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Determining core versus non-core privileges

Credentialing Resource Center Connection, December 7, 2006

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For organizations moving towards the development of a criteria-based core privileging system, determining whether a certain procedure or privilege is core or special/non-core can be problematic.

The core is defined by those procedures or privileges that any well-trained physician within a particular specialty or subspecialty should be competent to perform upon completion of post-graduate training.  If you were to review the majority of privileges currently held and performed by providers within a given specialty/subspecialty at your facility, this would provide you a good start on determining what would be considered "core."  You can obtain this information a variety of ways including:

Ø      reviewing the privileges forms completed by the practitioners at your facility

Ø      collecting clinical information from your health information management department

Ø      obtaining a list of procedures currently being performed from the operating room/ambulatory surgery settings 

In addition, the core curriculum for residency programs can be found in the American Medical Association's (AMA) annual publication, Graduate Medical Education Directory. This is another very beneficial resource.

There are several factors to take into consideration in order to identify specific privileges or special procedures that fall outside the core and therefore would be deemed special or non-core. All of these factors recognize the need for additional education, training, or recent experience in order to safely perform the procedure.

1.      Knowledge: Does this procedure/privilege take additional education/training gained either within a post graduate training program or via hands-on continuing medical education?

2.      Skill: Is there a higher level of skill involved or does the procedure require routine occurrence in order to maintain that particular skill?

3.      Judgment: Does the procedure require a higher level of judgment to perform than those procedures that are typically delineated within the core?

4.      Risk: Is it a high risk procedure?

5.      Ability to manage complications: Is additional training, skill and/or technique needed if complications arise?

6.      Technique: Is the clinical technique a new approach?

7.      Equipment: Is it technology or equipment that has recently been introduced that requires additional training, clinical skills and/or judgment?

Typically, the answers to these questions require clinical expertise in order to make this determination. If the answer to these questions is "yes," then the procedure would be special or outside of the core.

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