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Ask the expert: Are all no- or low-volume providers created equal?

Medical Staff Leader Connection, February 13, 2008

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No. You cannot handle all no- and low-volume providers in the same manner. The approach a hospital takes to gather information regarding the practitioner's competency depends on the reason for which he or she performs no or few procedures at your facility. Consider the following three scenarios:

The provider treats the majority of his or her patients at another facility.

Medical staff leaders can easily assess the competency of a physician who has significant inpatient volume at another institution by requesting that the other institution provide you with specific competency data. Send a questionnaire to responsible individuals at the site to confirm the practitioner's clinical knowledge, technical skills, professional performance, absence of disciplinary issues, judgment, behavior, and other factors relevant to clinical privileging decisions. However, even after collecting this information, your organization still lacks personal proof of the practitioner's competency. Depending on the physician's track record at your organization, you may choose to conduct a focused review of the physician's work.

The physician is not clinically active at another institution but is active within the community.

Some practitioners, including many family physicians, dermatologists, and allergists, primarily practice at an ambulatory facility or in their own offices. In such cases, the practitioner should provide:

• A specified number of patient records that reflect his or her clinical work
• References of three physicians who have worked with him or her and who can attest to his or her technical skills, knowledge, ability, technique, and interpersonal communication skills
• A billing printout of procedures performed in his or her office. The billing information should include information about the volume and types of procedures.

Your hospital can also collect performance data by consulting the physician's "report card" put together by his or her MCO (managed care organization) and by conducting a survey of procedures performed by the physician in his or her office.

The physician has not practiced medicine for several years.

It is unacceptable to grand independent clinical privileges to such practitioners, but do not shut these physicians out of your hospital. You can require such a physician to co-admit his or her patients, work in conjunction with a senior physician, work with a proctor, or complete a mini or full residency. Because it is impossible to assess current clinical competency of a low- or no-volume practitioner who is not active in any clinical setting, it is necessary to observe his or her clinical work directly in a controlled environment.

This tip of the week was excerpted from Medical Staff Leaders' Practical Guide, Sixth Edition, by William K. Cors, MD, MMM, FACPE; Mary J. Hoppa, MD, MBA; and Richard A. Sheff, MD. To learn more about privileging no- and low-volume providers, click here.

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