Query key authorities before developing APP scopes of practice

Organizations must enlist and authorize advanced practice professionals (APP) for practice according to all applicable requirements, their available resources, and their medical staff’s comfort level. Once an organization has decided to move forward with development of an APP authorization process, it’s time to determine appropriate eligibility requirements and parameters for practice within the facility. Each professional group will have different education, training, and certification norms. The institution’s job is to determine whether the applicant’s training aligns with the level of care he or she is seeking to perform.

State licensure/regulations

To determine acceptable standards, check to see whether the discipline is licensed or certified in your state. Typically, state laws define a licensed APP’s allowed scope of practice and the parameters of any applicable collaborative or supervisory agreements. These regulations will help you identify the minimum eligibility criteria you must establish for professionals seeking to practice at your facility. If the APP discipline is not licensed in your state, you may want to consider an alternative process to medical staff credentialing and privileging (e.g., one driven by HR).

Wide variation among and within states

The scope and specificity of state regulations on APP practice and supervision vary widely across states and even between disciplines within a state. Given this degree of variation, organizations may struggle to create appropriate criteria for specialties whose practice is governed by ill-defined regulations. To avoid confusion over permitted practice within the given facility, medical staffs should be as specific as possible when describing the practice parameters, rules, and supervisory terms that will affect a new APP group.

Other sources

Of course, regardless of licensure status, your organization may decide to adopt stricter requirements, especially if professionwide standards far exceed the state’s mandates. To identify reasonable criteria over and above the state’s provisions, consider the following sources and steps:

  • Meet with a few representatives of the profession to obtain their education and training history and an overview of typical practice.
  • Identify relevant professional associations, many of which publish helpful overviews of typical practice, job descriptions, and/or credentialing or privileging recommendations.
  • Research certification options. If there is a certification board, consider adopting its eligibility and/or performance assessment requirements (e.g., those surrounding CME), which reflect professional standards regarding competency and current practice. If, however, the discipline is still in its formative years, and certified professionals are few and far between, consider tabling these requirements until certification is a mainstay in the profession.
  • Connect with physicians who may supervise or collaborate with the APP discipline. Share key findings and materials regarding practice authorization (e.g., job descriptions/privilege forms from professional associations or healthcare organizations), and obtain the physician’s recommendation about how these forms should be adapted to reflect internal needs.

Source: Overcoming Contemporary Credentialing Challenges: Practical Strategies for MSPs and Medical Staff Leaders