Ask the expert: We received a reapplication from a physician who is now considered a low-volume provider. What should we do with it?

When faced with an initial application or reapplication submitted by a low- or no-volume provider, remember to separate the issue of medical staff membership from that of clinical privileges.

Keep in mind that 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 thing.

Medical staffs are often separated into categories that define members’ voting rights and their eligibility 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 Maintenance of Certification 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 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 and treat patients.

An inclusive medical staff is defined as one that includes as many local physicians who meet the medical staff’s membership requirements as possible. These physicians often wish to belong to the medical staff even if they do not spend a significant amount of time providing hospital-based care, and hospitals are often more than happy to appoint them to the medical staff because these physicians provide referrals.

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 on-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 from Assessing the Competency of Low-Volume Practitioners by Sally Pelletier, CPMSM, CPCS; and Mark Smith, MD, MBA.