Home

  • Home
    • » e-Newsletters

Resolve privileging conflicts between cards and rads

Radiology Administrator's Compliance and Reimbursement Insider, April 1, 2007

Editor's note: This is the fourth in a series about approaches to the cardiology-radiology debate over professional ownership of heart imaging techniques and reimbursement.

Cardiac imaging represents such a hot button issue for many facilities-from hospitals, to freestanding imaging, to independent cardiology and radiology practices. Cardiology-radiology turf battles can be extremely explosive, emotional, and destructive within an institution, so it's important to have a mechanism for addressing these privileging disputes when they arise at your facility.

Everyone knows the intensity of cardiology-radiology turf battles has increased in frequency and ferocity across the country in recent years, said Todd Sagin, MD, JD, vice president and national medical director of The Greeley Company, a division of HCPro, Inc. , in Marblehead, MA. Sagin spoke during the December 21, 2006, HCPro audioconference "The 64-Slice CT Scanner: The latest battleground in specialty turf disputes" (www.hcmarketplace.com/prod-4874.html).

Facilities can mitigate the conflict over control of cardiac imaging procedures through staff credentialing and privileging determinations. To understand this process, begin with the following four steps of credentialing and privileging:

1. Establish policies and procedures (e. g. , criteria)

2. Gather information

3. Assess and recommend

4. Review and grant

Identify existing policies

At the first intimation of any turf disputes, pull your hospital's policies for credentialing information to ensure that everyone understands the parameters for dealing with the issue, Sagin said. The criteria for establishing new credentialing and privileging standards shows all of the parties involved how to proceed.

Once you've identified the appropriate policies and procedures, determine whether the facility established a moratorium on processing any new privilege requests for emerging technology (e. g. , those for 64-slice CT scanners). Most policies do hold new requests until they create a policy specific for that modality.

But moratoriums must contain a definitive end point. That way, physicians-either radiologists or cardiologists-won't bypass the process simply out of frustration. A facility's credentialing development policies should also include clear guidelines for how long the moratorium lasts. Sagin suggested 60-90 days as a good general gauge.

"That's enough time for the facility to gather additional information and form a panel for discussion," he said.

Gather data

When gathering information, Sagin suggested that hospitals, as well as those involved in the cardiac imaging credentialing dispute, should examine the entire "universe of data out there to ensure that you make an informed decision. "

That means gathering credentialing information from other hospitals, specialty societies, literature, Credentialing Resource Center white papers, and the Web (e. g. , www.credentialinfo.com).

Determine what other hospitals of similar size and demographics in your region have established as criteria, said Sagin. Examine what involved specialty associations, in this case the American College of Radiology and American College of Cardiology, say about competency determinations for the specific modality and exam. Developing a competency in a particular area generally means performing the exam several times in a learning setting and providing evidence supporting that when you performed the scans, you performed them well.

Take some time to look at the proliferation of literature examining evidenced-based data for cardiac imaging. Look for information that correlates privileging data to outcomes to determine what effect such measures have.

If you're the radiology director of a large hospital bringing the turf issue to the credentialing committee, expect the group to push back much of this work onto your plate. If this is the case, take some wise advice and come to the committee prepared ahead of time. But also expect additional investigations from the credentialing committee for you and your staff.

"It doesn't all fall to a committee or to the medical staff office," said Sagin.

Develop the task force

With recommendations from cardiology and radiology department experts in hand, the credentialing committee can move forward.

"If everyone agrees [on a set of credentialing criteria], that's great-you don't have a dilemma anymore," Sagin said. "But if they don't agree-and that's more likely going to be the case-be ready to go back to your policy and take the next steps. "

At this point, with a plethora of information in hand and tensions still running high, look for the credentialing committee to appoint a task force that may or may not include leaders from the cardiology or radiology departments.

"You want some parties not involved in the turf battle to sit on the task force committee," said Sagin.

Hospital policies often make it clear that establishing privileging criteria "is not the domain of particular departments or specialties," Sagin said. "Just because they have expertise in an area does not give them the authority to establish privileging criteria. "

That doesn't mean radiology administrators can't offer their services to the task force.

Sagin recommended that the task force pull specialties in for testimony and evidence when not using such experts as task force members.

The task force mainly needs to make recommendations for cardiac imaging credentialing criteria back to the hospital's credentialing committee. It remains up to that group to finalize the recommendations and set parameters for who ultimately performs cardiac imaging scans and interpretations.

"As much as possible, participants should work within the framework of the results of the task force's research," Sagin said.

Take final steps

Before moving on to implementation, the credentialing committee must review the proposed criteria, vote on it, and refer the issue to the executive committee. If it the new credentialing and privileging criteria receive approval, then apply the criteria and consider your facility at least part of the way down the path to conflict resolution.

Insider source

Todd Sagin, MD, JD, vice president and national medical director of The Greeley Company, 200 Hoods Lane, Marblehead, MA, 01945, 781-639-1872; tsagin@greeley.com.

Most Popular