Hospitals are no longer the primary setting for many physicians and advanced practice professionals (APPs). When they do spend a slight percentage of time working in the hospital, it poses one of today’s great performance data challenges for the MSPs and credentialers who process them at reappointment.
It might be time for a check on how your organization incorporates low-/no-volume providers into the hospital practitioner community. The goal is to ensure that the relationship is beneficial to the hospital’s needs. One place to start is by examining medical staff categories and membership.
When accommodating low-/no-volume providers jeopardizes accreditation status, economic goals, and clinical needs to serve your patient population, it’s not a win-win for the two parties.
Performance data is key today
Known as low-volume or no-volume providers, they often lack sufficient hospital performance data. Interestingly, their split-service in ambulatory or outpatient plus the hospital comes at the precise time when quality and performance data drive decision making. Healthcare parties seek increased quality tracking and scoring for any hospital-privileged provider. This is true among patients, accreditors like Joint Commission and NCQA, and regulators such as CMS.
Why maintain ties?
So if outpatient, urgent care, and ambulatory sites are attracting more patients than ever, is low-/no-volume a short-term healthcare competency assessment problem? Probably not as long as hospitals exist. Hospitals benefit from the professional connections with providers in the community for strategic and economic reasons. Low-/no-volume providers’ reasons for wanting to maintain hospital privileges can vary. Some must comply with payers who mandate that participating providers keep hospital clinical privileges. Others request privileges to keep tabs on or perform services on admitted patients. Some like the collegiality and connections.
But the hospital itself imposes another common reason: Hospital policy for membership requires maintenance of privileges.
Terminology check: Membership vs. privileges
According to the Greeley Company, membership in a medical staff category should be separate from privilege delineation. This is the case whether the clinician is considered low-/no-volume or not.
The main reason is that membership is often a highly political decision by the self-governed medical staff, because of the allowances that go with the designation. Voting rights, ability to hold office, or committee position appointments are a few common perks. Privileges on the other hand determine what care and services a provider can administer in the hospital. Despite the distinction, many muddle the terms membership and privileges.
Ensure that your hospital’s medical staff categories reflect the type and amount of activity that members must carry out. And the volume required must also make sense for your hospital culture and community.
Questions to begin your analysis
While changing policy around low-/no-volume providers and membership might not be on the table now, you can recommend best practices through discovery in this exercise.
Tackling the providers first, ask:
- Does your credentialing software track a complete, updated listing of the kinds of low-/no-volume providers who have privileges in the hospital?
- Are there sub-categories of low-/no-volume practitioner types at your organization, such as locum tenens, consultants, those with zero activity, etc.?
- Does your organization have a policy for whether low-/no-volume providers can be members of the medical staff? Is it documented?
- What medical staff category(ies) currently include them?
Moving onto the medical staff categories, ask:
- What are the medical staff categories and what non-clinical freedoms do they allow?
- Is there any language in the documentation about clinical privileges as a prerequisite for membership?
- Has your healthcare organization created new membership categories when only privileged vs. non-privileged is the difference among members?
Ensure your organization incorporates low-/no-volume providers into the hospital practitioner community in a meaningful and beneficial way. Start with understanding the types of low-/no-volume providers you have, where challenges lie in assessing their performance at reappointment, and any issues that present in how they’re categorized as members. You might discover changes needed to the number and type of medical staff categories, in order to keep pace with providers’ changing clinical practice habits today.