Obtaining hospital privileges can be similar to the process of passing a bill in the legislature. Being prepared and laying the groundwork before getting started are crucial. It is important for the optometrist to know prior to applying for privileges what the reaction will be to that application. Will there be opposition? Where will the opposition come from? Are there specific privileges that are being requested that will be controversial? What committees will be involved (bylaws, credentials, privileges, etc.)? Submitting an application cold without preliminary discussions with key individuals is much more likely to meet with resistance.
Many optometrists find it advantageous to have a sponsor help facilitate the process. This may be a physician on the medical staff, the hospital administrator, or other individual familiar with the application process. Frank discussions with the hospital administrator, chief of staff, and other appropriate members of the medical staff can lay the groundwork and avert last minute surprises. The next step is to make the application.
Some hospitals have a formal application form that must be filled out; in other cases, the hospital may simply need a letter indicating that the optometrist is interested in applying for privileges (Seer Appendix A for a sample application form). As part of making the application, the optometrist will be asked to specify the position for which he/she is applying.
It is important for the optometrist to understand the categories of providers within the individual hospital. The hospital bylaws will answer most of these questions, so be sure to review them thoroughly before beginning the process. Optometrists should request the highest appointment level when possible. The active medical staff level allows the broadest privilege consideration and gives you the opportunity to serve on hospital committees and attend staff meetings.
Once the category of staff has been determined, the optometrist needs to determine the clinical privileges or the exact clinical procedures he/she is requesting. How this is done can vary considerably from one hospital to another. Some hospitals will require a detailed list of each individual test and procedure the doctor will provide; others prefer a more broad and general document. In either case, the privileges requested will be submitted to the appropriate committee (typically a standing privileges committee) for review. The AOA has developed model documents that can help with this process (See Appendix B, AOA Guidelines for Delineation of Hospital Privileges). Be aware that all information and data supplied on the application document will be verified.
The optometrist’s scope of practice within the hospital is determined by this process and does not necessarily have to follow state law (e.g., hospitals may choose to limit the scope of practice). Optometrists should request privileges that appropriately allow practice at the fullest scope possible in the hospital setting. As part of the credentialing process, the optometrist will be asked to document the ability to perform each of the procedures requested.
Credentialing (assuring professional competency) is an important part of the hospital application process. Credentialing demonstrates that you are qualified to perform the procedures you have requested. Credentialing usually requires documentation of proof of graduation, state licenses, diagnostic and therapeutic certification, malpractice insurance, completion of continuing education requirements, professional experience, curriculum vitae, and other similar documentation. It is wise to gather these documents before beginning the process. Credentials will typically be reviewed at the time of the request for staff membership. The hospital will also query the National Practitioner Data Bank (NPDB) prior to granting privileges and upon credentialing.
The process of applying for and obtaining hospital privileges can be a long and arduous one. The number of committees and their structure will vary from hospital to hospital. The greater the number of committees that the application must pass through, the slower the process will be; these committees may only meet annually, biannually or quarterly. Applications from optometrists are likely to be new to the hospital and will move more slowly simply because of their uniqueness. Bylaws changes, if they must be made, can be very slow, requiring review and passage by multiple committees. Credentials and privileges are typically reviewed by the medical staff and proceed at a somewhat faster pace. Ultimately, staff membership and bylaws changes have to be approved by the hospital board. The entire medical staff may, at some point, have the opportunity to vote on both bylaws and staff membership. Patience and persistence are keys. It may take a year or more to complete the entire process. Remember that at any point in the process you may remove your application from consideration. This may be necessary if denial seems inevitable and more time is needed to educate committee members about your qualifications. Managed care applications or future hospital staff applications may ask “Have you ever been denied hospital privileges?” Take the appropriate steps to be certain that your application is approved or remove your application from consideration prior to a negative vote.
Recourse can be limited if the hospital denies privileges for valid reasons. It is important that the hospital provide in writing the reasons for denial. It is important to make sure that the hospital followed its own rules, as outlined in the bylaws, during the review process. It is also important to determine if an appeal process is available to you.