Credentialing & Privileging

Guard against credentials mischief

Credentialing Resource Center Connection, August 25, 2004

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Dear credentialing colleague:

A small, sole-provider community hospital is lucky to have two radiologists on its 42-person medical staff. The husband and wife team has worked at the hospital for more than 12 years and provides excellent service. Two years ago they rejected an exclusive contract offered by the hospital, under the mistaken belief that no other radiologist would ever be interested in moving to town.
 
However, an application has recently been submitted by a lone radiologist who is a former classmate and friend of a prominent banker in town. The radiologist's appointment to the hospital staff should have been a snap but now, six months later, the application has not been approved. According to the hosptial's chief executive officer (CEO), it has been "left hip-pocket denied" by the elected director of the radiology department who has simply chosen not to act on the request. Therefore, the medical executive committee (MEC) has not received a "departmental recommendation" as required in the bylaws.
 
Is another radiologist needed at the hospital? Probably not. Are there grounds to reject the application? No, since all verifications are clean and references are excellent. Can the director simply refuse to act on the application and therefore stymie the process? Yes, unless one or more failsafe systems kick in.
 
The MEC could act without a recommendation from the reluctant chair.  Unfortunately, the bylaws specifically state that the MEC will act only after receipt of a departmental recommendation. The board should decide the question, but it will not for fear of angering the medical staff. The CEO should comply with relevant laws and regulations; this is in fact part of his job description. However, he will not intervene because he enjoys his relationship with the staff and the hospital. 
 
Unfortunately, the banker took action to move the process along. A quick interview with the local newspaper and a discussion with a local attorney placed the situation in danger of becoming extremely controversial. 
 
All credentials committees or MECs should assure themselves that they have the authority to act on an application if a department chair withholds his or her recommendation. The appointment process must not be allowed to become clouded by competitive concerns. It is professional evaluation of qualifications and competence that should determine the decision.

That's it for today.

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



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