Provider Privileging 101

Provider privileging is essential for quality of care, patient safety, and risk management.

Improper privileging can lead to patient harm and lawsuits, as in this example: A physician had completed a one-day training course in robotic hysterectomy, using pigs on which to learn the procedure. A hospital granted the physician privileges to perform the robotic procedure as long as a proctor, who already had privileges to use that technique, was present for his first three surgeries. The physician performed his first robotic hysterectomy on a patient without the required supervision. That patient, who lost bladder function as a result of the surgery, sued the hospital for negligent privileging.1 In this case, the physician lacked the necessary training and experience to safely perform the surgical technique.

Provider privileging is the process of authorizing a specific scope of practice for patient care based on an evaluation of a provider’s credentials and training. Providers are given permission to perform a specific service, or procedure, or to treat a certain condition at a specified healthcare facility such as a hospital or ambulatory surgery center. A provider who is not properly privileged at your healthcare facility cannot see patients there. Health systems must answer to regulatory entities such as The Joint Commission to ensure that physicians are appropriately privileged at their facilities.

Hospital privileging typically falls into three primary categories:

  • Admitting Privilege — Allows a physician to admit a patient to the hospital
  • Courtesy Privilege — Allows physicians to occasionally treat or admit at the hospital
  • Surgical Privilege — Allows the physician to perform outpatient or operating room surgeries

Although the terms are sometimes used interchangeably, privileging differs from provider credentialing. Credentialing is the process of obtaining, verifying, and assessing providers’ qualifications—education, training, licensure, and experience—to ensure they are competent to provide patient care, in general. Credentialing comes before privileging—which dictates the specific patient care services providers can deliver in a particular healthcare facility. A privileged provider has the training, skills, experience, and competencies necessary for the clinical services they plan to provide.

Like the credentialing process, the provider privileging process is complex, labor-intensive, and time-consuming—for providers and administrators. Provider privileging can take up to 60 to 90 days, assuming no delays in verifying credentials.2 Here’s what’s involved in the multistep process:

Application. Providers apply for privileges at one or more healthcare facilities. Providers must submit lots of documentation, including (but not limited to):

  • Credentials (e.g., education, training, experience, current competence, board certification, state licensure, proof of malpractice insurance) and curriculum vitae (CV)
  • Letters of recommendation from instructors, physicians who have monitored their clinical work, or colleagues.
  • Case reports, including data about the number and types of cases, and treatment outcomes.

Review:

  • First, the facility’s medical staff office receives the privileging request application and verifies the credentials.
  • Next, the specialty department chair or committee approves the complete packet of information for review.
  • The approved packet is reviewed by one or more of these groups: credentialing committee, medical executive committee, and/or the facility’s board of trustees.
  • Reviewers may request/require additional information or reject the application at any step in this process.

Interviews. Providers should be prepared for in-depth interviews with a credentialing committee, a medical executive committee, and/or a board of directors.

Decision. The credentialing committee may grant the provider limited or full privileges or may deny privileges.

Renewal. According to The Joint Commission, hospital privileges for physicians must be renewed every 24 months.

Inefficient provider privileging processes can cause:

Privileging delays and reliance on temporary privileging. Inefficient credentialing and privileging processes result in duplication of work, staff turnover, and delays in provider onboarding. Privileging timelines depend on the accuracy and completeness of the credentialing documentation provided. Overuse or abuse of temporary privileging can have disastrous consequences for patients and health systems. A single negative outcome by a provider granted temporary privileges can lead to a negligent credentialing lawsuit.

Provider dissatisfaction. Inefficient processes and non-standard forms frustrate providers, who spend too much time filling out forms and submitting the same information multiple times. Compounding the problem, physicians are typically uninformed about the process and the progress of their application.

Implications to quality of care: Rushing to complete provider privileging with inadequate processes opens healthcare organizations up to liabilities and complications in providing quality care.

An automated provider privileging solution that integrates with contracting, credentialing, and enrollment solutions streamlines and accelerates provider onboarding and increases provider satisfaction. Consolidating privileging across the health systems, standardizing processes and procedures using technology, and streamlining the review and approval process expedites for timely completion.

TractManager’s modernized technology integrates with over 150 sources of primary information and provider data, eliminating manual processes. TractManager’s Provider Privileging software speeds up the process and reduces provider burden by providing easy access to real-time provider data stored in a single, central database.

To learn more about TractManager’s Provider Privileging solution, download the Provider Onboarding eBook.

Sources:

1 https://www.leagle.com/decision/inlaco20180621351
2 American Society of Anesthesiologists. April 2017. Timely Topics – Payment and Practice Management: Got Credentialing?

Author:

Anna Arutyunyan

Vice President, CVO, Provider Management

Anna has extensive experience in the development and implementation of full-scope credentialing programs.

 

Related Blogs:

Related Resources:

Provider Management Demo

Provider Management Demo

Announcing TractManager’s Provider Management DemoJoin us Tuesday, October 13 at 4:00 pm ET / 3:00 pm CT. Register for TuesdayJoin us Wednesday, October 14 at 1:00 pm ET / 12 Noon CT. Register for WednesdayDemo RegistrationLearn more about our Privacy PolicyOur ...

To Delegate or Not to Delegate – That is the Credentialing Question

Realize improvements in the processes that govern the growth and representation of your network, shorten turnaround times for network participation, enhance provider experience and brand integrity, and expedite access to revenue.

Share This