Physician Practice

MSPs, physicians, and hospital-owned clinics: No easy answers

Physician Practice Insider, February 24, 2015

More community practices are joining hospital systems because it makes economic sense for both parties. However, when hospitals acquire community practices and clinics, the medical staff services department (MSSD) faces credentialing and privileging questions. Will physicians in newly acquired clinics be considered members of the hospital medical staff? Will they be credentialed by the hospital's medical staff office? Will they need two sets of privileges?

The answers to these questions vary by organization.

The fundamental question that must be answered first is whether hospital-owned practices will be included on a hospital's license. Practices may be owned by a system without being on its license, but from a compliance perspective, it can be more complicated for a hospital if clinics are included. For example, if a practice is on the hospital's license, Joint Commission-accredited hospitals must grant privileges and conduct Ongoing Professional Practice Evaluation (OPPE) and Focused Professional Practice Evaluation (FPPE) for the clinic's practitioners just as they would for practitioners with hospital privileges, although the OPPE and FPPE must be appropriate for the physician's practice setting.

For Barbara Stockton, director of medical staff at Katherine Shaw Bethea (KSB) Hospital, a not-for-profit, independent facility in Dixon, Illinois, the major challenges aren't related to whether providers should be included in the hospital's medical staff. "We acquired our medical group a long time ago, and all the providers we acquired are already on our medical staff," she says. KSB is an 80-bed acute-care hospital. Its affiliated medical group of almost 80 physicians are employed by the hospital. KSB is CMS and state-certified.

Most of the KSB medical group uses hospital medicine, so they're practicing primarily in the office. The medical staff saw a need for hospital medicine privileges, but the task of developing them wasn't hard because most of the hospital medicine physicians practice internal medicine or family medicine.

"Now we're building ambulatory privileges because we have practitioners coming on board, or who are scheduled for reappointment and have not provided care to in-house patients for up to two years, who practice only in the office. We have a couple of family medicine physicians who are helping us build ambulatory care privileges," she adds.

The changes at KSB over the years have led Stockton to seek a new way to define "active medical staff."

The hospital has some physicians who primarily use hospital medicine, but are on the physician leadership groups of KSB's clinics and help with patient experience tactics, attend meetings, and they participate in the quality projects. "They may not admit anybody; they're in the clinic. Active staff needs to be redefined to include them," she says. "I think we have to take out the volume and [focus more on participation]. We have a lot of active providers that don't admit anymore so their inpatient volume doesn't matter. But they're active because they're clinic leaders."

More than 30 outpatient clinics are associated with Ventura County Medical Center, a county medical system based in Ventura, California. All credentialing and management of physicians is done within the medical staff office, says Tracy Chapman, manager of Ventura County Medical Center's medical staff office.

The organization has a medical staff of more than 730; of those, about 90 are midlevel practitioners. The rest are physicians; the majority of them work in outpatient settings and have hospital privileges and call responsibilities. In addition, a good portion are community providers not specifically contracted with the county, but are privileged to see patients at Ventura County Medical Center. The majority of practitioners are active, Chapman adds.

Many of the physicians are contracted, and a few hold administrative positions, but they also see patients. For example, the medical director also sees patients at one of the outpatient clinics on a part-time basis, she says.

"We are delegated with several health plans, so we are held to [National Committee for Quality ­Assurance (NCQA)] standards for credentialing as well. We are audited annually by the health plans for NCQA, so we're doing that dance between the [The Joint Commission and the NCQA], trying to find practices that work with both sets of standards," says Chapman.

All credentialing of practitioners is done in-house through the medical staff office.

Some of the system's clinics are owned by Ventura County Health Care Agency and some are affiliated clinics and considered independent businesses, but all medical staff are credentialed through the medical center's medical staff office. "I'm still getting up to speed on which clinics are owned by the Health Care Agency versus which ones are affiliated clinics," she says.

When the associated clinics hire physicians, they come to the Ventura County Medical Center office for credentialing. The medical director is involved in a portion of the interviews, according to Chapman. "All physicians have gone through the same credentialing process and are held to the same OPPE, regardless of whether they're contracted with the county or with a specific clinic," she says.

To read more, visit HCPro’s Credentialing Resource Center.

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