Clinical Privileges (#2)

Question 1

What are clinical privileges?

Answer 1

TJC: Process whereby the specific scope and content of patient care services are authorized for a healthcare practitioner by a healthcare organization, based on evaluation of the individual’s credentials & performance

Question 2

Methods for delineating clinic privileges

Answer 2

Laundry list: exhaustive list of individual procedures or conditions
Category or levels: describe privileges in terms of a hierarchy of levels based on treatment grouping or the level of training and experience
Core privileges- encompass treatment of medical conditions or performance of invasive procedures for which the applicant has been trained

Question 3

Clinical Privileges

Answer 3

CoP: Criteria for determining the privileges to be granted
TJC: Privilege delineation system must be tailored to the hospital
HFAP: Bylaws describe qualifications and criteria that must be met by candidate
DNV: All individuals permitted to provide patient care shall have delineated clinical privileges
NCQA: Not addressed
URAC: Application includes hospital affiliations or privileges, if applicable
AAAHC: 3 phase process- determine clinical procedures & treatments to be offered, determine qualifications to obtain each privilege, establish process for evaluating qualifications

Question 4

Temporary Privileges (Hospital Setting only)

Answer 4

TJC: Allow CEO to grant temporary privileges, cannot exceed 120 days
HFAP: Bylaws provide for granting temporary privileges
DNV: Allow CEO to grant temporary privileges, cannot exceed 120 days
NCQA: No reference to privileges
AAAHC: Not specifically addressed

Question 5

Allied Health Professionals

Answer 5

AHP are non-physicians who provide services
CoP: Medical staff may include non-physician practitioners
TJC: Required to be credentialed & privileged
HFAP: Must be credentialed, privileges may be granted without membership
DNV: Eligible for appointment under state law
NCQA: Must be credentialed
URAC: Verify qualifications
AAAHC: Up to each organization, must create process if allowed

Question 6

Analysis & Use of Information Received

Answer 6

TJC: Requires clearly defined process, privileges granted for no more than 2 years
HFAP: Examine each practitioner’s qualifications and demonstrated competencies
DNV: Not specifically addressed
URAC: Organization must accept information from providers to correct inaccurate information
AAAHC: Not specifically addressed

Question 7

Determination of Organizational Resource Availability

Answer 7

Before granting privileges, the hospital must determine if it has the necessary resources to support the requested privilege or that the resources will be available within a specified time frame.

Question 8

Disaster Privileges

Answer 8

TJC: Hospital can grant disaster privileges to volunteers, must present valid government issued ID, PSV license within 72 hours or ASAP
HFAP: Primary source ID from volunteer’s hospital
DNV: Bylaws include process for approving practitioners in case of emergency
NCQA: Not specifically addressed
URAC: Not specifically addressed
AAAHC: May have policy to credential physicians & dentists with admitting privileges at nearby hospital

Question 9

Telemedicine

Answer 9

CoP: Practitioner must be licensed in state where they are located and state where patient is located
TJC: Providers are subject to credentialing/ privileging process at originating site (where scan is taken)
HFAP: Standards are a direct quote from CMS regulations
DNV: NIAHO (National Integrated Accreditation for Healthcare Organizations) are a direct quote from CMS regulations
NCQA: Not specifically addressed
URAC: Not specifically addressed
AAAHC: Not specifically addressed