589 Navigating the Complexity of Healthcare Credentialing and Privileging – Dr. Vipul Kella
As an LNC, you will probably work with cases where the credentials and granting of privileges for doctors are in question. To be able to assess this, you need to understand the complex processes involved. Dr. Vipul Kella, an emergency medicine and highly experienced physician in a number of areas, unravels this complicated web.
During the late twentieth century, doctors whose reputations were tainted by malpractice suits and other violations could move from state to state and set up practices and get credentialed and receive medical and surgical privileges. Now a National Practitioner Data Bank exists to flag wayward practitioners, making it more difficult for them to elude detection.
Like all systems, it has flaws. Because practitioners may be credentialed in multiple facilities, those who give credentials have much more data to handle. The weight of data involved can penalize blameless practitioners in terms of the time involved to receive credentialing and medical and surgical privileges. Privileges are particularly sensitive. It makes a difference what kind of medicine or surgery is being practiced. Privileges are less likely to be granted for new or experimental surgery, for example.
On the other hand, a variant of the “old boy” network may activate. Credentialers will face the challenges of being objective when a colleague, a good friend, wants to be re-credentialed and yet has a series of problems or poor outcomes. There may be a lot of pressure on the hospital to keep them on staff.
Dr. Kella’s detailed explanation clarifies many of the issues you may need to untangle in a case involving credentials and privileges in both a hospital and an outpatient setting.
What You’ll Find in Credentialing and Privileging with Dr. Vipul Kella Podcast
- What is the purpose of credentialing?
- How can medical practitioners with questionable histories be identified?
- What’s the difference between credentialing and privileging?
- What does remediation involve?
- Do hospitals share liability with independent medical contractors?
