Credentialing & Privileging

How to avoid 'avoidable' fair hearings

Credentialing Resource Center Insider, February 14, 2003

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Dear Credentialing Colleague:

Hospitals and their medical staffs should attempt to minimize the occurrence of fair hearings and appeals. These proceedings are often incredibly expensive, divisive, and time consuming. I know of a hearing that lasted more than 18 months, consumed three different hearing panels, and involved at least nine attorneys.

Physicians who serve on hearing panels tell me that they'd rather undergo a colonoscopy than participate in another hearing. A hearing is not only complicated and costly, but also represents somewhat of a failure for the medical staff and the institution. What sequence of events occurred to warrant an action so serious that it triggered a hearing? Why did the medical staff fail to address the issues earlier? What could have been done to avoid a "disciplinary" action?

The overlapping question is: What can be done to avoid fair hearings? First, hospitals should revise their medical staff policies so they provide for a hearing only when required by law or regulation. A hearing should be offered only if a final action has a substantial impact on a physician's ability to practice medicine (e.g., loss or suspension of clinical privileges, denial of medical staff appointment, etc.). Please note: The issue of offering a hearing for denying an initial application may be subject to individual state regulations.

Second, think hard and long before you design policies that provide for a fair hearing in response to the denial of a requested departmental assignment, denial of a requested staff category, consultation requirement, or short-term suspension. None of these actions should give rise to a hearing, as they do not substantially affect a physician's ability to practice.

Third, realize that fair hearings that result from appointment or clinical privilege denials are often avoidable. Avoid nearly all such denials by simply placing the burden on the applicant to produce the information needed to resolve any doubt or fill in the blanks on an application. Most denials of requested privileges aren't due to incompetence, but a lack of appropriate education, training, or experience. Clearly established privileging criteria would eliminate most of these denials.

So the next time you find your hospital setting its sights on a denial, stop, think, and clarify. Avoid "avoidable" hearings.

That's all for this week.

All the best,

Hugh Greeley

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