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Differentiating membership and privileging

Credentialing Resource Center Connection, May 24, 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:

No matter how long you've worked in the field of medical staff services-and I know from speaking with many of you that you are true veterans-it's always appropriate to take time for a "refresher course." In today's column, we take a fresh look at membership versus privileges, as well as what that might mean for due process afforded to privileged allied health practitioners.

As you process requests from applicants, it is important to remember that there are options for granting privileges to practitioners on your medical staff-especially in cases where an individual practitioner no longer actively practices at your facility. This is increasingly relevant as many PCPs delegate care of their patients to hospitalists.  

Medical staff membership is typically related to citizenship rights, such as the right to vote or to hold office. Your organization might choose to grant membership-but not privileges-to a practitioner assigned to the organization's honorary staff, for example. This category is traditionally created and defined for practitioners who are no longer actively practicing at the hospital, but who the organization wishes to honor for past service.

Privileging is the process of defining the scope of practice (patient care, treatment, or service) that will be performed within a facility. Practitioners who might be granted privileges but not membership include advanced practice professionals (APP) such as physician assistants and advanced registered nurse practitioners.

One of the issues organizations must consider for APPs-who are privileged but who are not licensed independent practitioners and are not members of the medical staff-are their rights related to fair hearings and appeals. An organization does not have to afford these practitioners the same rights as those of medical staff members. However, you should afford such a practitioner "due process" if there is a decision made that has a negative impact on their privileges by revising, revoking or modifying those privileges. 

Additionally, the human resources department should provide APPs who are also hospital employees with access to an employee grievance process. For those who are not hospital-employed, the organization may define an alternative process to the full medical staff fair hearing and appeal. That alternative process should be outlined in a policy and address at a minimum the notification process to the APP, the practitioner's rights to present their relevant information, and whether or not the action of the governing body is final.

If the hospital would voluntarily choose to report any professional review actions related to professional competence or conduct to the National Practitioner Data Bank, then the hospital should give thoughtful consideration to what would be deemed fair to the APP, and whether they would want to provide the APP with the same rights as those of medical staff members

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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