Avoid denying an application for privileges

There should be very few times when a medical staff needs to deny an application for privileges. For the most part, the physician and other licensed independent practitioner applicants are practitioners who have excellent records and will continue to deliver high quality in their ongoing patient care.

As for the (thankfully) few “problem children” who may apply, the organization should look for ways to avoid denying their applications. Here is the main reason why: If you process an application and only then discover that the applicant has either a clinical or behavioral problem that requires you to deny his or her application, said applicant has certain rights. If there is a subsequent denial or limitation of a practitioner’s privileges, then he or she has the right to challenge that negative recommendation and have a fair hearing.

The Health Care and Quality Improvement Act (HCQIA) of 1987 guarantees the right to a fair hearing to challenge the recommendation, and these rights are generally spelled out in the medical staff bylaws as well. Fair hearings can result in a protracted quasi-legal process that can take a lot of time and money from the medical staff members and the institution. Attorneys tell me that the typical bill for a fair hearing today averages about $500,000—and that is just the average for legal costs to the hospital and medical staff.

Most of this potential threat can be avoided by having (and following) robust policies and procedures, as well as sound institutional practices. Base all activities on the following premise: If an applicant does not meet the criteria set out in these policies, then the application cannot be processed.

Source: The Credentials Committee Manual