Privileging considerations for low-volume providers

Low-volume providers are, by definition, practitioners who perform very few procedures or admit or treat very few patients within their appointment cycle. At reappointment, these providers may request clinical privileges that they have not performed on a regular basis. Often, the credentialing process for these providers will include requesting their office and/or surgery center activity in addition to reviewing any activity that they performed at the facility. There are usually two options for addressing these types of requests. The medical staff could begin a proctoring or FPPE process to ensure competency before reinstating the privilege to be performed independently, or they could request that the provider withdraw the request.

Some members of the medical staff may never have enough activity in the hospital to exercise all of the privileges that were initially granted to them. That is why it is critical to review privilege requests carefully at each reappointment, compare the requests with those privileges that the practitioner currently holds, obtain the proper activity/procedure logs, and address any low-volume issues as outlined in the medical staff bylaws.

Consider a large orthopedic group in a nearby town. Four of the group’s orthopedic surgeons are on the active staff and have a full-time practice in the hospital. Several of the group’s other physicians have joined the medical staff in order to share the weekend call schedule. This group covers five area hospitals. These new members of the medical staff will be covering weekend call and will rarely perform surgery in the hospital. Their intended practice at the facility makes it difficult to evaluate their performance relative to all of the privileges that have been granted.

This often happens with emergency medicine providers and large hospitalist programs. In order to staff appropriately and cover unanticipated holes in the schedule, physicians may come on staff in the courtesy category or another category established for those who do not intend to have an active practice in the hospital. The practice of these physicians could be so sporadic that it could take two or three years for them to demonstrate competency in all of the privileges granted.

In these cases, it is best to conduct the focused evaluation as soon as possible based on the physician’s limited activity in the hospital. Once this evaluation is completed, a note from the credentials committee or medical executive committee should be placed in the file stating that this physician does not intend to have an active practice in the hospital, and the organized medical staff has completed a focused evaluation based on their limited activity.