Can different specialties use different criteria for the same privilege?

A challenge that commonly arises in addressing crossover privileges occurs when one specialty recommends different criteria for the same privilege requested by another specialty. Although it might be simpler to make the criteria the same regardless of the specialty, this does not take into account the training and experience of the different parties. There is no specific Centers for Medicare & Medicaid Services language that requires that the criteria be exactly the same for every specialty. Medical staffs that have adopted a more flexible approach generally have not run into accreditation problems as long as they ensure the criteria is consistently applied.

Let's use colonoscopy as an example. One medical staff might choose to establish the criteria that only fellowship-trained, board-certified gastroenterologists are eligible to perform colonoscopies in the hospital. Although this may be an acceptable standard, it excludes colorectal surgeons, general surgeons, internists, and family medicine physicians from performing colonoscopies. According to criteria recommended by the American Society for Gastrointestinal Endoscopy, a physician must have performed 140 procedures under supervision to be eligible to perform colonoscopies. This could be adopted as a credentialing criterion for the privilege to perform colonoscopies. However, this volume of procedures is usually achieved in gastroenterology fellowships, so adopting this criterion is a de facto process of requiring fellowship training in gastroenterology to be eligible for colonoscopy privileges.

A colorectal or a general surgeon could reasonably make the case that because he or she operates on and handles the colon so frequently, he or she can recognize pathology and work with a colonoscopy effectively with fewer than 140 precepted procedures under his or her belt. Can a medical staff adopt criteria for gastroenterology that require fellowship training in gastroenterology to perform colonoscopies and require a colorectal or general surgeon to perform 75 colonoscopies under supervision to be eligible to perform colonoscopies? Yes; such an approach is acceptable and will likely pass regulatory standards. The MEC still must approve criteria for the granting of privileges to perform colonoscopies, but the criteria could read as follows:

Criteria to be eligible for colonoscopy privileges include either of the following:
(a) Board certification in gastroenterology and successful completion of at least 50 colonoscopy procedures within the past two years
(b) Successful completion of a residency program in general or colorectal surgery, plus the completion of at least 75 colonoscopy procedures under supervision and the successful completion of at least 50 colonoscopy procedures within the past two years

Note that the criteria for gastroenterologists address training, experience, and current competence, as do the criteria for the other disciplines. Even though the criteria for privileges differ between disciplines, the medical staff has adopted a single criterion that just happens to have two options within it. Interpreting this as a uniform standard depends somewhat on semantics. However, many organizations that have used this approach have met the regulatory requirement for a uniform (or equivalent) standard of care throughout the organization. In the case of the gastroenterologist, it would be logical to assume that colonoscopy would be included within their core procedures. Therefore, it would follow suit that the healthcare organization would want to see evidence of a minimum of 50 colonoscopy procedures within the past two years, even though the procedure has been included within the core.

Source: Criteria-Based Core Privileging: A Guide to Implementation and Maintenance