QUESTION: Our hospital uses a team of hospitalists who provide care for all internal medicine admissions. This has been a successful program; quality of patient care and patient satisfaction have markedly increased. The problem is that now we have a number of internists appointed to the medical staff who very rarely, if ever, come to the hospital, however they still have clinical privileges. This brings up problems during reappointment in being able to assess current clinical competence. Any solutions?
ANSWER: Reappointment, when it includes the renewal of clinical privileges, is to be a “performance-based reappraisal,” which does become harder if you have little clinical data. If an internist is appointed at another hospital, you can request the physician’s quality file from a hospital where he or she is more active, obtain peer evaluations that incorporate the six ACGME general competencies from physicians to whom referrals are made (including the hospitalists), and also, possibly, seek managed care quality profiles. You could request office records from the physician to review as well, although not many medical staffs seem to take that approach because of how onerous it is for a physician who no longer provides services at the hospital.
The approach that many medical staffs and hospitals have taken in the recent past is having a staff category that does not include clinical privileges – Ambulatory Care Staff or Community-Based Staff – which includes perks like being able to access patients’ electronic records and being able to have office H&Ps entered into the record, while not granting clinical privileges which gets the hospital off the hook for performing OPPE, FPPE and needing to assess clinical data at reappointment. Because so many physicians are transitioning to such staff categories from the Active Staff due to changes in clinical practice patterns, we are also seeing a move towards permitting these individuals to vote and serve in leadership roles as part of the desire to keep them connected to the hospital.