New and special privileging processes

Special privileges require additional training and demonstrated competencies beyond those required for core privileges, enabling providers to perform such privileges competently and safely. In addition, special privileges often necessitate both an initial volume threshold to receive the privilege and an ongoing volume threshold to maintain the privilege. New privileges can either be absorbed into the existing core privileges or be designated as special privileges for qualifying licensed independent practitioners (LIP).

Volume requirements for special privileges should be objective and evidence-based. If they are not, they may be perceived as arbitrary, which can result in legal action for a number of reasons, including legal action on behalf of a LIP or a patient. Volume thresholds may follow those recommended by noted professional and educational associations (i.e., specialty societies), such as the American College of Surgeons, American Academy of Family Practitioners, American Urological Association, or American Society of Plastic Surgeons.

If specialty societies have not addressed requirements for a privilege, a literature review may be necessary. Industry experts have long held that the hospital credentials committee should be at the forefront when developing the privileging requirements, with guidance from the respective department chair and/or the subspecialty chief. A 1991 issue of the Journal of Law, Medicine & Ethics states the following:

“It's the departments that gather information and provide their point of view, but there should be a separate mechanism (e.g., credentials or ad hoc committee) that facilitates that conversation, analyzes the input/information received, and makes recommendations up to the medical executive committee (MEC) and ultimately the board for approval of criteria.”

If the privilege requires specialized equipment, the manufacturer may also provide guidance for privileging. When evidence-based requirements are not available, and no other hospital can be found that offers the specific privilege, the best course of action may be to mitigate risks to the organization by putting privileging efforts on hold until objective and evidence-based requirements become available.

Editor's note: This article was excerpted from our Medical Staff Briefing newsletter.