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End the charade: Make the MEC your board's 'subcommittee'

Credentialing Resource Center Connection, July 24, 2003

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Dear Credentialing Colleague:

How long do physician leaders spend reviewing the application or reapplication of a perfectly qualified physician? In my experience, the department chair spends probably no more than 10 minutes reviewing it before recommending approval to the credentials committee. The credentials committee, in turn, spends another five minutes confirming the department chair's recommendation. From there, the application or reapplication is presented to the medical executive committee (MEC) for review and recommendation prior to a final decision by the hospital's governing body--a decision that rarely takes more than a few seconds.

Individuals charged with the job of credentialing might take advantage of the current JCAHO standard (MS.5.1.1) that permits the governing body to act on "clean" applications/reapplications through a subcommittee. Modify your credentials policy (if necessary) to permit a governing body subcommittee to make final decisions on any application or reapplication that meets predefined criteria. Be sure to define in your policy the limits of this subcommittee's authority.

Your hospital might discuss this proposal and determine how often the full governing body or its current subcommittee add real value to the approval process of "clean" applicants or reapplicants. My guess is not that often, if ever. So end the charade--permit the MEC (acting as both the MEC and the governing body subcommittee) to make final, positive decisions on clean applications and reapplications. Make sure at least two governing body members also serve on your MEC.

Taking this step will eliminate the necessity of taking hundreds of MEC recommendations before the full governing body each year. With that said, I encourage you to take the following eight steps toward "ending the charade":

1. Study the current and proposed JCAHO standards to determine the "limits" of your discretion.
2. Determine how often the governing board (or its current subcommittee) takes a final action that differs from the MEC's recommendation.
3. Draft a proposed change to your current credentials policy that permits the governing body to act through a designated subcommittee. Establish in this proposed policy a set of criteria that clearly identifies what type of applications and reapplications will be acted upon by the subcommittee and which will require consideration and action by the full governing body.
4. Create an amendment to the corporate bylaws that establishes the MEC as a formal subcommittee of the governing board (as stated above, make sure at least two MEC members are also board members).
5. Run the policy by your organization's legal advisor.
6. Explain the policy to the MEC and the governing body.
7. Seek both medical staff and governing body approval for the necessary changes to existing documents.
8. Move ahead in a deliberate and thoughtful manner.

All the best,

Hugh Greeley

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