Privileging versus authorization of mid-level practitioners

Many medical staff organizations are grappling with the issue of which practitioners should be privileged via the medical staff organization. This is not a simple issue and is complicated by the fact that there is a lot of "folklore" about what is required in this area to meet accreditation requirements.

Let's see if we can apply our Albert Einstein principle here: Make the complex simple.

First, the medical staff organization is required to privilege all licensed independent practitioners (LIP). LIPs are individuals who (according to The Joint Commission's definition) function without supervision or direction. Practitioners who are typically included in this grouping are physicians (MDs, DOs), dentists, podiatrists and clinical psychologists. Each organization defines which practitioners will be classified as LIPs, and typically, there are state licensing laws that impact the decision of which practitioners fall into this definition.

Second, The Joint Commission requires that physician assistants (PA) and advanced practice registered nurses (APRNs) be privileged. APRNs are usually defined as including the following disciplines:

• certified nurse midwife
• clinical nurse specialist
• certified registered nurse anesthetist
• nurse practitioner (NP)

PAs and APRNs may be privileged via the medical staff organization process (recommended) or an alternate (and equivalent) process. It should be noted that the elements related to the privileging process must be applied whether they are employed by the organization or not.

For example, some NPs may enter the organization via an employment relationship with a physician; others may be employed by the organization. Both groups need to be privileged (much in the same way that a physician with a contract with the hospital, i.e., radiology, must still be credentialed and privileged in order to be able to provide clinical services).

HR.1.20 requires that qualifications and competence for a non-employee brought into the hospital by a LIP to provide care, treatment or services be "commensurate" (equivalent) to the qualifications of those employed by the hospital.

Each organization should determine the best method to handle these healthcare workers who are not employed by the organization. The human resources department (HR) may be in a much better position than the medical staff organization to assure that there is equity between what is in the job description of a hospital-employed surgical assistant and a surgical assistant brought in by a LIP, as well as the qualifications that must be met by the individual in order to provide services as a surgical assistant.

There are other ramifications, such as health screening, orientation, etc., that may be more efficiently managed by HR.

Remember, when the medical staff organization credentials and privileges a healthcare professional, they are also assuming responsibility for ongoing monitoring and evaluation of the services provided so that competency can be assessed and appropriate privileges recommended.

Until next week,

Vicki L. Searcy, CPMSM
Practice Director, Credentialing & Privileging
The Greeley Company
vsearcy@greeley.com
www.greeley.com