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

Dear medical staff leader:

It is likely that your credentials committee currently has a reappointment request before them that was submitted by a physician with privileges who rarely--or never--admits patients or performs procedures at your facility. As a medical staff leader, it is important that you understand why so many hospitals are presented with this challenge.   

First, many hospitals view medical staff membership and clinical privileges as synonymous. Many think that denying privileges is akin to denying membership--a perceived injustice with potential for legal action. The reality is that you can grant a physician medical staff membership without also granting him or her privileges. This approach is commonly taken by medical staffs that adopt affiliate, non-admitting, or honorary staff categories. Conversely, privileges can be granted without membership. For example, privileges without membership are granted in emergency situations and to allied health professionals. The distinction between membership and privileges becomes even more important when you factor in the new Joint Commission (formerly JCAHO) medical staff standards that require you to establish a process to determine current and ongoing competency for all privileges granted--a task made even more complicated when you do not have the data to prove a no- or low-volume provider's competence.

Physicians' perception or interpretation of hospital privileges is also making it difficult for hospitals to find a solution to the challenges presented by no- or low-volume providers. Many physicians mistakenly believe that hospital privileges are necessary to participate in managed care plans and are therefore reluctant to accept medical staff membership without privileges. However, a review of the fine details in many managed care contracts reveals that this may not be the case.

Physicians may also want privileges to:

• Maintain a social contact with the hospital

• Secure access to educational forums presented by the organization

• Maintain a perceived professional prestige of being affiliated with a hospital

A third consideration that arises when hospitals attempt to find a solution to no- and low-volume providers is it's own strategic and business reasons for maintaining relationships with these providers. Hospitals often want to maintain relationships with no-volume physicians who are active in the community and who can refer patients for diagnostic testing and specialty care. The hospital may also consider the advantages of maintaining relationships with influential or prestigious physicians. Lastly, the hospital and medical staff may wish to have access to certain low-volume specialists for consultation.

Low-volume providers generally fall into one of three categories:

• Active at another facility

• Not active at another facility but active in the community

• Has not practiced medicine for several years

Part two of this series will address the practitioner active at another facility but not at your facility. Part three will offer strategies for dealing with practitioners who are not active at any facility but are active in the community. Part four will deal with the challenges posed by practitioners who have not practiced medicine for several years. In addition, we will discuss the importance of focused professional practice evaluation (FPPE).

Until then, be the best you can be.

William K. Cors, MD, MMM, FACPE

Senior Consultant

The Greeley Company