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Flaws in CMS' privileging memo

Credentialing Resource Center Connection, May 20, 2005

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Dear credentialing colleague:

With the publication in November 2004 of its memo titled "Requirements for Hospital Medical Staff Privileging," the Centers for Medicare & Medicaid Services (CMS) demonstrated a significant lack of understanding of the appointment and clinical privileging processes.

In the memo, CMS states that "the medical staff, as a group, is responsible for the quality of care provide to the patients by the hospital." However, in reality, nearly all individuals with experience in the field of credentialing know that the medical staff is responsible for the review of care provided by individuals with clinical privileges. They also understand that the board is in fact responsible for the quality of care provided. Both case law and various state statutes are clear on this issue.

CMS also indicates in the memo that "practitioners may be granted active, courtesy, emergency, temporary, etc., privileges in the hospital." Here the CMS simply confuses membership issues with clinical privilege issues. The "active and courtesy" designations have nothing to do with a clinician's clinical privileges. They simply describe a physician's status within the medical staff structure.

Furthermore, in the same paragraph, CMS alludes to "honorary privileges," apparently unaware that this designation is no longer used in any acute care facility in America. While it is true that some practitioners have honorary appointments to the medical staff, such appoints do not confer honorary privileges on the individual.

The CMS memo may also serve to spread confusion over the mechanisms available to hospitals to identify the clinical privileges granted to a practitioner. For example, the memo states that "the hospital's medical staff bylaws must state the duties and scope of privileges each category of practitioner may be granted." In today's environment, it is rare that medical staff bylaws contain detailed descriptions of the privileges that hospitals may grant to individual practitioners. Because such descriptions are so voluminous, most hospitals have chosen to place them in separate policy manuals or on separate forms. Attempting to incorporate such detailed clinical materials within a document as difficult to approve or amend as the bylaws is surely a recipe for contention, conflict, and increased legal or consultation fees.

Credentials committees should clearly be aware of this CMS memo addressing appointment and clinical privileges. They should, however, be encouraged to use those procedures that make both clinical, and common sense, and await further developments before making substantial changes to their medical staff bylaws or clinical privilege systems.

You can view the memo in its entirety at http://www.cms.hhs.gov/medicaid/survey-cert/sc0504.pdf.

That's it for this week.

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

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