Hospital privileges are the authorizations given to individual practitioners to perform specific tasks and procedures on site. Privileges are highly individualized, based on the provider's education, training, experience, competency, and treatment outcomes. Granting and renewing privileges is a rigorous process that must follow federal, state, and hospital-specific laws and regulations.
Clinical privileging is critical to safe patient care, and failures in this area can threaten patient wellbeing and introduce risk for negligent privileging lawsuits. However, advancing technology, shifting compliance standards, and the integration of non-physician providers onto care teams can make the process far from simple. We'll provide an overview of the process and answer common questions, such as what types of privileges can be granted, how they're evaluated, and more.
How Hospital Privileging Works: An Overview
Hospitals are responsible for evaluating and monitoring the ability levels of their staff, so that the services offered are safe and meet quality standards. One way to ensure this is through the privileging process.
While the exact components of the process can vary, federal and state laws set a precedent for the rigorous verification of each provider's ability to provide specific healthcare services. Local clinical experts and medical committees may examine the provider's professional history and level of expertise. Ultimately, the hospital's board of directors (or governing body) decides whether the privilege is granted. They also hold the power to suspend or revoke clinical privileges if patient safety is at risk.
Example of Medical Staff Privileges at a Hospital
For example, a physician employed by a hospital may be authorized to provide core internal medicine privileges, which the facility further defines with a comprehensive list, including:
- Obtaining health histories
- Performing physical exams
- Interpreting lab data
- Interpreting diagnostic tests
- Performing procedures within the scope of the internal medicine services
- Monitoring patients
- Delivering patient education
- Discharging patients
Additionally, the physician may hold specialized privileges that fall outside the scope of practice for internal medicine practitioners at the facility, such as:
- Bone marrow biopsy
- Lumbar puncture
- Echocardiography stress testing
Provider Privileges in Hospitals: FAQ
Credentialing and privileging processes work together to verify that practitioners have the necessary qualifications and clinical skills to provide patient care. Below, we'll focus on medical staff privileges by answering commonly asked questions.
What is privileging?
When a patient seeks medical care from a healthcare facility, they need to have some level of trust in the providers rendering services. Facilities earn this trust by evaluating each provider's clinical skills and creating individualized, tailored delineations of exactly what the provider can safely and competently do at the facility. This evaluation and authorization process is called privileging.
What are hospital privileges?
These authorizations detail the exact services that a provider can render within a specific hospital setting. If a healthcare system has multiple sites, the privileges are typically site-specific. The process verifies that the provider has sufficient training, experience, and current clinical competence to provide specific treatments and services.
Properly granting, monitoring, and re-issuing privileges is critical to compliance with federal and state laws. Hospitals accredited by The Joint Commission (TJC) or another oversight agency must also meet specific standards regarding medical staff privileges.
How are privileges granted?
The steps of the process vary from one facility to another. In general, the following actions occur:
- A provider submits a request, along with documentation and evidence of clinical competence.
- A medical staff office (MSO) reviews the request.
- A hospital medical committee, sometimes called a peer review committee, assesses the provider's competence and forms a recommendation.
- The recommendation is sent to the governing body, such as a hospital board of directors.
- The governing body decides if the privilege will be granted.
These steps represent a simplified process. In reality, many clinical skills must be evaluated and authorized. They're sometimes grouped into clusters, such as a group of core privileges. Each practitioner is typically issued a legally binding privilege form (sometimes called a delineation of clinical privileges form) specifying the services, or clusters of services, that the provider can render.
Are there different types of hospital privileges?
Yes, there are many different types. A common organizational strategy is to structure competencies by department, such as core cardiology privileges, or core obstetrics and gynecology privileges. These groups represent fundamental treatments and procedures that providers in the specialty area perform. Even when this type of grouping is used, the hospital is responsible for assessing individual providers and perhaps excluding specific tasks from the grouping.
Other types of clinical privileges that may be granted by hospitals include:
- Specialty privileges that are granted for specific surgeries.
- Hospital admitting privileges that allow providers who typically work outside the hospital to admit patients requiring inpatient care.
- Courtesy privileges, which are similar to hospital admitting privileges in that they allow external providers to occasionally admit patients to inpatient facilities.
What's the difference between credentialing and privileging?
Credentialing is a formal process that verifies the provider's background, education, and qualifications. Once this is completed, privileging determines the specific procedures and services the provider can safely perform with hospital resources. While credentialing is fairly standardized by role, medical staff privileges are highly individualized to each provider's training and speciality, and specific to the facility's capabilities.
What is re-privileging?
Once a provider is granted approval for specific services, the hospital engages in ongoing monitoring to determine clinical competence. Hospitals may use the Focused Professional Practice Evaluation (FPPE) and Ongoing Professional Practice Evaluation (OPPE) frameworks to re-evaluate medical staff. After a set amount of time the evidence is evaluated and privileges may be denied, reduced, or re-issued.
Why would a doctor not have hospital privileges?
Not all physicians work with patients requiring inpatient care. Physicians may choose not to pursue clinical privileges in hospitals because they prefer to work in outpatient settings. In other cases, physicians once held privileges in hospital settings, but they were suspended, reduced, or revoked. The National Provider Data Bank tracks adverse actions taken against provider privileges as well as decisions not to re-privilege.
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