Privileging is intended to authorize the practice of medicine. If a privileged practitioner (either a physician or an advanced practice professional) meets criteria to qualify for privileges requested it is assumed that the practitioner is clinically competent to perform the privileges requested. The goal of privileging is to ensure that clinical quality expectations are met and to protect the patient.
At initial application we collect data from the applicant and verify credentials and other practice related data required to assess their clinical competence to be granted the privileges requested. In order to be granted privileges the applicant must also meet the criteria specified on the privilege delineation. From there the application and related data is evaluated by medical staff leaders and finally is either approved or denied by the Board of Directors. The entire application process is concluded by sending the practitioner a “board letter” informing them of the outcome of the processing of their application.
A tremendous amount of time and effort goes into privileging practitioners. Some organizations regard the privileging process as largely a paper or file management process that is concluded when the board decision is made until the next reappointment. Other organizations seek to make privileging meaningful at the point of service...to move beyond meeting CMS, State and accreditation requirements and make privileging meaningful and beneficial for the patient. Here are some strategies that will extend the benefits of your privileging program to the point of service to ensure that benefits from your privileging program are realized.
1) Make sure that information regarding privileges granted to each practitioner is available in all clinical departments and that they can be effectively interpreted by clinical staff.
Contemporary best practice is to make privileges granted available to clinical departments electronically via the Web. Despite this practice many medical staff offices continue to receive phone calls asking whether or not a practitioner is, in fact, privileged to provide a particular clinical service or perform a particular procedure. Privilege forms need to be developed with the end users in mind. Nomenclature needs to be shared across the organization. Here are a couple of examples regarding how that might be accomplished.
- When privilege forms are initially drafted share the proposed language/nomenclature with managers of high volume users of the form. This will permit adjustments or clarifications in language that might allow schedulers and other staff who will be required to conclusively determine whether the practitioner has privileges to provide the intended service.
- After privilege forms are in use for a period of time the medical staff office can track requests for clarification and can target beneficial adjustment of language/nomenclature. Many times the department chair may determine that these are simply administrative clarifications or edits that do not impact the previous scope of privileges granted by the board of directors and the form is not required to undergo board approval again.
- Provide education and training to schedulers and other high volume users of privilege forms so that they may gain the expertise and insight necessary to accurately interpret the form. It is also helpful if management (in the Operating Room for example) replaces staff with someone with a clinical background (LVN, coding, etc.) as attrition in scheduling positions occurs.
2) Improve techniques for surveillance that ensures that each practitioner’s clinical practice conforms to the scope of privileges granted at renewal of privileges or during OPPE.
When reviewing case logs, most Medical Staff Services Professionals (MSSPs) are focused on whether the applicant meets privileging criteria – either specific numeric clinical activity requirements or general clinical activity representative of the privileges requested. An adjustment in surveillance posture and the way reports are reviewed/interpreted can provide additional valuable information. For example, the case log or OPPE report may reveal that the applicant for renewal is providing clinical services for which they are not privileged. Sometimes this is a disciplinary matter, but more frequently it is a miscommunication or misunderstanding regarding what was included in the delineation that was previously granted. This provides the MSSP with the opportunity to intervene and ask that the physician or APP cease performing the privilege until they meet the qualification requirements, complete the application process and are granted the privilege.
3) Practice anticipatory management techniques that identify when new privileges need to be added to the privilege form.
Perhaps the biggest opportunity afforded to the medical staff office manager to positively impact the relationship between privileging and clinical service is to perform regular environmental surveillance throughout the hospital. This allows the manager to identify clinical services that are poised for implementation at their organization. This avoids the situation where management is contacted by a physician or OR scheduler regarding a patient that is scheduled “tomorrow” for a procedure that is not even present on the privilege form. Here are some activities that can be undertaken to engage in anticipatory management of privileging.
- Schedule regular meetings or “do lunch” with key department heads (i.e., the Operating Room, Cath Lab or GI Suite) where you can discuss issues associated with privileging. These individuals have advanced knowledge regarding what new procedures are in the pipeline. Frequently they are involved in new equipment purchases and leases and have to schedule staff training for device related support. They can provide medical staff office management with a “heads up” on upcoming/new procedures or clinical services so that management can work toward any adjustments to privilege delineations that may be required. It is important to emphasize the benefits of early and close communication when partnering with these clinical department heads.
- Develop a relationship with the Institutional Review Board (IRB) coordinator. The IRB coordinator is frequently aware of clinical research where the organization is participating in a lead investigator capacity. For example, if the new procedure is device related it can be expected that physicians at the organization will be early adopters of the device once it becomes FDA approved. Frequently they schedule patients ahead of time and in March (for example) the physicians may be authorized to perform the procedure by the IRB but in April (after the clinical research is concluded and FDA approval is received) they must be authorized to perform the procedure via clinical privileging. Staying on top of developments in this can assist in avoiding painful case postponements.
- Periodically meet or huddle with the director of marketing at your organization. The marketing department is frequently involved in development of promotional materials for new clinical services prior to implementation and may be able to provide medical staff office management with similar lead time to update the privilege delineation, if needed. Also keep an eye on the organization’s Website. It is amazing how often clinical services are marketed on the Website that are not reflected on the privilege form. The most important thing is to open the lines of communication so that YOU are one of the first people they call when a new program is in the pipeline.
To realize benefits of a privileging program at the point of service it is necessary for medical staff office management to get out of the medical staff office and regularly engage management in other areas of the organization as well as modifying their paradigm regarding how the program is administered. Besides providing the information necessary to ensure that delineations reflect contemporary practice and are effectively administered this networking can be stimulating and fun! Take the first step!