When to grant temporary privileges

Dear medical staff leader:

Many hospitals are granting temporary privileges to locum tenens for coverage in the emergency, anesthesia, or other clinical departments. For some facilities, granting temporary privileges to many new applicants has become routine.

All temporary privileges must be granted by the CEO after recommendation from the medical staff president. However, these hospitals must keep in mind that several years ago the Joint Commission (JC) stated that there are only two circumstances in which temporary privileges may be granted:

1. When an applicant is awaiting review and approval by the medical executive committee (MEC) and the governing body, the applicant may be  granted temporary privileges for no more than 120 days.

2. To fulfill important patient care, treatment, or service needs, temporary privileges may be granted for the time period defined in the bylaws.

If the first scenario comes up repeatedly and new applicants are frequently awaiting MEC and board approval, the medical staff should consider an expedited credentialing process.

This process allows the credential committee chair, representing the credentials committee, to recommend appointment or  reappointment for a clean applicant who raises no concerns (no successful challenges to licensure, no termination of staff appointment, and/or no reduction or limitation of clinical privileges.)

The JC requires an MEC to make a recommendation (not just the medical staff president) regarding the granting of privileges. The MEC  vote must  satisfy its own quorum requirements. However, your bylaws can establish a lower MEC quorum ( at least three members) specifically for requests for routine appointment, reappointment, and clinical privileges.Then a board committee of at least two members may render a final decision. An expedited process like this would dramatically lessen the need to grant temporary privileges for new applicants.

In the second temporary privileging scenario, we commonly see bylaws that include temporary appointments of 30 to 120 days. Organizations sometimes have difficulty in this area since they may require a locums emergency department (ED) coverage physician to cover two months now and then need his or her services again in six months.
 
In that case, temporary privileges would have expired. If you see a possible on-going need for locum tenens coverage, credential an applicant through your regular credentialing process to eliminate the need to constantly re-grant temporary privileges (and go thru the credentialing process) once every 30 to 120 days.

Until next time,
Joseph Cooper, MD