Part 2: Strategies for solving the challenges posed by low-volume providers

Dear medical staff leader:

My letter this week discusses strategies to address the challenge posed by practitioners who have low- or no-volume at your hospital but who are active at another hospital. 

The job of assessing the competence of a provider who treats a majority of his or her patients at another facility is fairly straightforward. Your hospital must submit a questionnaire/professional reference form to the physician's primary facility to confirm the physician's clinical knowledge, volume, outcomes, technical skill, professional performance, absence of disciplinary issues, and any additional factors relevant to clinical privileging decisions. This professional reference form should include questions concerning multiple dimensions of physician performance as outlined by The Joint Commission (formerly JCAHO), which is framed around the Accreditation Council on Graduate Medical Education competencies of:

• Patient care
• Medical knowledge
• Practice-based learning and improvement
• Interpersonal and communication skills
• Professionalism
• Systems-based practice

However, at the time of initial appointment your organization must follow a clearly defined proctoring policy to monitor the physician's activity at your hospital to ensure compliance with the Joint Commission's standard requiring focused professional practice evaluation (FPPE) that is effective January 2008.

The issue of whether to include such practitioners on your medical staff is a strategic organizational decision that should be made in concert with the medical staff and is outside the scope of this series. However, keep in mind that if your hospital grants privileges to such practitioners, you must have a clearly delineated policy and process to ensure their competence.

In part three of this series, I will address the challenges associated with practitioners who are not active at other hospitals but who are active in your community. Until then, be the best that you can be.

William K. Cors, MD, MMM, FACPE
Senior Consultant
The Greeley Company