Complicaciones más frecuentes de la muestra y por grupos a los dos meses de finalizar el programa.

Credentialing and privileging play a vital role in the ability of health care organizations and public health agencies to assess the qualifications and shape the practice of health professionals. Obtaining credentialed status and clinical privileges are an important process for many health professionals. A health professional who has been credentialed in his or her field will typically have additional opportunities to practice in health care organizations that require credentialed status. Likewise, many health care facilities require health professionals to undergo a clinical privileging process prior to practicing in that facility. The level of privileges granted to a health professional within a specific facility will dictate that practitioner’s scope of practice.

State laws generally require hospitals and other health care organizations to formulate procedures governing the credentialing and privileging process for health

professionals. These procedures frequently are enunciated through a hospital’s medical staff bylaws108 describing the hospital’s policies and procedures regarding the granting and denial of privileges and credentials to practitioners.109

Credentialing and privileging are two distinct processes. Credentialing provides a framework for assuring that health professionals have certain skills and competencies. The credentialing process involves “obtaining, verifying, and assessing the qualifications of a health care practitioner to provide patient care, treatment, and services in or for a health care organization.”110 Credentialing determinations utilize criteria such as the health professional’s licensure, education, training, experience, and other

qualifications.111 Hospitals and other health organization may engage in credentialing internally or accept credentialing determinations made by external organizations, such as credential verification organizations (CVO).

Privileging processes are distinguishable from credentialing by their integral role in the professional relationship between a health professional (most often a physician) and the health care organization. A practitioner seeks clinical privileges in order to obtain the necessary authorization to provide specific care, treatment, and services in an organization. Privileging decisions are usually within the discretion of the health care entity from which the practitioner seeks privileges, and made on a case-by-case basis. Hospitals will make privileging determinations in accordance with their duty to provide for the safety and quality of care of their patients.112 In doing so, the hospital will seek to ensure that all members of its staff are competent and qualified to provide the health services based on their privileges.113

Similar to the assessments made for credentialing and licensure decisions, privileging determinations are based on the practitioner’s applicable experience, education, licensure, training, and judgment.114 The health care entity may make privileging decisions based on its determination of the practitioner’s credentials, experience, and performance, in accordance with its medical staff bylaws.115 Unlike licensure and credentialing, however, privileges only apply within well-defined parameters on scope of practice, and only within the specific institution granting the privileges. Thus, a health care professional who has satisfied credentialing and

privileging requirements for one health care organization will not necessarily be offered privileges elsewhere.

3.2.2.1 Credentialing and Privileging Requirements and Accreditation of Health Care Entities

Hospitals and other health care entities may lose their accreditation status if they fail to meet standards for credentialing and privileging of health professionals. Several national organizations, including the Joint Commission for the Accreditation of Health Care Organizations (JCAHO) and the National Committee for Quality Assurance

(NCQA), have generated credentialing standards that are widely utilized by hospitals and other health care organizations. JCAHO sets the standards for patient safety and quality of care for hospitals and other health care organizations.116 Although not a governmental entity, JCAHO’s standards for patient safety and quality of care are nationally accepted. Similarly, NCQA accredits, among others, managed care organizations (MCO), preferred

provider organizations (PPO), managed behavioral health care organizations, and credentialing verification organizations (CVO) based on a variety of quality assurance indicators.117

JCAHO credentialing standards differ from licensing regulations in that

compliance is strictly voluntary and does not carry any penalties for non-compliance.118 Critical elements of the credentialing process are:

• Procedures for the verification of credentialing and licensure information of medical staff, which are set out in the medical staff bylaws;

• Selection criteria which are designed to ensure that patients receive care, treatment, and services from qualified providers;

• Mechanisms to confirm that the person identified in the credentialing documents is the same person that is seeking privileges;

• Verification of the applicant’s current licensure, relevant training and experience, and current competence, including queries of the National Practitioner Data Bank (NPDB);

• A fair process for the reappraisal of privileges, which evaluates the individual’s continued ability to provide competent medical care, treatment, and services within the parameters of the individual’s privileges; and

• A hearing and appeals process in the case that an adverse privileging decision is made.119

Like many state laws, JCAHO requires hospitals to maintain medical staff bylaws that “delineate [the medical staff’s] responsibilities in the oversight of care, treatment and services.”120

3.2.2.2 Exceptions to Credentialing and Privileging Requirements During Emergencies

Several legal and policy provisions may alter credentialing and privileging

requirements during an emergency in a way that facilitates the rapid assessment of health professional qualifications and supports the sharing of VHPs across facilities and

jurisdictions. For example, various state licensure regulations and/or federal laws require hospitals to be able to provide emergency medical care at all times121 and to provide emergency and first aid care to any patient who comes to the facility.122 Meeting these requirements in the case of a public health emergency may require the hospital to activate the emergency management plan and begin to seek out additional health professionals to meet the expanded medical care needs.

JCAHO requires medical staff bylaws to feature emergency management plans that include a means by which hospitals identify health professionals to provide care during emergencies. During emergencies, the hospital must also identify the roles and responsibilities of the medical staff, including establishing the command structure within the hospital. As part of the emergency management plan, bylaws must contain policies regarding the granting of medical privileges during a disaster. A hospital may grant disaster privileges to a health professional upon a showing by the individual of: (1) a

hospital ID card; (2) a current license to practice and a valid picture ID issued by a governmental authority; (3) identification indicating that the individual is a member of a Disaster Medical Assistance Team (DMAT); (4) identification indicating that the

individual has been granted authority to care for and treat patients under disaster circumstances; or (5) a hospital staff member that has personal knowledge of the individual’s identity.123

JCAHO also requires hospitals to have policies regarding the granting of temporary clinical privileges. Temporary privileges are granted either when a new applicant is awaiting formal approval by the medical staff executive committee or “to fulfill an important patient care, treatment, and service need.” Prior to granting

temporary privileges to meet a need for patient care, the hospital must verify the health professional’s licensure and competence.124 As a registry of licensure and credentialing information for volunteers, ESAR-VHP can play an important role in this process.

Credentialing and privileging requirements for health professionals have a clear connection to the purpose and the functionality of ESAR-VHP. In a public health emergency or other disaster that affects health, VHPs may be called on to provide surge capacity and assist in the provision of medical care on short notice. ESAR-VHP will act as an important means of reviewing the credentials of VHPs to determine if they are qualified to provide the type of care requested of them. Health facilities may utilize the information provided by ESAR-VHP to grant temporary or disaster privileges to VHPs. Therefore, an understanding of credentialing and privileging requirements is essential to the effective implementation of ESAR-VHP.