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Basic credentialing rules to ensure quality patient care.

Credentialing Resource Center Connection, October 14, 2004

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When faced with a complex credentialing situation, medical staff leaders and medical services professionals must remember that the ultimate goal of credentialing is to ensure quality patient care. A hospital's credentialing policies, procedures, and decisions should reflect that goal. Especially when a medical staff application poses difficult questions, it is important to keep the following credentialing rules in mind:

Place the burden on the applicant

Some hospitals feel compelled to expend significant amounts of administrative and staff time verifying the qualifications of practitioners who apply for medical staff appointment with or without clinical privileges. Every hospital should make clear in its policies and in practice that the applicant is responsible for providing the hospital with the information it needs to make an informed decision and to resolve any doubts regarding appointment and/or clinical privileges.

Establish clear and rigorous appointment and clinical privileges criteria for applicants

The hospital should never be forced to deny medical staff appointment because of an applicant's or reapplicant's inadequate education, training, and experience; these are shortcomings that a hospital can easily identify when it receives the application or reapplication from the practitioner. A good credentialing process should start with threshold criteria and objective preapplication screening. If a hospital considers a practitioner who lacks specific, defined training or fails to meet education requirements, hospital leaders and staff will waste time and energy processing an application or reapplication that the hospital will inevitably deny.

Continuously improve credentialing practices and procedures

Hospitals are sometimes reluctant to upgrade credentialing policies and procedures, arguing that it is not fair to require new applicants to meet more rigorous requirements than existing members. This is simply the wrong attitude. The practice of medicine--and therefore the medical education and clinical experience of applicants--is constantly changing. As a result, the criteria for clinical privileges must reflect those changes. Sound, rigorous standards should never need justification.

By following these three basic credentialing rules, your credentialing professionals will have the tools they need to confidently tackle even the most difficult medical staff credentialing situations.

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