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Don't grant privileges to AHPs

Credentialing Resource Center Connection, January 3, 2003

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Dear Credentialing Colleague:

If your credentials committee continues to review requests for clinical privileges from allied health professionals (AHPs) practicing under supervision, you should encourage it to revise its procedures.

Hundreds, if not thousands, of hospitals nationwide now recognize the benefits of giving AHPs job descriptions, scopes of practice, or other types of agreements rather than clinical privileges.

JCAHO standards require members of the medical staff to practice pursuant to clinical privileges. The JCAHO also requires any other practitioner who is permitted by the institution and state law to practice independently (i.e., without physician supervision) to be granted clinical privileges by the governing body after a recommendation by the medical executive committee.

But it's quite clear that no one in a hospital practices without supervision--not the neurosurgeon, chief of staff, cardiac surgeon, or a physician's assistant (PA), surgical assistant, nurse practitioner, or other individual employed by either the hospital or a physician.

All of these individuals are subject to some kind of defined supervision. It is therefore entirely appropriate for the credentials and medical executive committees to design policies and procedures that permit certain types of AHPs to practice (provided that they are deemed competent) pursuant to a job description, scope of practice, or other form of permission.

For example, it makes little sense for a hospital to grant privileges to the PA employed directly by an orthopedic surgeon on your staff. It makes far more sense for the institution to have policies that permit the employer (i.e., the orthopedic surgeon) to utilize his or her employed PA pursuant to scope of practice. It would be up to the employer to appropriately supervise the activities of his or her PA and to provide full and verifiable information concerning the employee's education, training, experience, and current clinical competence. Such an employee also must be covered by the physician's professional liability insurance policy, if required.

Credentials committees may, through the development and subsequent adoption of good policies and procedures, avoid the need to review privilege requests from a large number of AHPs. This approach would permit the credentials committee to concentrate its efforts and energy on those individuals who will truly practice independently as members of the medical staff.

That's all for this week.

All the best,

Hugh Greeley
www.greeley.com/seminars/

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