes and required actions

FPPE should lead to either confirmation of privilege competency or identification of areas requiring remediation or additional oversight.

Key Components of an Effective OPPE Process

Effective OPPE systems rely on:

• Objective performance metrics
• Peer review and feedback
• Ongoing documentation
• Integration with credentialing and privileging systems
• Transparent communication with clinicians

OPPE should not be a reactive process. Instead, it should support continuous improvement and provide organizations with a complete view of workforce quality.

Common Challenges Organizations Face

Despite the importance of OPPE and FPPE, many organizations rely on manual or fragmented systems that create significant operational friction, such as:

• Spreadsheet-based tracking
• Disconnected credentialing, collaboration, and quality systems
• Inconsistent review criteria across states or departments
• Limited visibility into provider performance
• Delays in privilege approval or renewal

These inefficiencies become more pronounced as organizations scale their clinical teams or expand into new jurisdictions.

Key Takeaways

OPPE and FPPE are core parts of credentialing and privileging for any accredited healthcare organization. They ensure safe practice, support continuous improvement, and protect organizations from compliance risk. By simplifying and standardizing these evaluations, healthcare organizations can focus on what matters most: delivering safe, high-quality care to patients.