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Ask the expert: Some of our low-volume providers want to be medical staff members to meet their managed care organizations' requirements, but they don't treat patients at the hospital. Is there any way to accommodate their requests?

Medical Staff Leader Connection, July 29, 2010

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Remember, the term credentialing refers to the overall process of gathering and verifying credentials information, reviewing that information, and making a decision to grant or deny medical staff membership. Although appointing physicians to the medical staff and granting them clinical privileges are part of the credentialing process, they are not the same.

Medical staffs are often separated into specific categories that define members’ voting rights and their ability to hold office. In addition, depending on your organization’s policies, membership allows physicians access to the physicians’ dining room, hospital library, CME classes, and other benefits. Medical staff members may also advertise their affiliation with your organization to satisfy managed care organizations’ requirements, if applicable.

A physician who seeks only medical staff appointment should complete an application or reapplication form, submit letters or completed reference questionnaires from colleagues, and provide a description of his or her private practice or practice at another facility. The hospital should also require the physician to complete an intended practice plan.

Appointing a physician to your medical staff does not automatically allow him or her to treat patients. Therefore, your credentials committee can recommend medical staff membership for a low- or no-volume practitioner who wants to be affiliated with your hospital but does not want or need privileges to admit patients.
If the medical staff wants the option of granting membership without privileges, its policies must allow for that. For example, if the medical staff’s membership criteria require members to provide ED call coverage, or if they specifically state that all members must hold clinical privileges, your organization will not have the option of appointing a physician to the medical staff without also granting privileges.

This week’s question and answer are derived from Assessing the Competency of Low-Volume Practitioners: Tools and strategies for OPPE and FPPE compliance, by Mark A. Smith, MD, MBA, CMSL; and Sally Pelletier, CPMSM, CPCS, published by HCPro. 
 

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