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Healthcare provider privileging is the process in which hospitals and clinics educate, train, and document the skills and procedures of all medical staff. Traditionally this process has been considered a cumbersome, administrative burden, but more recently has become an opportunity. Institutions who optimize this process can increase revenue, for example by utilizing APPs (Advanced Practice Providers) efficiently when a pandemic hits and more providers are needed in ICUs and Emergency Departments. CNS, NP, PA, CRNA and other APRN Leaders who work to create and optimize the privileging process for APP can increase reimbursement, redeploy APPs when needed, and fully utilize APPs in their roles.
Medical Staff privileging is determined by the Medical Staff bylaws, rules, and regulations, CMS, Joint Commission or other certifying bodies, and the state scope of practice for NPs and PAs. Some states, such as Georgia, require a state run organization to grant APP privileges. This is very laborious and requires members of the state committee to understand the scope of practice for APPs. Most states, however, leave the process up to individual organizations and their respective certifying bodies. Under the APP Leadership of Diana Vance, Summa Health, an Ohio-based hospital system, has built a reliable system for educating, training, and evaluating APP skills to justify granting privileges on an annual basis. Diana worked with others to create clinical competency pathways to ensure not only that APPs are consistently and properly oriented, but also that they meet specific competencies within specialties. When Assessing Privileging at Your Organization, Here are Some Questions to Ask:
If there are areas of misalignment, your hospital could be at risk for negligence in credentialing. The cost of non-compliance with Stark Law and Anti-Kickback statutes can be $10 to 50 million dollars in fines or more according to a 2017 article in Compliance Today by Charles Oppenheim, Esq. and Amy Joseph, Esq. To Assess Stark Law Risks, Here are Some Questions to Ask:
According to the Greeley Company, in an Becker's Hospital Review Article, not credentialing in a timely fashion for a primary care physician can amount to a lost revenue of $30,000 per month. APPs bring in the same, or slightly less revenue than physician colleagues, at a lower cost to the institution. Inpatient providers, who also need to be privileged at the hospital and who can produce higher revenue, can have a much bigger impact on the bottom line. Privileging appropriately not only impacts the quality of care, but revenue for the employer.
According to the Joint Commission, Ongoing Professional Performance Evaluation (OPPE) is “a document summary of ongoing data collected for the purpose of assessing a practitioner’s clinical competence and professional behavior. OPPE allows organizations to identify professional practice trends that impact the quality and safety of patient care.” A Focused Professional Practice Evaluation (FPPE) is “a process whereby the organization evaluates the privilege-specific competence of the practitioner who does not have documented evidence of competently performing the requested privilege at the organization. This process may also be used when a question arises regarding a currently privileged practitioner's ability to provide safe, high-quality patient care.” Providers need to be evaluated not only on the number of encounters, but the quality of care for those encounters. In her JNP article, titled Ongoing Professional Performance Evaluation: Advanced Practice Registered Nurse Practice Competency Assessment, Sharon L. Holley, DNP, CNM, defines the OPPE as a “documented summary of ongoing data collection and tracking for the purpose of assessing a practitioner's clinical competence and professional behavior.” Questions to Ask:
Building relationships and working collaboratively with finance, data, legal, credentialing, compliance, and leadership is an effective way for APP leaders to move initiatives forward, support the role of the APP, and advance the organization. The next step for many APP Leaders to optimize privileging at their institution is to:
Helping your organization achieve compliance, reduce risk, and create accurate, measurable goals is a big task.