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Determining which clinical privileges are special, or outside the core

Credentialing Resource Center Connection , April 2, 2009

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Dear readers,

The advent of criteria-based core privileges gave the healthcare industry a method for effectively separating out rare, controversial, or extraordinarily complex procedures as “special,” or beyond the core, signifying to the department head or other party responsible for privileging that the applicant must show evidence of training, education, and/or experience beyond what would be required for procedures within the core.

Identifying patterns in your organization’s historical privilege delineation pattern can help with this phase of core privilege design, but keep in mind: this is just one of multiple phases of research to determine which procedures are core versus special at your organization.

1. To identify patterns, start by looking for privileges commonly requested by all or nearly all applicants in a particular specialty. It is likely that all physicians interested in practicing in the ED, for example, request exactly the same privileges. Likewise, ophthalmologists, anesthesiologists, radiologists, pathologists, and many other types of specialists probably request clinical privileges nearly identical to those requested by others in the same specialty. Mark applicable privilege delineation forms with the letter “A,” which stands for “requested by nearly all applicants.”

2. Next, look for privileges within each specialty that are requested and granted without controversy. Use a green marker to identify these uncontroversial privileges.

3. Following that step, identify privileges that are granted to some—but not all—practitioners within each specialty. This situation might occur because some practitioners in a specialty have not requested certain privileges. Other practitioners might have requested certain privileges but, due to insufficient education, training, experience, or demonstrated current competence, have not been granted those privileges. Regardless of the reason, these privileges are slightly more controversial than those in the previously noted set of privileges. Such privileges might include pulmonary artery catheters (also known as Swan-Ganz catheters), colonoscopy, admission and management of patients in critical care units, normal and complicated obstetrics for family physicians, and advanced intra-abdominal laparoscopic work for general surgeons. Highlight the appropriate privileges for each specialty with an orange marker; these privileges mark the beginning of your special noncore request list.

4. Next, look for privileges that have been associated with extreme controversy. These might include privileges that cross specialty lines and privileges for which the medical staff has identified the need for significant education, training, experience, and demonstrated current competence either within or outside the residency/fellowship program. These privileges should be marked in red to call attention to their controversial nature.

Remember that special privileges encompass areas that practitioners in the specialty may be trained in and might want to do, but they are not included the “core” description because they typically require demonstration and/or documentation of additional qualifications above and beyond the core privileges in the specialty. Thus, special privileges are separated from the core and have specific criteria related to education, training, and experience. Sound research from specialty societies, academies, colleges, the Clinical Privilege White Paper library, and any other sources that provide authoritative data concerning the granting of clinical privileges will also aid you in the research phase of determining core versus noncore.

All the best,

Maureen Coler
Executive Editor

HCPro offers many resources to assist hospitals with core privileges. Services range from assistance with developing core forms/criteria to a software “add-on” designed to disseminate core privileges throughout your organization. For more information, email Executive Editor Maureen Coler at mcoler@hcpro.com or call 781-639-1872 x3741.

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