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Developing intended practice plans for low- and no-volume providers

Credentialing Resource Center Connection, May 1, 2008

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Sally J. Pelletier, CPMSM, CPCS, is a consultant with The Greeley Company, a division of HCPro, Inc., specializing in the areas of credentialing and privileging.

Dear credentialing colleague:

Practitioners who have been granted privileges at your organization, but whose only presence in your organization is a credentials file, can be a cause of great stress for medical staff leaders and MSPs. The increasing trend of low- and no-volume providers in hospitals is due to many factors, some of which hospitals cannot solve internally. However, healthcare organizations can be proactive in their approach by utilizing an intended practice plan as one strategic tactic. The use of an intended practice plan can help determine the value a particular individual brings to your organization and can facilitate communication regarding the hospital’s expectations of the practitioner.

Your organization should construct this document to ask specific questions about the applicant’s plans to utilize the facility. These questions typically include:

• Do you plan to admit to the facility? If so, how many admissions per year?
• If you do not plan to admit to our hospital, will you refer patients to our hospital when they need acute care services?
• Do you plan to perform procedures at our facility? How many per month/year?
• If not, where do you plan to perform procedures?

The line of questioning should be such that it provides the healthcare organization with a clear picture of the applicant’s intention vis-à-vis his or her value to the organization and its strategic goals. The organization can also use this information as needed at a later date to remind the practitioner of his or her stated intentions, as well as the importance of sharing goals and values should this practitioner end up being a low- or no- volume provider.  

As applicable to the individual, your organization should provide an intended practice plan at initial appointment for the applicant to complete. The organization may determine it doesn’t need to provide intended practice plans to employed practitioners or in other circumstances where the use of an intended practice plan would not apply. In addition, prior to sending routine reappointment applications, an analysis of low- and no- volume practitioners should be conducted to determine if there is a need to have an applicant for reappointment submit an intended practice plan with his or her reappointment packet reaffirming facility utilization intentions.

Ongoing communication between the medical staff leaders and any low- or no-volume practitioners should occur as needed. Six-month intervals are an excellent time for discussion to occur regarding the individual’s limited use of the hospital services with a reminder of his or her originally stated intentions. This should be a collegial conversation about why the practitioner’s plans have changed, or whether he or she plans to begin performing procedures in the near future, and should set the expectation that the organization wants a win for both parties. The mutual goal should be supportive of both the practitioner’s objectives and the hospital’s strategic plan to provide the volume and types of services that benefit the community served.

Remember, credentialing has no other master than the patient.

That’s all for this week.

All the best,

Sally J. Pelletier, CPMSM, CPCS
http://www.greeley.com/consulting.cfm

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