Should Providers Be Asked to Withdraw Requests for Privileges?

I get lots of questions from organizations regarding privileging – and many of those questions relate to how privileging recommendations and decisions are made. One of the more common questions is: The provider does not meet our criteria for privileges – should I ask the provider to withdraw the request?

The following explores situations in which an organization might contemplate asking a provider to withdraw privileges:

The provider requested privileges for which he/she does not meet qualifications/criteria.

When the provider does not meet the written/stated qualifications, the decision can be not to grant the privileges because qualifications were not met. This is not a denial of privileges and is not reportable to the National Practitioner Data Bank (NPDB). Essentially, the organization has not made a determination of whether or not the provider is/is not competent because the provider didn’t meet the eligibility requirements to apply. The documentation for the privilege or group of privileges that will not be granted would include a notation that the provider did not meet qualifications and therefore the privilege(s) were not granted. There would be no disruption to the evaluation and decision-making process. The provider would be notified after the Board decision that privilege(s) were not granted because criteria was not met.

In order to be fair (and avoid challenges that would not easily be defended), the privilege delineation should clearly and unambiguously document the criteria for the privilege(s) in question. For example, if a provider requested privileges that requires specific training (i.e., a residency or fellowship) or clinical activity (must perform 10 procedures during the past 24 months) – this information should be clearly stated on the privilege form. I would not recommend using subjective criteria such as, “applicant must provide evidence of competence acceptable to the Department Chair.”

The provider might have asked for privileges for which s/he meets the qualifications, but it has been determined that because of competency or conduct issues not to grant the privileges.

In this case there are two options: (1) Deny the privilege(s) and make a report to the NPDB; (2) Ask the provider to withdraw the request for those privileges.

If the second option is selected, there are two ways to handle this: (1) the evaluation and decision-making process will need to stop and the request for privileges will need to go back to the applicant so s/he can complete a request for privileges that does not include the privilege(s) in question; or (2) the evaluation and decision-making process can proceed and privilege note(s) can be added to identify that the provider withdrew the request and therefore the privileges were not granted (and supporting documentation to this effect scanned into the software to substantiate the withdrawal).

Waivers of Privileging Criteria

There may be occasions when a provider fails to meet the minimum clinical activity requirement, education/training requirement or other standard for a specific privilege or group of privileges. The relevant Department Chair may recommend to the Medical Executive Committee and the Board (via the Credentials Committee if one exists) that the requirement in question be waived – and document the specific rationale for why the requirement is recommended to be waived. The individual who is requesting a waiver is responsible for demonstrating that his or her education, training, experience and competence are equivalent to or exceed the requirements that are requested to be waived. Waiving of requirements should be an unusual occurrence, but it is acknowledged that there may be times when patient safety will not be compromised by alternative methods of assuring competency. Waiving of requirements for privileges is always a Board decision. The Board may grant waivers in exceptional cases after considering the findings of the Medical Executive Committee, the specific qualifications of the individual in question, the quality profile of the individual and his or her performance record in the organization (if the credentialing event is a reappointment). Ultimately, the major consideration and decision should be focused on the best interests of patient care and the community served by the organization.

No individual is entitled to a waiver or to any hearing procedures in the event the Board determines not to grant a waiver. The individual has not received a denial, but rather is simply ineligible to apply for the privileges in question. In the event the Board grants a waiver to any particular individual, that waiver is not intended to act as a precedent for any other provider or group or providers. Each individual request for a waiver should be evaluated on its own merits.