Do we need hospital privileges at all?

[emd123]

As a spin off from the Stark thread, I wonder, do we even need hospital privileges?

If you don't implant, I don't know why you would need hospital privileges, at all. If you implant stims at a surgery center, you don't need hospital privileges, per se. I suppose, for pumps, you need to admit (usually), but pumps are falling out of favor anyways. The less we are dependent on hospital politics and bureaucracy, the better. Is anyone on here, completely outpatient, without privileges at a hospital or surgery center?

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[Pain Applicant1]

Yes, you definitely do. Insurances may require them to reimburse you for certain procedures and in order to limit fly by night SCS trials, Medicare has recently passed requirements in order to be reimbursed for stim trials. One of the reqs is that you have privileges.

 

[emd123]

Yes, you definitely do. Insurances may require them to reimburse you for certain procedures and in order to limit fly by night SCS trials, Medicare has recently passed requirements in order to be reimbursed for stim trials. One of the reqs is that you have privileges.

Stim trials only, or all procedures?

 

[bedrock]

It can be very difficult to get credentialed with insurance companies if you don't have privileges at a local hospital.

I obtained courtesy privileges , (not full-time attending privileges) at the two largest hospitals in my area. Only used them once in 3 years, but was glad I had them for that one situation.

I would recommend getting privileges at two hospitals, so you have a fall-back in case some political issue arises at one of the hospitals.

 

[101N]

No, we don't need hospitals for 90% of health care. Those big albatrosses are realizing this and working hard to buy us up before we can mount a counter attack.

A much better model of health care would be physician groups with strong primary and preventative care departments, a robust urgent care dept, and a limited number of specialists with their own ASC. 90% of care could be performed in this setting. The other 10% are the high utilizers, trauma, and major surgeries that need a formal hospital.

But we don't play well together and we all yearn to be independent and work for ourselves. We tend not to heard well.

 

[facets]

I resigned from our hospital in 2005, after 15 years there. I never used it and got tired of going to meetings. The insurance companies here don't care as long as your ASC has a transfer agreement with the nearest hospital and a doctor to admit your patients, eg hospitalists.

 

[Jcm800]

Emd, just so you are clear, so far the answers have been 1) yes, 2) no and 3) maybe.

 

[bedrock]

Emd, just so you are clear, so far the answers have been 1) yes, 2) no and 3) maybe.

Yeah, we've really helped him a lot...........LOL

I think that when you start out in a new area and you are trying to get on insurance panels, you have to have some kind of hospital privileges, at least courtesy privileges at one of the major hospitals in your area, or you're not going to be credentialed by most insurance companies.

Once you've been there are while like facets, and you're well known in the area and on every insurance panel, you could probably blow off the hospital, but I wouldn't do that fresh out of fellowship.

I finished fellowship 3 years ago.
I still remember that credentialing with the hospitals took longer than I would have liked, but once the main area hospital gave me privileges, my insurance credentialing with 4 of the top 5 insurers in the area went through within in a week.

 

[facets]

where did you get this information pain? As noted above I have been in practice 23 years, the last 6 without hospital privleges with no problem. I have not heard of this new requirement and do scs trials in my ASC and get paid by MC

Yes, you definitely do. Insurances may require them to reimburse you for certain procedures and in order to limit fly by night SCS trials, Medicare has recently passed requirements in order to be reimbursed for stim trials. One of the reqs is that you have privileges.

 

[facets]

Agreed, it would be good PR to the other docs for a new guy and reassuring to the insurance company to know you have hospital privileges to do these procedures. Also a lot of hospitals are buying primary care offices and they can't refer to doctors who are not on staff at the hospital, they want the cases done at their hospital.

Yeah, we've really helped him a lot...........LOL

I think that when you start out in a new area and you are trying to get on insurance panels, you have to have some kind of hospital privileges, at least courtesy privileges at one of the major hospitals in your area, or you're not going to be credentialed by most insurance companies.

Once you've been there are while like facets, and you're well known in the area and on every insurance panel, you could probably blow off the hospital, but I wouldn't do that fresh out of fellowship.

I finished fellowship 3 years ago.
I still remember that credentialing with the hospitals took longer than I would have liked, but once the main area hospital gave me privileges, my insurance credentialing with 4 of the top 5 insurers in the area went through within in a week.

 

[Pain Applicant1]

where did you get this information pain? As noted above I have been in practice 23 years, the last 6 without hospital privleges with no problem. I have not heard of this new requirement and do scs trials in my ASC and get paid by MC

Note the recently passed, with emphasis on recently, the past few years don't indicate much; contact your Bos Sci rep for more info as that's where I received mine. The others should know as well. Recently passed but will be implemented in near future. Perhaps ASC privileges will be enough, but I'm not sure.

Starting out, my payers are requiring me to maintain privileges for my contracts as I belong to a PHO.

 

[Pain Applicant1]

Stim trials only, or all procedures?

Stim trials for now.

 

[lonelobo]

I have Hospital priviledges but not (admitting) consult for occasional ESI done there(6/yr),
90% procedures done in office(stim trials inc), 10% in ASC..could get rid of priviledges
at hospital and would not be a problem .

 

[brori]

Also a lot of hospitals are buying primary care offices and they can't refer to doctors who are not on staff at the hospital, they want the cases done at their hospital.

This is the main reason to have privileges. We are seeing the large baby steps toward the ACO model in my area. The PCPs are being "strongly encouraged" to only refer to doctors in their hospital system. The EMR system that is placed in the PCPs office only has options for referral to physicians associated with XYZ hospital, etc.

