Prevent Privileging Criteria Disputes by Leveraging These 2 Principles

When it comes to privileging criteria disputes and their resolution, remember that eco­nomics and politics must be excluded from such deliberations to the extent possible.

This article was originally published by HCPro Credentialing Resource Center March 8, 2018.

In some form or another, almost every practitioner has either heard of or been involved in a privileging criteria dispute.

Fortunately, there are ways to resolve the situation—or to avoid it altogether. Adhere to two important principles when creating criteria that could potentially be disputed.

First, ensure that all the concerned voices participate in the process. Any specialties that have a stake in the establishment of a particular privilege must have a forum in which to put forth their perspective, as well as any supporting data or documentation that may help them establish or amend criteria for a privilege.

Most organizations encourage participation in one of two ways. In the first approach, represen­tation from each involved specialty is a formal part of the criteria development group. In the second approach, each specialty submits information to such a group either in writing or in person, sometimes both. To quell anxieties, it is usually better to allow an in-person presentation. Doing so gives groups the greatest assurance that they have been heard.

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The second principle is that the decision should be mediated through a non-biased source.

If a criteria committee includes representation from all specialties, then such representation should be equal and the majority of the committee should be practitioners in specialties that do not have a direct interest in this resolution. If the committee does not have representation from the spe­cialties, then all members should be free from direct interest, and the presentation opportunity should be equal for all the involved parties. Your organization’s policies and procedures should include language to this effect.

In addition, clinical privilege criteria can be very technical, and specialty training in a given procedure area may vary by provider. Therefore, most organizations benefit from having the involved specialties equally represented and directly participating in the privilege criteria devel­opment group.

In short, when it comes to privileging criteria disputes and their resolution, remember that eco­nomics and politics must be excluded from such deliberations to the extent possible. Final decisions should always reflect the group’s sense of what will be best for the patient, rather than what is best for individual practitioners or for the organization.