Credentialing & Privileging

The benefits of core privileging

Credentialing Resource Center Connection, September 20, 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 significant amount of my work in the field is to help hospitals develop and implement criteria-based core privileging. This requires interviewing practitioner representatives identified by the hospital or health system who will provide input into the draft privileging form for their particular specialty or subspecialty.

Recently I met with a particular physician representative who made the comment that a well-trained physician should be able to perform anything they wanted to in a hospital and shouldn't be required to fill out any privileging request whatsoever. Recognizing that this particular physician hadn't attended an earlier education session, I knew that in order to be able to continue with the interview and have it be successful, I had to reiterate the fundamentals of why hospitals need to privilege practitioners to provide care, treatment, and services to patients.

That confused physician isn't alone. Even seasoned medical staff leaders and MSPs continue to struggle with creating effective privileging systems. In 1962, Dr Kenneth Babcock, then director of The Joint Commission (formerly JCAHO), which was then called JCAH, said "There is no more controversial question in medical practice than who may be granted hospital privileges and to what extent."

His statement was just as relevant then as it is in 2007. It is not an easy task for medical staff leaders and medical staff offices to take on this kind of project given their day-to-day workload related to credentialing and privileging. However, there are many benefits to successfully developing and implementing a criteria-based core privileging system. Once these fundamentals are understood by all parties involved, champions of the project will have a much easier time obtaining the buy-in needed to move forward.

Let's begin with the benefits a sound privileging system imparts to the patient. The patient and the family of the patient deserve to know that a practitioner has been fully vetted by an organization in terms of his or her education, training, and experience to provide the care that the patient will receive.

Secondly, privileging systems are designed for the benefit of both medical staff leaders and the applicant. Medical staff leaders who are evaluating requests for privileges and making recommendations related to privileges benefit from having a process that is criteria based. This allows them to objectively analyze a practitioner's request(s) and to make evidence-based decisions related to the granting of requested privileges.

Healthcare organizations should design their privileging system to facilitate physicians' clinical practice. If the organization is using a template from another facility, it should adequately customize the system as its own. The hospital must provide the applicant with an up-to-date privileging request form that he or she can use to apply for only those services, procedures, and techniques that the hospital offers. In addition, the applicant needs to know the qualifications or criteria to be eligible to apply for a privilege and/or procedure. Knowing the criteria up front prevents the applicant from requesting a procedure that he or she is not qualified to perform and cuts down on confusion.

Thirdly, a privileging system should be designed to protect the hospital's reputation and to support both its obligation to payers, and its responsibility in the areas of risk management and legal accountability. The hospital wants to be known for the high quality of its practitioners, and its commitment to patient safety; from a risk management perspective, the hospital and the governing body want a credentialing and privileging process that is as risk adverse as possible and provides a strong defensive from negligent credentialing lawsuits.

Another critical element that drives the need for having a well designed privileging system are the requirements of the various accrediting bodies, and state and local regulators, to ensure that privileges granted are based upon the review of an individual practitioner's qualifications (which include character, competence, training, experience, and judgment) and the organized medical staff recommendations.

In summary, privileging systems should be designed with the premise that it is one of the tools that ensures the hospital has quality physicians that have been fully vetted by an evaluation of their licensure, training, experience, and competence to perform the procedures and privileges requested and granted. It is important that privileges are criteria based and establish minimal qualifications to apply. Each candidate must be assessed and reassessed regarding character, competence, training, experience, and judgment before granting and regranting privileges.

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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