The intersection of APPs and H&Ps
This week, CRC Daily covers advanced practice providers (APP). Today, we explore how APPs’ growing presence on the medical staff is helping reshape traditional compliance approaches in a fundamental practice: the medical history and physical examination (H&P).
Although performance of the H&P is commonplace, accreditation surveyors aren't taking competency for granted, according to a recent discussion on "Medical Staff Talk," a professional forum for members of the Credentialing Resource Center. In February, a couple Talkers reported fielding inquiries about H&P delineation during mock or actual accreditation surveys. In particular, surveyors seemed keen on policies outlining which disciplines are permitted to perform H&Ps, as well as privilege forms containing specific language on this formal evaluation and assessment.
Although the H&P has always been at the heart of quality patient care, the performance dynamics have changed in recent years.
"We are credentialing and privileging more and more kinds of nonphysicians," says Melinda E. Whitney, RN, BSN, BS, MS, CPHQ, CPMSM, FACHE, senior consultant of quality management services at The Quality Management Consulting Group in Columbus, Ohio.
Surveyors may be targeting H&P language to drive the adoption of credentialing processes that reflect the widening array of APPs who provide clinical care in the hospital—and whose privileging applications pass through the medical staff office.
"In looking for (or at) those nontraditional, nonphysician privileged providers, like nurse practitioners or PAs, that is probably where these [H&P survey] questions will rise from," says Whitney.
APP privileges depend on a facility's location, patient population, operational circumstances, and preferences. The reason for this variation? "The medical staff in many states retain the authority and control of the ability to determine who can provide for the H&P," says Whitney.
Given these fluid privileging circumstances, some surveyors may be emphasizing H&Ps to fuel the development of thoughtful governance documents that distinguish between practitioners who can perform full H&Ps, those who may have limited privileges, and those who are not permitted to perform the evaluations at all.