Credentialing & Privileging

Privileges to refer and follow

Credentialing Resource Center Connection, July 29, 2004

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Dear credentialing colleague:
 

There is little question that the manner in which many physicians practice their profession is in a state of dramatic change.

Only a few decades ago, the average family physician or general internist might have had 10 or more patients under his or her care in a hospital. These physicians may have visited the facility twice each day to attend such patients, arrange consultation, or just be there post op to provide comfort and continuity. Between those hospital visits, a physician's day was filled with office hours and for some the day ended only when the clock ticked past midnight and they were off emergency back-up call.

Much has changed for many physicians. Many now choose to remain in their offices and refer their critically ill patients to colleagues on staff at the hospital and many are happy to leave the emergency department (ED) call to others. The causes for that shift may include a change in the reimbursement situation, increasing pressure to see patients efficiently in the office, and perhaps a desire for a more stable home environment. Regardless, at some point most credentials committees will question their ability to recommend full internal medicine or family practice privileges to these physicians who no longer provide care to hospitalized patients. 

Many "office-based" physicians will continue to desire membership on the staff and seek clinical privileges. Credentialers must recognize this new reality and prepare for it wisely. Some have already crafted a set of privileges for physicians who no longer admit and treat patients -- often referred to as "privileges to refer and follow."  (These privileges allow a physician to refer patients to colleagues at the hospital or to the hospitalist program, follow patients through access to the electronic record, see their patients while hospitalized, chart observations in the record, consult with the attending physician, obtain the results of tests and therapy, etc.) Other medical staffs have designed "dependent privileges," permitting co-management in conjunction with another experienced physician on staff.

In many instances, the office-based physician is appointed to the active category due to his or her demonstrated interest in the community and the mission of the hospital. ED back up responsibilities are modified for these physicians, with the hospitalists often accepting call in their stead.

That's it for today.

All the best,
Hugh Greeley
www.greeley.com/seminars/



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