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'Economic credentialing' has nothing to do with credentials

Credentialing Resource Center Connection, August 3, 2003

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Dear Credentialing Colleague:

It's a situation that's becoming increasingly familiar: A well-respected member of the medical staff decides to establish his or her own surgery center, invest in a competing hospital, accept full-time employment at a competing medical center, or establish a convenient outpatient cardiac bypass center.

The reaction of other staff members usually ranges from curious to incredulous. Some take a wait-and-see attitude, while others suggest that the hospital should not allow physicians to enter into such competition. Still others say that this is America, and America was built on competition, so it should be encouraged.

When the news reaches the board of directors, the reaction is more cautious and methodical. The board considers what impact this proposal would have on the institution's patient care, revenue, employment, ability to carry out its mission, and wherewithal to support services that do not receive adequate reimbursement. Some board members will call the physician disloyal, while others will take it a step further and call for expulsion from the staff.

Let reason prevail. Hospitals and physicians have "competed" with one another for decades, so why react differently to it now? Reimbursement and survival, that's why. Some physicians believe that entering into an outside arrangement will maximize their reimbursement and enable them to survive. But many hospitals recognize that they cannot survive and serve if all "paying" services are stripped from their facilities.

We invariably end up with a significant polarity between physicians and the hospital. It is important to recognize that such a situation has absolutely nothing to do with "credentialing" (as the frequently used term "economic credentialing" suggests). After all, it does not involve the review of qualifications, licensure, or clinical competence. But it has everything to do with a policy that's clearly articulated in advance of any conflict--one that's designed to permit the facility to fulfill its mission to the community and itself.

What auto repair shop would allow its employees to open a similar shop next door for weekend and late-hour service? The answer is none, yet no one could stop a committed individual from pursuing his or her own goal. Most likely, management would terminate the individual's employment and compete for business. This is America, and in America anyone is free to compete for business. However, it is not required that airlines, law firms, auto garages, or hospitals assist their competitors in this endeavor.

That's all for this week.

All the best,

Hugh Greeley

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