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What you can do about low-volume or non-active physicians

Credentialing Resource Center Connection, January 14, 2004

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Dear Credentialing Colleague:

How does a hospital and its medical staff deal with the issue of low-volume practitioners or non-active physicians?

This touchy issue has been raised many times, but in some hospitals, it has become manageable due to the adaptation of the intended practice plan concept. (Please e-mail my assistant at diana@greeleywi.com for more information about the intended practice plan.)

Sometimes medical staff services professionals can deal with the problems associated with low-volume or infrequent users by:

-not processing a request simply because the hospital doesn't offer the service the physician is interested in providing

-or if that service is already provided by employees or under an exclusive contract

Because of their low inpatient volume, another stumbling block is that sometimes these physicians cannot provide the medical staff with information required to evaluate their current clinical competence. A hospital only has to process an application for privileges if a physician provides significant evidence of current clinical competence in all requested areas, including data demonstrating that they engage elsewhere in clinical work very similar to the privileges they are requesting.

In addition to evidence of actual clinical performance, the physician requesting privileges would have to submit evidence that the performance was of good quality, such as providing references from other physicians. If the physician did not provide this evidence, his or her application for privileges could not be processed.

In the above examples, "denial" is not necessary because the physician did not meet specific requirements. The medical staff office can simply tell the physician, "We can't process your application until we receive this material from you."

If you do permit such physicians to remain on staff with clinical privileges, it is perfectly reasonable to ask all physicians who use the facility very infrequently or not at all to provide information on how they intend to assist the board and medical staff in meeting their mission, i.e. participating in emergency department on-call duty.

If you do not believe that your facility will benefit from having these non-users on staff, you can simply let them know that by sending a notice such as, "Due to the fact your practice has not resulted in any need for inpatient privileges, you will not be eligible for reappointment. However, if your practice needs change and you believe your patients will need the resources of our facility, please feel free to apply at that time."

Be business-like in a nice way. Let such individuals know that they may be unable to apply for privileges, but membership will not be a problem, reminding them that membership requires contributing to the hospital's mission.

Your credentials committee can establish a policy that physicians will be ineligible to reapply if they have had no clinical activity at the facility during the past ___ years. Physicians affected by this policy will be eligible to reapply if practice needs change.

The physician's request for privileges is not denied, and he or she will not qualify for a hearing. The physician is simply ineligible to apply until he or she demonstrates a need for services provided by the hospital.

That's it for today.

All the best,

Hugh Greeley

http://www.greeley.com/seminars/

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