What is required for fair hearings focused on advanced practice professionals?

In my travels as a consultant, I get asked a lot of questions regarding the status and rights of advanced practice professionals (APP). Some medical staffs include APPs on the medical staff and others don’t, and there are pros and cons to both approaches, depending on your perspective. For example, if APPs are members of the medical staff, they are afforded the right to the same fair hearing as physicians, and some medical staffs feel that this is only fair. Other medical staffs, however, would rather reserve that sometimes herculean effort for physicians. However, the water gets muddied because APPs must be credentialed and privileged through the medical staff or an equivalent process, even if they are not technically medical staff members.

Below are three questions that medical staff should ask themselves when faced with the possibility of having a fair hearing for an APP. 

1. Is the APP a member of the medical staff?

• If the answer is yes, then the APP is entitled to the same fair hearing and appeal plan that all medical staff members have.
• If the answer is no, then the APP must be entitled to a fair hearing and appeal for the same reasons that a medical staff member does. The fair hearing and appeal process for the APP may be different than that from medical staff members. For examples, see “Streamline fair hearings for APPs, but don’t cut corners.”

2. What situations would invoke fair hearing and appeal rights?

• The situations that would invoke access to due process rights for APPs would be the same as those for the medical staff, as defined by the Health Care Quality Improvement Act (HCQIA) of 1986:
  • Denial or termination of membership (if APPs are members) or privileges on appointment or reappointment
  • Termination, restriction, suspension or other limitation of privileges for greater than 14 days for reasons of competence or conduct
  • Application of a concurring consultation requirement, or an increase in the stringency of a pre-existing concurring consultation requirement, when such requirement only applies to an individual APP and is imposed for more than 14 calendar days and is done for reasons of competence or conduct

3. What is an acceptable fair hearing process for APPs that are not medical staff members?

• In reviewing bylaws, The Greeley Company frequently see that APPs are allowed a fair hearing but not an appeal. If you are Joint Commission accredited, it is noted that a fair hearing and appeal process must be afforded to practitioners who are not members but are privileged by the medical staff as noted in MS.10.01.01.
• The fair hearing can be a simpler process than that for members.  It could be a hearing in front of the MEC or a smaller group of members (such as the department/clinical service chair and chief of staff).  The fair hearing could be conducted without the presence of attorneys.
• The appeal still is directed to the board. Again, the appeal could be performed without the presence of attorneys.
• The process must include the opportunity for a fair hearing and an appeal, if requested by the APP. However, it does not have to occur in the same timeframe as that for members or in the same manner as members. It needs to be a mechanism that allows fairness to the APP and to the medical staff but without the burden of time and money inherent to  fair hearing and appeals for medical staff members.

Mary Hoppa, MD, MBA, CMSL, is a senior consultant with The Greeley Company, a division of HCPro, Inc. in Marblehead, MA.