Locum tenens and temporary privileges

The potential for a breach of duty dramatically increases when the awarding of temporary privileges becomes routine. To quickly bring a practitioner on board, some hospitals are tempted to short-circuit the process.

For instance, they may accept less information than is required for a full initial application or fail to follow the medical staff bylaws, policies, or any number of accreditation standards or state regulations. This is a mistake. Remember that under The Joint Commission (TJC)’s MS.06.01.05, an objective, evidence-based process is required that includes consistent evaluation of all criteria for all practitioners holding a specific privilege.

The increasing use of locum tenens physicians brings potential pitfalls. If an organization consistently relies on temporary privileges and does not fully verify practitioner credentials, it places patient safety at risk and exposes itself to a potential breach of duty.

Required information for granting temporary privileges may vary according to hospital policy, but typically includes:

• Licensure verification in the respective state
• Confirmation of completion of medical or osteopathic school and residency
• Evidence of clinical competence in the form of paper-based or electronic references
• A National Practitioner Data Bank check, a check with the excluded provider databases, (ex. OIG, GSA and state specific) and confirmation of a valid Drug Enforcement Administration (DEA) registration

While the CMS Conditions of Participation are silent on temporary privileges, standards under TJC, the National Committee for Quality Assurance, DNV GL, and the Healthcare Facilities Accreditation Program allow for them.

Hospitals must comply with applicable standards regarding temporary privileges. They should not have policies or provisions in their medical staff bylaws that circumvent regulatory requirements—for example, by allowing a provider to practice pending receipt of his or her DEA check or any other requirement that constitutes a complete initial application.

The overuse of temporary privileges has long been considered a red flag for organizations undergoing a TJC survey. Such overuse is often a product of pressure from locum tenens agencies, influential medical groups, medical staff leaders, or senior management to appoint a practitioner as quickly as possible.

The expedited governing body approval process under TJC standard MS.06.01.11 may be used for both initial appointment and reappointment to the medical staff as well as for granting privileges, provided criteria are met. This can help organizations avoid the temptation of short-circuiting the credentialing process in order to save time.

Source: News and Analysis