Do PAs and APRNs need to be credentialed and privileged by the medical staff? Analysis of The Joint Commission's BoosterPak

The Joint Commission has just recently changed its position on the issue of credentialing and privileging physician assistants (PA) and advanced practice registered nurses (APRN).  In the 2011 hospital accreditation standards, The Joint Commission still allowed the use of an “equivalent process” to credential and privilege these practitioners (HR.01.02.05, elements of performance 11-15).  However, with the release of the Standards BoosterPak™ for FPPE/OPPE, the accreditor has changed its position.
 
There is a very definitive statement on page 26 of the BoosterPak™ document, which was sent to all Joint Commission accredited hospitals, that states “APRNs and PAs who provide ‘medical level of care’ must be credentialed and privileged through the medical staff process. APRNs and PAs who do not provide ‘medical level of care’ can utilize the human resources ‘equivalent process’ in HR.01.02.05, EPs 10-15.”  The trouble for some hospitals is that if you credential and privilege these practitioners, then you must also do FPPE and OPPE on these individuals.

Many medical staffs have chosen to use the medical staff process to credential and privileged the PAs and APRNs in their facilities out of a desire to not create a somewhat duplicative process and to ensure that all practitioners providing a medical level of care go through the same rigor of credentialing, FPPE, and OPPE.

A smaller (but increasing) number of medical staffs had chosen to use the equivalent process to lessen the burden on the medical staff credentials committee. They have also done this in an attempt to decrease the burden of FPPE and OPPE associated with these practitioners, knowing the difficulty of obtaining data for some of these providers.

This change will not affect many hospitals, since they already use the medical staff process for credentialing and privileging and for FPPE and OPPE.  But for those that were considering switching to an equivalent process, don’t.  It will no longer be compliant with Joint Commission standards.
For those hospitals that already use the equivalent process, you will need to change to the medical staff process.  The big question is when this new change will go into effect.  As of publication, there has been no announcement on the effective date.  Although it will cause some burden to add these practitioners to the medical staff credentialing and privileging process, the greater burden will be for those organizations to determine how they will do FPPE and OPPE on these practitioners.  These are practitioners who may not be as readily identified by computerized systems.  The advice is to quickly start planning how this transition will occur in your organization so that when the effective date of this change occurs, you will be in the best position possible.

Mary Hoppa, MD, MBA, CMSL, is a senior consultant at The Greeley Company, a division of HCPro, Inc. in Danvers, MA.