Credentialing and Privileging
Hospitals and health care organizations are responsible
for assuring the professional competence of staff
physicians. We can offer assistance with credentialing
and privileging to hospitals. We also respond to the
increasing demand for credentialing for new technologies
and procedures, as well as cross specialty
credentialing. Demonstrated
competence along with sufficient
training and experience should be the
basis of a fair credentialing program.
We can assist in review of these
criteria and offer practical solutions
which may include preceptor programs under the
Foundation for Advanced Medical Education.
Monitoring Temporary Privileges
To assure the professional competence of physicians who
are seeking clinical privileges for the first time, hospitals
or other health care facilities may wish to utilize a process
that prospectively, but only conditionally privileges
physicians. During this conditional period, an outside
proctor may audit the physician’s patient records. This
may include on-site observation of techniques. Upon accumulation of an
adequate number of satisfactory cases, the Foundation
will forward a recommendation regarding the granting of
unconditional privileges to the physician at the health care
facility. The
physicians seeking privileges should agree to be bound by
the results of the process.
Arbitration
The Foundation can assist in several ways in developing
mechanisms for arbitration, which is a much speedier and
less costly process than litigation for resolving differences.
We can identify nationally prominent authorities to serve
as arbitrators. They will be expert physicians in the same
specialty as the physician in question or in some cases,
physician attorneys or health attorneys. Agreeing to arbitration means acceptance of the findings
and binding resolution of the issues. Arbitration can be in
the form of an in-depth review of a physician’s practice by
an arbitrator, or a hearing examer, or both. This agreement to be bound by the results of the process can help resolve
privilege and other dilemmas without actual litigation.
Mediation
Mediation is a
special form of negotiation that facilitates the
reaching of an agreement through give and take between
the parties in the presence of objective listeners.
Mediation of both clinical and behavioral staff
problems is often welcomed when the mediator is an
experienced outsider with no personal interest in the
outcome. The Foundation can provide experienced
physicians, physician-attorneys, and attorneys with
mediation experience. Although mediators do not have
the power to impose a settlement as arbitrators do,
they are trained and experienced in dispute resolution
with the result being that achieving a settlement is
more likely. Mediation is less adversarial than
litigation or arbitration and is less disruptive to
medical staff relations. If preconditions exist that
both parties share a genuine desire to resolve the
dispute, failure of the process is the exception.
Expert Hearing Officers
Upon request, the Foundation will supply medical or surgical specialists and attorneys expert in hospital law to act as hearing officers under medical staff bylaws. The Foundation provides a full hearing panel (for example: two medical specialists and
an attorney hearing officer) in order to fulfill the Health Care Quality Improvement Act mandate that panel members not be in economic competition with the affected physician.
