Strategies for solving the challenges posed by low-volume providers

Many primary care physicians have decreased their hospital activity and instead focus on their ambulatory-based community practice. Financial factors and lifestyle choices are often behind such changes to a physician's practice. Although these physicians' ties to the hospital are weakened, many hospitals and their medical staffs want to maintain relationships with primary care physicians in the community to secure ongoing referrals for specialty care, provide ancillary services, and maintain a strong commitment to community health. Likewise, certain specialists whose main activities are ambulatory outpatient based, such as allergists and dermatologists, want to maintain access to the hospital and its medical staff. To facilitate such arrangements, the hospital should consider the following category options:

• Membership-only status:  Medical staff membership and the granting of clinical privileges are not synonymous. Offer physicians membership without privileges. Hospitals are not required to verify the competence of physicians who don't request privileges. Therefore, reappointing these physicians would require only that you follow your policy that details the information (e.g., license, insurance, etc,) you must verify before granting membership. Also keep in mind that many managed care panels no longer require hospital privileges for participation.
• Refer-and-follow privileges: This level of privileging permits the physician to refer patients for inpatient admission. A hospitalist or specialist then assumes admitting responsibilities. The referring physician may visit and provide follow-up care, but the admitting physician makes medical decisions during the inpatient stay. The practitioner with "refer and follow" privileges must provide the hospital with evidence of current competence. Such competence might include: performing a history and physical, ordering outpatient tests and services, and consulting with attending physicians.
• Special membership category: Many medical staffs have categories of membership that confer less than full clinical privileges. Reappointment criteria for limited privileges might include outpatient data/chart review, retrospective review of a specified number of inpatient cases, and three reference letters from physicians who can attest to the physician's knowledge, technique, and interpersonal interactions.