A Practical Guide to
Assessing the
Competency of
Low-Volume Providers
A Practical Guide to
Assessing the
Competency of
Low-Volume Providers
H u g H g r e e l e y
H u g H g r e e l e y
C
ontents
About the Author . . . v
Introduction . . . vii
Glossary . . . . xi
Chapter One: The Increase of Low- and No-Volume Providers . . . 1
Chapter Two: Understand the Appraisal and Reappraisal Process . . . 5
Figure 2.0: Reappointment Flow Chart . . . .6
Figure 2.1: Application for Medical Staff Appointment and Clinical Privileges . . . 30
Figure 2.2: The New Credentialing Standard: Ten Steps to Credentialing Excellence. . . 38
Figure 2.3: Instructions for Completing an Application for Medical Staff Appointment . . . 43
Figure 2.4: Application Completion Checklist . . . .46
Figure 2.5: Notification of Failure to Submit Application. . . 49
Figure 2.6: Policy on Clinical References . . . 50
Figure 2.7: Reappointment Activity Summary . . . 52
Figure 2.8: Fast-Track Credentialing Policy. . . 54
Chapter Three: Guidelines for Responding to Low- and No-Volume Practitioners’ Applications . . . . 57
Figure 3.0: Sample Policy and Procedure: Placing the Burden on the Applicant . . . . .65
c
o n t e n t sFigure 3.2: Notification of Incomplete Application . . . 67
Figure 3.3: Notification of Unsatisfactory Response . . . 68
Figure 3.4: Notification of Failure to Respond . . . 69
Figure 3.5: Appointment and Clinical Privileges Myths and Truths. . . 70
Chapter Four: Options for Processing Low- and No-Volume Providers’ Applications . . . 73
Figure 4.1: Letter Accompanying Professional Reference Questionnaire . . . .86
Figure 4.2: Professional Reference Questionnaire . . . 87
Figure 4.3: Sample Guidelines for Proctoring. . . 90
Figure 4.4: Sample Proctor Assignment Procedure . . . 93
Figure 4.5: Intended Practice Plan . . . .95
Figure 4.6: Sample Bylaws Language: Categories of the Medical Staff . . . 97
Chapter Five: Case Studies: Low- and No-Volume Providers . . . 99
Case study one . . . 100
Case study two. . . .103
Your credentials committee likely has had a reappointment request before them in the past year that was submitted by a physician who admitted few or no patients to your facility during his or her soon-to-be expired appointment period.
The credentials committee also likely received a medical staff application/clinical privilege request from a physician who has not provided inpatient care for many years, admits all of his or her patients to another hospital in the community, or works exclu-sively in his or her office.
Yours is not the only credentials committee confronted with the challenge of process-ing such appointment requests.
Medical services professionals, department chairs, and credentials committee mem-bers in hospitals across the country are faced increasingly with applications for medi-cal staff membership or clinimedi-cal privileges from physicians who treat few or no patients at their hospital.
Hospitals and credentialing professionals, understandably, are concerned about this trend and its effect on the credentialing process. These concerns are elevated by fear that the hospital will not meet accreditation standards and fear that a physician may lack the skills and knowledge to care appropriately for patients. In addition, hospitals worry that a low- or no-volume physician may admit and treat a patient who subse-quently files a corporate negligence suit against the hospital, accusing the hospital of negligent retention.
T
he
I
ncrease
of
L
ow
-
and
n
o
-
voLume
provIders
c
h A P t e ro
n eThe emergence of low- and no-volume providers
There are many explanations for a decline in a physician’s activity at the hospital—he or she may have relied on your organization’s hospitalist program, referred a majority of his or her patients to another facility for inpatient care, or focused attention on his or her office practice.
L
ow-
voLumeandno-
voLumeprovIders usuaLLyfaLLInToThefoLLowIng Three caTegorIes:
1. The provider treats the majority or all of his or her patients at another inpatient facility 2. The physician is not clinically active at another inpatient facility but is active within the
community (e.g., family physician, dermatologist, or allergist) 3. The physician has not practiced medicine for several years
Whatever the reason for the decline in hospital activity, processing medical staff appli-cations and privileging requests from such providers have many credentialing and medical staff professionals stumped. And the biggest stumbling block is the absence of data with which to assess the physician’s competence.
Remember, competency is the main issue during appointment, reappointment, and privileging, whether the physician is an active member of the medical staff or is a low- or no-volume provider.
Absence of competency data
The phenomenon of low- and no-volume providers is relatively new and has arisen primarily because of general internists’ and family physicians’ decision to change the
t
h ei
n c r e A s e o fl
o w-
A n dn
o-V
o l u m eP
r o V i d e r sway they practice medicine. That is, more and more of these practitioners are finding it beneficial to devote time to their office-based practices rather than providing inpatient services.
It’s not difficult to understand why these physicians are concentrating on their office-based practices. However, physicians’ decisions to do so make reappointment an even more difficult task as medical staff and credentialing professionals struggle to gather competency data for physicians with limited or no hospital activity.
In Chapter three, we will present strategies to help your organization gather the com-petency data it needs to confidently appoint a low- or no-volume practitioner to its medical staff.
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