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Determine the competency of low-volume providers

Credentialing Resource Center Connection, September 15, 2004

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Dear credentialing colleague:

Medical services professionals, department chairs, and credentials committee members in hospitals across the country are faced increasingly with applications for medical staff membership or clinical privileges from physicians who treat few or no patients at their hospital.

A hospital that must assess the competency of a low- or no-volume practitioner should first determine whether he or she actively practices at another accredited healthcare facility. The hospital must then determine whether the provider performs satisfactory clinical work at another organization. To answer this question, the medical staff office (MSO) must collect volume and performance data from the facility at which the practitioner actively practices.

If the physician provides care at another accredited healthcare facility, your job of assessing his or her competency is conceptually quite easy. Your credentials committee can turn to that organization for evidence of the physician's competency. However, your hospital may have trouble obtaining from that organization information needed to assess the practitioner's competency. Remember, if that facility is reluctant to release the information, you must put the burden on the applicant.

You may discover that the practitioner applicant does not actively practice at another inpatient facility but rather focuses his or her practice on treating patients in an ambulatory setting. If this is the case, your task of evaluating requests for medical staff appointment is again fairly straightforward but, assessing the physician's request for clinical privileges may be daunting.

Your task remains the same in this situation-you must determine what information the organization needs to assess whether the physician is competent to perform the requested privileges. You must then decide the best course for obtaining that information.

Before processing the physician's request for privileges, engage in a collegial conversation with the physician applicant to determine whether he or she is interested in privileges that authorize him or her to  treat patients on an inpatient basis.

Keep in mind that, in many instances, physicians who practice only in the ambulatory setting are satisfied with medical staff appointment and have no interest in obtaining inpatient treatment privileges. Suggest to the physician that dependent privileges or privileges to "refer and follow" may be the best options.

That's it for today.

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

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