How to start privileging APPs

We want to begin privileging APPs. How and with whom do we start the conversation?

Carol Cairns, CPMSM, CPCS: APPs practice in all kinds of clinical settings and provide a wide range of important medical services. That said, I have been to regions and individual facilities where APP practice authority is a highly controversial topic, but those places are in the minority.

When exploring the possibility of bringing APPs into your organization, start by taking stock of your current practitioners. Are any APPs already practicing there? If so, what are they doing, and where are they doing it? For example, a health system might own multiple physician offices and employ the clinicians who practice there. If PAs and nurse practitioners (NP) are providing a medical level of care at those locations, they need to be privileged, regardless of the organization’s regulator or accreditor. If office-based clinicians also practice at the hospital, you must privilege them for work performed in the acute care environment, as well.

If there aren’t any APPs currently practicing at your organization, then speak with your CEO and medical staff leaders about potentially bringing these clinicians on board. The governing body will also need to weigh in. In many cases, a physician will approach one of these leaders directly with a request to allow an affiliated APP that he or she employs into the hospital (and, by extension, through the medical staff credentialing and privileging processes). If the consensus is to move forward, MSPs should begin researching the best APP privileging model for their needs. They should investigate how others in the field have approached this task by reaching out to peer groups, including the National Association Medical Staff Services and the relevant state and local chapters, as well as publishers and consultants.

Editor's Note: Carol Cairns, CPMSM, CPCS, is an advisory consultant with The Greeley Company and president of PRO-CON, an Illinois-based medical staff services consulting group.