 

[facets]

Holy crap, I have to sit through 2 hour committee meetings again!

Note the recently passed, with emphasis on recently, the past few years don't indicate much; contact your Bos Sci rep for more info as that's where I received mine. The others should know as well. Recently passed but will be implemented in near future. Perhaps ASC privileges will be enough, but I'm not sure.

Starting out, my payers are requiring me to maintain privileges for my contracts as I belong to a PHO.

 

[Jcm800]

Holy crap, I have to sit through 2 hour committee meetings again!

i don't go to any of those meetings. yet to get the boot.

 

[PMR 4 MSK]

Consider this - you don't have any hospital privileges. You do an injection, and 6 hours later the pt is in the ER 5 minutes away with weakness and severe pain. The ER calls you to admit pt to you. You can't. They admit to hospitalist. Hospitalst calls you to consult. You can't. They get another pain guy to consult. He tells the pt you f'ed up and BTW, did they know you couldn't even get privieges at their hospital. He questions your credentials. PT gets mad.

At the trial, the opposing lawyer asks which hospitals you are credentialed at. "None? Why? You didn't feel like it?"

 

[pmrmd]

i don't go to any of those meetings. yet to get the boot.

I don't use the hospital at all and one of them kicked me out. They made me a "community affiliate" or something similarly generic. I think I used their facility once or twice for an injection years ago and never admitted anyone. I felt so unloved.

 

[Tenesma]

my major payers require hospital privileges... which in turn means a minimum malpractice coverage as dictated by hospital medical staff by-laws... i am convinced that the trial lawyers are behind all of this... somehow.

 

[lonelobo]

Consider this - you don't have any hospital privileges. You do an injection, and 6 hours later the pt is in the ER 5 minutes away with weakness and severe pain. The ER calls you to admit pt to you. You can't. They admit to hospitalist. Hospitalst calls you to consult. You can't. They get another pain guy to consult. He tells the pt you f'ed up and BTW, did they know you couldn't even get privieges at their hospital. He questions your credentials. PT gets mad.

At the trial, the opposing lawyer asks which hospitals you are credentialed at. "None? Why? You didn't feel like it?"

If there is "true" weakness this is a Neurosurgery problem

 

[jsaul]

If there is "true" weakness this is a Neurosurgery problem

no it's your problem but neurosurgery may be able to resolve it

 

[Tenesma]

just because you are not credentialied doesn't mean you didn't meet the standard of care...

i am credentialed, and I do agree that from a physician point of view a doc who isnt board certified, who isn't credentialed does raise some red flags in my mind...

i recently saw a pamphlet on a pain guy who under "Board Certification" listed: Certified to practice medicine in the states of X, Y and Z.

 

[lonelobo]

no it's your problem but neurosurgery may be able to resolve it

Tell me what you as pain doctor are going to do?
Go exam the patient, and if their is true neurological deficit
than getting MRI and consulting Neurosurgery.

You can go see the pt in hospital without privileges with patients
permission and talk to doctors in person or phone.

Hospitalists should be more than capable of simple exam
and detecting neurological deficits and making appropriate
consults.

If you make good faith effort in helping the pt your will be just
fine ...if they are going to sue you privileges won't mean squat

 

[Ducttape]

patients are much less likely to sue if their physician who performed a procedure is honest, supporting and caring for the patient. that includes seeing the patient in the hospital to discuss the situation (of course, dont admit blame)

doing an injection then saying "oh well, see a neurosurgeon, they will fix it" probably wont endear a pain doc to a patient.

 

[PMR 4 MSK]

patients are much less likely to sue if their physician who performed a procedure is honest, supporting and caring for the patient. that includes seeing the patient in the hospital to discuss the situation (of course, dont admit blame)

doing an injection then saying "oh well, see a neurosurgeon, they will fix it" probably wont endear a pain doc to a patient.

Nor to the neurosurgeon who likely hates everyone, and especially his own life, and will tell the patient you caused his new problem, increasing the likelihood of you being sued.

 

[Louisville04]

Consider this - you don't have any hospital privileges. You do an injection, and 6 hours later the pt is in the ER 5 minutes away with weakness and severe pain. The ER calls you to admit pt to you. You can't. They admit to hospitalist. Hospitalst calls you to consult. You can't. They get another pain guy to consult. He tells the pt you f'ed up and BTW, did they know you couldn't even get privieges at their hospital. He questions your credentials. PT gets mad.

At the trial, the opposing lawyer asks which hospitals you are credentialed at. "None? Why? You didn't feel like it?"

Some hospitals deny privileges strictly for business reasons. For example at one hospital I know only one neurology group is allowed to do EMG's and only one cardiology group is allowed to do inpatient consults. If the patient asks, you tell the truth about why you aren't privileged at that hospital.

patients are much less likely to sue if their physician who performed a procedure is honest, supporting and caring for the patient. that includes seeing the patient in the hospital to discuss the situation (of course, dont admit blame)

doing an injection then saying "oh well, see a neurosurgeon, they will fix it" probably wont endear a pain doc to a patient.

Even if you don't have privileges, I guess you could visit the patient in the hospital, but would they even let you review the chart?

Nor to the neurosurgeon who likely hates everyone, and especially his own life, and will tell the patient you caused his new problem, increasing the likelihood of you being sued.

If the patient wants to sue, no amount of support and caring is going to change that. Unless the neurosurgeon writes it is your fault in the chart, it will not sink you.