Gather data to measure competency of low-volume providers

Dear medical staff leader:

Health care facilities continue to receive applications for privileges from low- and no-volume providers. The challenge for a medical executive or credentialing committee in processing such requests is gathering data to measure competency.

Low- and no-volume providers applying for privileges generally fall into three categories:

• a provider who treats most or all of his or her patients at another facility
• a physician who is not active at an institution but is active in the community
• a physician who has not practiced medicine for several years

In the first scenario, a provider who treats most or all of his or her patients at another facility makes the job of assessing his or her competence fairly easy. Submit a questionnaire to responsible individuals at the applying physician's primary facility to confirm the practitioner's clinical knowledge, technical skill, professional performance, absence of disciplinary issues, judgment, behavior, and any additional factors relevant to clinical privileging decisions. Gather references from that hospital's CEO, department chair, and director of medical records. Also obtain volume and outcomes data from the physician's primary institution by putting the burden on the physician applying for privileges.

If a physician is not active at another institution but is active in the community as a family physician or dermatologist, for instance, gather current clinical competence data by having the practitioner produce a specified number of patient records to reflect his or her clinical work. Appoint a member of the medical staff to review the work the provider has done in his or her office that is comparable to procedures performed at the hospital.

In addition, require the low- or no-volume practitioner to provide three physicians as references who have worked with him or her and can attest to his or her knowledge, ability, technique, and ability to get along with patients. Referring physicians who can assess the treatment of the applying physician's work are good references.

Also, the applying physician should supply the credentials committee with a billing printout of procedures performed in his or her office that includes information about volume and types of procedures.

For a physician who has not practiced medicine for several years, the privileging process presents additional challenges. While it is not acceptable to grant independent clinical privileges to such practitioners, neither should they be shut out of your hospital. Rather, create a policy that allows these physicians to reenter medicine.

It is virtually impossible to assess the current clinical competency of a low- or no-volume practitioner who is not active in any clinical setting.  Therefore, observe his or her clinical work directly in a highly controlled environment. Require the physician to co-admit his or her patients, work in conjunction with a senior physician, work with a proctor, or complete a mini or full residency.

After a specified time, the department chair can rely on assessments and information provided by the physicians co-treating patients with the low- or no-volume practitioner to make clinical privileging decisions.

Editor's note: The above passage was based on an excerpt from the book "A Practical Guide to Assessing the Competency of Low-Volume Providers" published by HCPro, Inc.