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Tip of the week: Avoid using vague terms

Credentialing Resource Center Connection, June 10, 2011

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Some organizations have labeled or may consider labeling the group of individuals to be privileged through the medical staff (either due to accreditation requirements or complexity of service) as “independent practitioners.” However, this term is often confusing. What does “independent” really mean in this context? Some organizations attribute the term to licensure status, meaning that the individual can function without a collaborating or supervising agreement. Even more confusingly, some organizations use the term “independent” to mean those practitioners who function with a collaborating or supervisory agreement. Other organizations attach the term “independent” to individuals who are not employed by a staff member but rather are sponsored. Some organizations use the term to define those practitioners who can independently bill for their services.

This mix of definitions often confuses organizations and medical staffs as they attempt to determine the level of privileges these practitioners should be granted. Other common terms for individuals who are privileged through the medical staff process and who are not licensed independent practitioners include:

• Associate staff
• Adjunct staff
• Midlevel practitioner or midlevel staff
• Clinical staff
• Allied health professional (AHP) staff

Further complicating the issue, the Centers for Medicare & Medicaid Services refers to physician assistants (PA) and nurse practitioners (NP) as non-physician practitioners and does not include them in its definition of AHP.

Organizations that use AHP staff or an equivalent term often privilege all practitioners brought into the organization by a physician, regardless of the person’s level of clinical practice. These organizations likely are not in compliance with Joint Commission standards.

Organizations must clearly identify the group of practitioners who must be privileged. Therefore, definitions and terminology must be carefully considered and established. The distinction between membership and privileging must also be preserved. Organizations that have expanded the composition of the “medical staff” to include a variety of non-physician practitioners, such as NPs and PAs, may also use one of the terms mentioned earlier to define a specific category of medical staff membership for these individuals.

Various specialty societies suppose that none of these labels are appropriate. For example, the American Academy of Physician Assistants strongly recommends that PAs be labeled as PAs and NPs be labeled as NPs. This is a very understandable position given the differences in their qualifications and state governing bodies. However, hospitals need to define practitioners under a global classification for the purpose of identifying individuals who are subject to the same rules, supervision requirements, and credentialing policies and procedures. Just as an MD is an MD and a DO is a DO, regardless of the medical staff category, a PA is still a PA even and an NP is an NP even when they are grouped together for this purpose.

This week’s tip is from Core Privileges for AHPs: Develop and Implement Criteria-Based Privileging for Nonphysician Practitioners, Second Edition, by Sally J. Pelletier, CPMSM, CPCS.
 

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