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In the dark about exclusive contracts

Credentialing Resource Center Connection, April 19, 2007

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Sally J. Pelletier, CPMSM, CPCS, is a consultant with The Greeley Company, a division of HCPro, Inc. specializing in the areas of credentialing and privileging.

Dear credentialing colleague:

We've had so many strong storms full of high winds and heavy snows here in New Hampshire lately, our power has gone out several times in the past few weeks. At our home, this hasn't happened for several years. We've been lucky, even during the famous ice storm of a few years ago; for some reason, the homes on our street never lost their power.

As I was sitting in the dark during one of these recent power outages (well, OK, there was candlelight), I was thinking about how often medical staff offices are "in the dark" regarding exclusive contract arrangements. Hospitals frequently enter such contracts with particular specialty groups that provide services to the facility. Typically, these contracts are for hospital-based specialties like emergency medicine, anesthesia, pathology, and radiology, but they are becoming more common in other specialties as well.

You would think that informing the medical staff office about these exclusive contracts would be guaranteed, particularly since their existence ultimately affects who may apply for privileges in the areas the contracts cover. However, I am finding that it is not at all unusual to hear that the medical staff office has never been informed about these contracts. Often, it seems that many hospitals do not understand, or even consider, why it is crucial that this information is communicated to medical service professionals.

When developing privileging criteria and/or a privileging system, exclusive contract arrangements should always be a part of the picture. No other individual or group may apply for privileges in an area that is covered by an exclusive contract, and it is imperative that this is communicated to all potential applicants, preferably right upfront on the privilege form. Communicating this can alleviate any embarrassment for a practitioner who may not be privy to the exclusive contract, and is told after applying for the privilege that they are ineligible. 

The inability of that practitioner to apply for the privilege has nothing to do with whether or not they are competent, or even whether they meet your existing criteria for that particular privilege or procedure. The hospital simply should not accept applications for those clinical privileges that are exclusive to practitioners included in this type of contract. Likewise, a practitioner is not automatically granted privileges if they are a part of an existing contract arrangement. They must request the privilege and meet the qualifications defined by the hospital in order to be considered for those privileges.

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