When credentialing AHPs, stick to specifics
In a recent conversation, Credentialing Resource Center Journal spoke with author Sally Pelletier, CPMSM, CPCS, advisory consultant and chief credentialing officer at The Greeley Company. She described some of the emerging challenges as well as "traditional" ones that allied health professionals—including physician assistants, advanced practice nurses, and other nonphysician practitioners—might pose for hospitals and medical staff services professionals.
Q: What are the biggest challenges that AHPs, otherwise known as advanced practice professionals (APPs), pose for the medical staff services department?
A: The challenges usually begin with unclear guidance in the fundamentals of the credentialing structure--or what we would refer to at The Greeley Company as step 1 of credentialing. What type of guidance (or lack of guidance) do they have through their medical staff bylaws, rules and regulations, credentialing policies and procedures, and delineation of privileges?
Too often, APPs are addressed ambiguously in bylaws, rules and regulations, etc., or the way that they are addressed is confusing and does not provide clear guidance about how to process these individuals, or plainly state what they can do within the facility, or the degree of supervision that is required.
The confusion is compounded by the questions raised in regulatory writings and accreditation directives, such as:
Should these nonphysician practitioners be members of your medical staff?
Does The Joint Commission still allow an equivalent process, or are APPs required to be processed through the medical staff privileging process if they are providing a medical level of care?
Does your organization have to allow APPs to have the same scope as their state license allows?
An additional challenge for hospitals is having the requisite skill sets and knowledge base to appropriately support medical staff leaders who may have to navigate through some potentially tough issues related to the culture of their organization—e.g., how APPs will be utilized in their organization and how broad their scope of practice will be.
Lastly, there is the continuing issue of data attribution, so the [nonphysician practitioners'] performance and competencies can be effectively measured, and appropriate adjustments can be made to privileges granted, based on this information.
Q: Can you talk a little about "training up" and the expansion of privileges for these practitioners?
A: We run into this all the time when working with hospitals. The supervising physician is training the APP to do additional procedures and very often does not hesitate to do so because many state licenses allow the APP to do whatever is within the scope of the physician.
The problem is that many organizations do not have the appropriate structure in place to manage the train-up process, including consulting with their liability carrier and obtaining patient consent.