Credentialing & Privileging: Establishing criteria for privileging practitioners
Establishing criteria for privileging practitioners
[In the first part of this four-part series, we introduced the four basic elements of clinical privileging:
1. Defining your organization's scope of services.
2. Defining the criteria (i.e. training, experience, behavior, skills) necessary to provide a specific service (or grouping of services). Determining how those expectations will be handled.
3. Allowing those interested to apply for privileges and identify if they meet established criteria. Make a decision on the privilege.
4. Monitoring privileged persons to ensure competence and practice.]
Before establishing criteria to qualify privileging, and to make the process more manageable, Vicki Searcy, president, consulting services at Morrisey Associates Inc. in Chicago, suggests grouping privileges. "If privileges are in a 'laundry list' format (with each privilege given equal weight), it would be necessary to establish criteria for each and every privilege an overwhelming task," she says.
Grouping privileges
There are several ways to group privileges, Searcy says:
Privileges can be bundled by residency or fellowship training.
For example, Searcy says, "privileges that an anesthesiologist would be trained for during a resident program might be one grouping, with additional groupings (sometimes referred to as clusters) related to fellowship training (such as pain medicine, cardiothoracic anesthesiology, critical care medicine)."
Privileges can be grouped by how specialties practice.
Family physicians, for example, learn in their residency programs to treat all ages in all settings, including ambulatory and critical care, Searcy says. Today, however, she says, "many family physicians do not continue to practice in this full spectrum of care and may specialize in ambulatory/primary care and not continue to seek privileges to handle obstetrics or critical care." Others, she says, may work in the acute care environment and seek privileges for advanced obstetrics, usually following additional fellowship training.
The grouping of privileges should mirror "this reality of how family physicians practice," Searcy says. Another example she gives deals with surgeons. "Some general surgeons specialize in treatment/surgery of the breast and do not continue to exercise privileges in other surgical areas."
Privileges for family physicians and general surgeons often relate to the location in which they practice.
"Physicians who practice in rural areas are more likely to exercise the full spectrum of privileges in a particular specialty than those in urban areas where there is access to sub-specialized care," she says.
Once you have grouped privileges, the criteria related to the group or a stand-alone privilege, "usually includes all or some of the following," Searcy says:
- education/training (residency, fellowship, etc.);
- continuing medical education;
- board certification;
- clinical activity (Searcy adds that it would be difficult to determine competency for something a physician has not done recently);
- outcome information;
- additional parameters, such as:
- current certification in areas such as basic life support (BLS), advanced cardiac life support (ACLS), pediatric advanced life support (PALS), or neonatal advanced life support (NALS);
- a contract with the hospital to provide a specific scope of services ("for example," Searcy says, "the organization may contract with a radiology group and, therefore, it would be necessary to be part of the group in order to be eligible to request privileges in radiology").
Also, to be eligible to request privileges, a physician could be required to live within a specific area, have no felony convictions, or no Medicare exclusions, Searcy says.
She offers the following as an example of initial privileging criteria for interventional nephrology privileges:
Initial Request 25 cases of each of the following during the previous 12 months OR completion of fellowship training in interventional nephrology during the previous 12 months:
The applicant also must be qualified for and obtain primary privileges in nephrology. |
Searcy says it's incumbent upon your facility to establish privileging criteria and to be sure those are obtainable. "Criteria must also be reasonable and established to ensure that patients will receive high-quality care not to protect the interests of a group of practitioners who don't want other specialties 'competing' with them to provide the same type of care [such as turf battles].
"One of the benefits to a health care organization in establishing criteria for privileges," she says, "is that when a practitioner does not meet criteria for privileges, the request does not have to be processed. The organization has not made a decision that the applicant is incompetent just that the applicant does not meet eligibility criteria. This is not reportable to the National Practitioner Data Bank."
(Editor's note: Stay tuned for the January 2011 issue of HPR and the third part of this series.)
In the first part of this four-part series, we introduced the four basic elements of clinical privileging:Subscribe Now for Access
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