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Reappointment processes for "membership only" practitioners

Credentialing Resource Center Connection, May 3, 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:

A medical services professional (MSP) recently asked what the requirements are for reappointing members of the medical staff who do not hold clinical privileges at that facility.

As you know, physicians don't practice in the hospital setting in the same way they once did. Therefore, credentialing professionals can no longer rely on the "traditional" approach of processing reappointments exactly the same way for all of the practitioners on staff. But what hasn't changed is the hospital's duty to evaluate a practitioner's ongoing competency to perform the privileges he or she requests, and to make a determination whether to revoke, revise, or continue his or her existing privileges.

However, for those practitioners who hold "membership only" (e.g. primary care physicians who do not admit patients or provide care, treatment, or services in your facility but refer their patients to hospitalists, podiatrists, and dentists) there are alternatives to the full-scale reappointment process.

At The Greeley Company, we always refer to "The 5 P's": Our policy is to follow our policy. In the absence of a policy, our policy is to create a policy.

Begin by looking in your medical staff bylaws or credentials procedure manual to specifically identify the requirements that applicants must to qualify as a member of the medical staff. Your organization's documents may or may not require that you conduct reappointment for all medical staff categories. Or your reappointment process may exclude honorary members who do not hold privileges in your hospital.

But if a practitioner appointed with membership only continues to maintain a practice, you should reappoint him or her using the standards required by your organization. Your organization's policy should define what needs to be verified for a membership only request (i.e. licensure, insurance, etc.).

Since these practitioners are not practicing at your facility, you would not have to conduct the "re-privileging" part of the process, because the requirements for determining current clinical competency for the requested privileges would not apply.

If, however, you have a primary care physician who requests "refer and follow" privileges you need to re-privilege him or her and obtain evidence of current competence to practice the privileges requested. Such privileges often include:

• Performing outpatient preadmission H&P
• Ordering outpatient diagnostic tests and services
• Reviewing medical records and writing in progress notes for patients referred for admission/services
• Consulting with attending physicians
• Observing diagnostic or surgical procedures with the approval of the attending physician or surgeon

Remember, credentialing has no other master than the patient.

That's all for this week.

All the best,

Sally J. Pelletier, CPMSM, CPCS

http://www.greeley.com/consulting.cfm

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