Criteria-based privileging system: Matching privileges to competence

In theory, organizations that struggle to gather adequate clinical data for low- and now-volume practitioners fail to establish the link between privileges and competency because they have not updated their delineation of privileges to accurately define the care, treatment, and services provided by their practitioners. In other words, some privileging systems have not evolved to accommodate the way physicians practice today.

Matching the clinical privileges a practitioner requests to his or her demonstrated current competence is critical. To accomplish this goal, hospitals must develop and maintain a criteria-based privileging system that accurately defines the services currently offered by the facility and appropriately reflects the scope of services provided by each practitioner.

Criteria-based privileging systems establish qualifications, such as education, training, previous experience, and demonstrated current competence, that an applicant or reapplicant must meet to request specific procedures or privileges.

The Greeley Company recommends that healthcare organizations develop and implement core privileges to help them achieve a criteria-based privileging system. Core privileging defines a core group of privileges that a specialist or subspecialist would be competent to perform after completing post-graduate training.

These privileges are customized according to the services that are within the hospital’s capability and are held by the majority of practitioners within a given specialty or subspecialty. The organization needs to establish criteria that practitioners must meet to be eligible to apply for core privileges. These criteria should include:
 

• Education
• Training
• Past and current experience reflective of privileges requested
• Outcomes data
   

Joint Commission-accredited facilities should also require those applying for initial privileges to undergo focused professional practice evaluation.

Procedures that are high risk, require additional training to manage potential complications, and/or are performed using new techniques or equipment are typically denoted as noncore or special procedures. Practitioners who apply for such privileges must meet specific eligibility criteria.

This week’s column is excerpted from Assessing the Competency of Low-Volume Practitioners: Tools and Strategies for OPPE and FPPE Compliance by Mark A. Smith, MD, MBA, CMSL and Sally Pelletier, CPMSM, CPCS.