Membership vs. Privileges-Part 1

Dear medical staff leader:

Medical staffs across the country are faced with the challenge of  privileging low- and  no-volume providers.  As an increasing number of family medicine and internal medicine physicians begin to use hospitalists and spend less time in the hospital, medical staffs struggle to assess these physicians' competency at reappointment. How do you reappoint a physician with limited or no clinical activity in the hospital over the past two years? Can these physicians remain on the active staff?
   
When faced with these questions, you must keep in mind that  medical staff membership is separate from privileges.  Many medical staffs automatically connect granting medical staff membership to granting clinical privileges. However, you have the option to appoint a physician to the medical staff but not grant him or her clinical privileges-which many hospitals have done in the case of retired, distinguished physicians on the honorary medical staff.

Medical staffs may also grant clinical privileges to non-members of the medical staff-such is often the case in regard to locum tenens or telemedicine physicians. In addition, according to Joint Commission standards, hospitals must  grant privileges to some advanced professional practitioners or allied health practitioners (e.g., certified registered nurse anesthetists, advanced practice registered nurses, and physician assistants) who are not typically medical staff members. These practitioners have privileges without medical staff membership.
     
Appointment to the medical staff (membership) and the granting of clinical privileges (work ticket) are different. As a result of limiting their time spent at the hospital, more and more physicians will  fall out of step with current hospital procedures, pharmaceuticals, treatment modalities, and patient care practices. These physicians may remain eligible for membership but will not be able to document the current clinical competence needed to obtain independent inpatient privileges (work ticket). When a medical staff applicant requests privileges make sure your criteria states that he or she must provide evidence of current clinical competence. You may want to consider the following alternatives for such members:

1. Offer co-management clinical privileges that authorize admission and full treatment in conjunction with another fully qualified practitioner on the staff
2. Offer privileges that authorize "refer and follow" with access to the patient record, test results, and allow the practitioner to comment in the progress notes but not manage the patient's care
3. Define the process and publicize, in advance, the education, experience, or additional training that is necessary for the practitioner to regain privileges to treat acutely ill patients on an independent inpatient basis.

We will address the second half of this question next week.

All the best,

Joseph Cooper, MD

The Greeley Company