What is expedited credentialing?
As The Greeley Company redesigns medical staff bylaws in hospitals across the country, there appears to be a lot of confusion about the expedited credentialing process. Commonly, medical staffs adapt the process of granting temporary privileges and call it expedited credentialing. Although this seems like a logical leap, it’s not. We need to differentiate between temporary privileges and expedited credentialing.
Temporary privileges are recognized by The Joint Commission in two particular circumstances. The first is an important patient care need. The second is a new application with no concerns that is awaiting the approval of the medical executive committee (MEC) and the board. In both cases, the temporary privileges are based on a recommendation from the medical staff president/chief of staff and approved by the CEO, acting on behalf of the board. Although The Joint Commission allows both types of temporary privileges, it seems that they are concerned about the number of temporary privileges that medical staffs grant in the second category: the clean application awaiting approval. Rather than granting temporary privileges, anecdotal evidence suggests that The Joint Commission prefers that medical staff organizations use the expedited process.
The expedited credentialing process is actually an expedited board process. The remainder of the credentialing process still must occur. If your normal privileging process includes the department/clinical service chair signing off on an applicant’s privileges, that must still occur if you choose the expedited credentialing process. If you have a credentialing committee, you must get approval from the credentialing committee. However, you can write into your bylaws that the credentials chair can approve these clean applications on behalf of the entire committee. The MEC must also approve the expedited credentialing application, but this task can be delegated to just two or three members of the MEC who can review these applications on behalf of the entire committee. Finally, the expedited credentialing application can go to a subcommittee of the board (at least two members) who can act on behalf of the whole board. All of these processes must be established in the bylaws.
In addition to the expedited credentialing process, the bylaws should also describe what the medical staff organization considers a clean application. Once an application is complete and verified, the remainder of the process (department/clinical service chair review, credentials chair review, and review by a subcommittee of the MEC) can occur in one or two days and can occur on an as-needed basis. Then these applications can very quickly go to the board subcommittee for approval.
The expedited credentialing process takes away the typical credentials committee and MEC approval processes, but for clean applications, there is usually little to discuss. It is usually only the applications that raise red flags that undergo the full rigor of discussion to vet the risks associated with these applications. Applications with a red flag must go through the regular channels of approval. Therefore, the expedited process serves the medical staff organization well by only allowing clean applications to go through this process while still maintaining multiple levels of review. It also serves the medical staff applicant well because it allows applications to be approved by the board quickly while allowing the applicant to begin caring for patients right away. The minimum criteria for an application to go to expedited credentialing is noted in The Joint Commission standard MS.06.01.11 but medical staffs can add more to these criteria if they choose to do so.
Mary Hoppa, MD, MBA, CMSL is a senior consultant with The Greeley Company, a division of HCPro, Inc. in Marblehead, MA.