Avoid privileging pitfalls in ambulatory care

The Association for Ambulatory Health Care’s (AAAHC) quality roadmap points to credentialing, privileging, and peer review as pervasive trouble spots for ambulatory care facilities. With these shortcomings in accreditors’ crosshairs, take extra pains to avoid the following vetting missteps:

• Insufficient review of medical director privileges: Per AAAHC standards, the medical director’s privileges must be reviewed by another practitioner on the medical staff—a task that can prove challenging for smaller facilities. To avoid delays in the process, be proactive in identifying viable reviewers, says Kathy Matzka, CPMSM, CPCS, FMSP, an independent medical staff consultant in Lebanon, Illinois. Ask the medical director which affiliates are qualified to assess his or her performance and make a recommendation.
• Unspecified privileging durations: Organizations sometimes forget to assign start and end dates for privileges, says Marshall Baker, FACMPE, president and CEO of Physician Advisory Services, Inc. in Boise, Idaho, and an AAAHC surveyor for ambulatory facilities. AAAHC requires privileges to be considered for renewal at least every three years, or more frequently depending on internal or state requirements.
• Cutting corners when awarding temporary privileges: Although not expressly covered in the AAAHC roadmap, temporary privileges are another prominent soft spot, says Cathy Montgomery, RN, CASC, president and managing partner of Excellentia Advisory Group, LLC in Saint Peters, Missouri. Many facilities see temporary privileges as a way to circumvent the standard credentialing checks and balances. Not so, says Montgomery. “You still need to have everything in the file, all your I’s dotted and all your T’s crossed.” Appropriate primary source verification, the medical director’s sign-off, and official board approval are other necessities, she says.