Monitoring ambulatory physician competency

This week’s quick tip comes from The Medical Staff's Guide to Employed Physicians by William K. Cors, MD, MMM, CPE, FAAPL. What options do you have for monitoring ambulatory physician competency? Cors recommends first determining whether your ambulatory physicians are required to have “medical staff” recommended privileges or not, as that will change the answer.

The following are some options to consider where privileges are required:

• Refer and follow privileges: This option is useful for a scenario in which your ambulatory physician is required to have medical staff privileges. As with any privilege granted, there must be a way to assess competency. Refer and follow privileges allow the ambulatory physician to refer a patient to a physician with full hospital admitting privileges. This ordinarily would be handled by a hospitalist or a medical or surgical specialist. As part of the OPPE process, the ambulatory physician is asked to whom he or she normally refers admissions or procedures. The medical staff can then develop a simple checklist form and distribute it to several of the physicians accepting the ambulatory physician’s patients. The forms are compiled in the usual manner for any ongoing OPPE of granted privileges and reviewed by the appropriate chair, chief, or service line leader. The work basically remains within the hospital-based medical staff peer review program under this scenario.

• Specific ambulatory competency metrics: An alternative when full privileges must be granted is to have the medical staff in conjunction with the physician leaders of the ambulatory group identify a set of competency metrics that are specific to the ambulatory setting. The forms might be those used in the hospital-based medical staff peer review program, or they might be new forms specifically developed for this purpose and approved to become part of the hospital-based medical staff peer review process. Under this scenario, the work of data collection can fall to either hospital- based support staff or ambulatory practice–based support staff. This might work well if your organization has one unified inpatient/ambulatory electronic health record that can collect information and generate reports easily. Most organizations, however, have a hodgepodge of systems, which makes integrating data collection and reporting much more cumbersome. How it is done in your organization depends on information systems and number of hospital staff to support the medical staff peer review function. Regardless of how it is collected and reported, however, all information would become part of the medical staff OPPE process and go through the same level of scrutiny by medical staff leaders as any other competency determinations.

If privileges are not required for any of the reasons outlined throughout this chapter, the medical staff has no obligation or responsibility to document OPPE for ambulatory physicians without privileges. If you decide to do so anyway, then you will be held to your own policy, even if the accreditation body does not require it. Unless you have a bulletproof way to accomplish this task, the best advice is not to do it as a medical staff OPPE/peer review function.