Avoid negligent credentialing claims with low- and no-volume practitioners

If a low- or no-volume practitioner is on staff at another hospital and working there, getting relevant data can be as easy as reaching out to the other facility with the appropriate consent and release forms, says Kathy Matzka, CPMSM, CPCS, a medical staff consultant in Lebanon, Illinois.

Some hospitals have bylaws requirements for a minimum volume in order to maintain medical staff appointment, she says. Instead of tying these minimum requirements to medical staff appointment categories, it may make more sense to tie them to clinical privileges. "Although a practitioner may be a low- or no-volume practitioner, all of his or her patients may be admitted to the hospital, so that practitioner will want to have a say in medical staff policies and procedures and be able to vote on bylaws, serve on committees, etc."

Medical staffs will be faced with a difficult decision when determining whether to allow a no-volume practitioner to continue to have clinical privileges, says Matzka.

"In today's climate of negligent credentialing lawsuits, it is going to be very difficult for medical staff leaders to justify recommending continuing privileges for a practitioner for which they have no documentation of clinical competency related to the inpatient setting. While some skills necessary to provide inpatient services may not deteriorate over time, others will. Medical staff leaders will have to make a determination as whether or not this is the case based on the clinical privileges the practitioner wishes to exercise in the inpatient setting. I believe that this legal climate is going to be a strong agent of change," she says.

Matzka has another recommendation for her clients: Rather than routinely sending reappointment applications to every provider who is due for recredentialing, she counsels them to look at the practitioner's volume over the last two years. If there is no volume, they should send the practitioner a letter stating this and ask why he or she wants to be on staff.

"In many cases, applications are filled out by medical office personnel and physicians do not put much time into considering whether or not they still want to be on staff at the hospital," Matzka says. "Additionally, there may be a different staff category that the practitioner will fit into."

Source: News and Analysis