Things to Consider when Granting Privileges to Retired Physicians

Covid-19 Waivers Are Allowing Retired Health Care Providers to Return to the Workforce in Order to Serve More Patients

For most of 2020, the rules have changed around health care provider license requirements and continuous monitoring for health care workers. A post-state-of-emergency plan is likely on the minds of the medical staff services team who may be working remotely, the chief medical officer, and the credentials or medical executive committee (MEC).

In this blog, Hugh Greeley, publisher of Hugh’s Credentialing Digest, talks about how to address the sensitive topic of the aging practitioner. While many of the tasks of credentialing and re-credentialing involve licensure verification, monitoring primary sources such as the DEA, OIG, and FACIS, peer review, performance reports— Focused Professional Practice Evaluation (FPPE), and Ongoing Professional Practice Evaluation (OPPE) can be subjective and often overlooked during a state of crisis.

THE AGING PRACTITIONER

Medical staff leaders recognize that all medical staff members are in fact aging. Some have reached their sixth decade, a few have reached their seventh and it is possible that a small number are in their eighth or even their ninth decades (generally, by the age of 90 most physicians have made the decision to retire from active practice and concentrate on reading, traveling, gardening, or other pursuits although a few do choose to continue their practices).

THINGS TO CONSIDER WHEN ALLOWING RETIRED PHYSICIANS TO RETURN TO THE WORKFORCE

7 issues that might need to be discussed when granting privileges to retired physicians include, but are not limited to:

• Assessment of competence in the aging practitioner
• Need for “fitness for practice” assessments at some defined age
• Accelerated use of Ongoing Professional Practice Evaluation (OPPE) beyond some defined age
• Use of collaborative privileges for the senior practitioner
• Specialty-specific implications (cognitive/procedural/consultative)
• Need for staff policy or guidelines
• The likelihood that current culture and peer interaction effectively address the issue

The effective medical staff services professional should prepare a compilation of articles and research addressing this issue (Google “physician retirement age” and/or “mandatory physician retirement”).

THE DEEPER DIVE INTO PRIVILEGES FOR THE INDEPENDENT PRACTITIONER

Another issue is “unknown and unknowable competence” perhaps a function of a number of factors including physician employment; reimbursement; practice preference; and competition.

Staff leadership should first determine if existing policies and procedures have adequately addressed the issue. The guiding principle involved here is that of granting clinical privileges authorizing independent practice. Such privileges may not be granted without convincing evidence demonstrating current competence in the areas of granted privileges. No evidence should equal no independent privileges.

PATIENT SAFETY REQUIRES ADHERENCE TO PROTOCOL

Reinstating retired physician privileges should not require lengthy debate at the MEC.  Medical staffs are increasingly requiring that all physicians observe and follow specific practice guidelines or safety precautions, such as using a containment bag in conjunction with the use of a laparoscopic power morcellator or outright prohibition of its use until further notice. Some physicians have reacted to such measures as if they are involuntary reductions in clinical privileges and have demanded hearings. The MEC should reaffirm its commitment to patient safety and strengthen bylaws provisions establishing that such actions do not constitute a reduction in privileges and will not give rise to fair hearings or judicial reviews.

IMPORTANCE OF FPPE – FOCUSED EVALUATION FOR NEW APPLICANTS REQUESTING PRIVILEGES

Last but not least is the issue of the very infrequently used clinical privilege granted to a new applicant. For those medical staffs in hospitals accredited by the Joint Commission, requirements for Focused Professional Practice Evaluation (FPPE) call for a focused review of practitioner performance in all areas of clinical privileges until competence has been demonstrated. In some areas (due to the way in which privileges have been granted) it is virtually impossible to directly assess competence because of lack of performance.

IDENTIFYING THE EFFICIENCIES IN PERFORMANCE ASSESSMENT FOR PRIVILEGING

In these areas, staff leaders should first consider one or more of the following: bundling the privilege with others that are clinically similar; determining how to assess performance using a simulator; either written or verbal examination, or perhaps a work-up and presentation at a continuing medical education event.

This issue seems to be one created almost entirely by requirements and it is often frustrating to both medical and administrative leaders. We often hear of an excellent physician who, after being granted infrequently-used privileges, remains on FPPE.

The administrative issues raised by this include a complex tracking dilemma and conflicting interpretations by surveyors about how long FPPE may be extended due to no volume. Discussion and refinement in the systems used to grant clinical privileges seem to be required.

See more about maintaining FPPE and OPPE compliance.

And check out Hugh’s E-Book, “10 Credentialing Guiding Principles”.

Written by Hugh Greeley Credentialing and Healthcare Industry Expert HG Healthcare Consultant Connect with Hugh