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The ingredients of privileging

Credentialing Resource Center Connection, October 4, 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:

I'm sure that there are more than a few of you out there who remember the 1979 song by Meatloaf that included the lyrics, "It was a hot summer night." That is a perfect description of the weather here today in New Hampshire as I write this article. In actuality, autumn has arrived and we will all too soon be wishing for a taste of summer. 

I find it interesting to see the links my mind makes to totally unrelated topics at the end of a long day. For example, this hot night made me think of that particular song's lyrics, which made me think of the band Meatloaf, which made me think that often the elements we put into our credentialing and privileging process are sort of like making a meatloaf-with the right ingredients you can't miss, and you'll produce excellent results. See how almost everything in life is within six degrees or less of our work as MSPs?

In many cases, it takes a variety of learned skills and techniques (i.e., ingredients) to solve credentialing and privileging conundrums. I recently assisted a client with a question she had about developing criteria for special non-core or supplemental privileges. Such privileges often fall outside of a practitioner's residency or fellowship training in a particular specialty or subspecialty, and therefore what they are competent to perform, because they take additional education or training, perhaps have a higher risk, or are utilizing a new technology. The client wanted to know if she must always define a minimum number of procedures that a practitioner must perform in order to demonstrate competency for each privilege when developing criteria for special privileges.

The opinion of medical societies and specialty boards on whether or not competency is linked to the number of procedures performed varies. At The Greeley Company, we refer to documentation of clinical activity (i.e., evidence that a practitioner has performed a procedure) as one component of the competency equation. The second part of the competency equation is whether or not the practitioner had good outcomes when he or she performed the procedure.

Based on this philosophy, I encouraged this MSP to seek out her physicians' clinical expertise to establish reasonable minimum volumes, as appropriate, for not only the special privileges but also for the core privileges. Any criteria adopted by an organization should also take into consideration any published research as a guideline, and should establish a method for monitoring clinical outcomes.

However, there was actually more to her privileging dilemma. Drilling down further into her question revealed that her organization had a practitioner who already held the privilege in question, but did not meet previously established criteria at the time of reappointment. We determined that there were many ingredients she'd need to "add in" to have a successful outcome for this particular privileging challenge, including how to:

• Communicate between her medical staff leaders and the applicant
• Educate her medical staff leaders on the "competency equation"
• Evaluate an individual practitioner's request for privileges
• Approach a situation where the applicant does not meet established volumes/criteria
• Apply the credentialing principle so that the burden is always on the applicant to prove competency

The recipe for a sound privileging process may have many ingredients, but all of them are essential.

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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