A Practical Guide to. Assessing the Competency of Low-Volume Providers

Transcription

1 A Practical Guide to Assessing the Competency of Low-Volume Providers Hugh Greeley

2 Contents About the Author v Introduction vii Glossary xi Chapter One: The Increase of Low- and No-Volume Providers Chapter Two: Understand the Appraisal and Reappraisal Process Figure 2.0: Reappointment Flow Chart Figure 2.1: Application for Medical Staff Appointment and Clinical Privileges Figure 2.2: The New Credentialing Standard: Ten Steps to Credentialing Excellence Figure 2.3: Instructions for Completing an Application for Medical Staff Appointment Figure 2.4: Application Completion Checklist Figure 2.5: Notification of Failure to Submit Application Figure 2.6: Policy on Clinical References Figure 2.7: Reappointment Activity Summary Figure 2.8: Fast-Track Credentialing Policy Chapter Three: Guidelines for Responding to Low- and No-Volume Practitioners Applications Figure 3.0: Sample Policy and Procedure: Placing the Burden on the Applicant Figure 3.1: Instructions for Requesting Additional Information/Clarification

3 C o n t e n t s Figure 3.2: Notification of Incomplete Application Figure 3.3: Notification of Unsatisfactory Response Figure 3.4: Notification of Failure to Respond Figure 3.5: Appointment and Clinical Privileges Myths and Truths Chapter Four: Options for Processing Low- and No-Volume Providers Applications Figure 4.1: Letter Accompanying Professional Reference Questionnaire Figure 4.2: Professional Reference Questionnaire Figure 4.3: Sample Guidelines for Proctoring Figure 4.4: Sample Proctor Assignment Procedure Figure 4.5: Intended Practice Plan Figure 4.6: Sample Bylaws Language: Categories of the Medical Staff Chapter Five: Case Studies: Low- and No-Volume Providers Case study one Case study two Case study three

4 Chapter One The Increase of Low- and No-volume providers 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 exclusively in his or her office. Yours is not the only credentials committee confronted with the challenge of processing such appointment requests. Medical services professionals, department chairs, and credentials committee members in hospitals across the country are faced increasingly with applications for medical staff membership or clinical 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 subsequently files a corporate negligence suit against the hospital, accusing the hospital of negligent retention.

5 C h a p t e r O n e The 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. Low-volume and no-volume providers usually fall into the following 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 applications 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

6 T h e I n c r e a s e o f L o w- a n d N o-volume P r o v i d e r s way 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 officebased 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 competency data it needs to confidently appoint a low- or no-volume practitioner to its medical staff.

7 Order your copy today! Please fill in the title, price, order code and quantity, and add applicable shipping and tax. For price and order code, please visit If you received a special offer or discount source code, please enter it below. Title Price Order Code Quantity Total Name Title Your order is fully covered by a 30-day, money-back guarantee. Enter your special Source Code here: Organization Street Address City State ZIP Telephone Fax Address $ Shipping* $ (see information below) Sales Tax** $ (see information below) Grand Total $ *Shipping Information Please include applicable shipping. For books under $100, add $10. For books over $100, add $18. For shipping to AK, HI, or PR, add $ **Tax Information Please include applicable sales tax. States that tax products and shipping and handling: CA, CO, CT, FL, GA, IL, IN, KY, LA, MA, MD, ME, MI, MN, MO, NC, NJ, NM, NY, OH, OK, PA, RI, SC, TN, TX, VA, VT, WA, WI, WV. State that taxes products only: AZ. Billing Options: Bill me Check enclosed (payable to HCPro, Inc.) Bill my facility with PO # Bill my (3 one): Visa MasterCard AmEx Discover Signature Account No. Exp. Date (Required for authorization) (Your credit card bill will reflect a charge from HCPro, Inc.) Order online at Or if you prefer: Mail The Completed order form to: HCPro, Inc. P.O. Box 1168, Marblehead, MA Call our customer service Department at: 800/ fax The Completed order form to: 800/ [email protected] 2008 HCPro, Inc. HCPro, Inc. is not affiliated in any way with The Joint Commission, which owns the JCAHO and Joint Commission trademarks. Code: EBKPDF P.O. Box 1168 Marblehead, MA /