Recently, we were discussing temporary privileges. One of our colleagues had attended a webinar in which an official from the Centers for Medicare and Medicaid Services (CMS) indicated that in accordance with the CMS Conditions of Participation, only the governing body could grant privileges. The Joint Commission (TJC) standards (MS.06.01.13, EP 3-5) address temporary privileges and indicate that the president of the medical staff (or designee) makes a recommendation to the chief executive officer of the hospital (or designee) for temporary privileges. The chief executive officer of the hospital (or designee) then grants requested temporary privileges.
As CMS requirements differ significantly from TJC standards, we contacted CMS for clarification. The Hospital Team at CMS affirmed that hospitals could grant temporary privileges; however, the process must be the same as the one for credentialing and granting for any other hospital privilege. CMS referenced the hospital CoPs in the Governing Body at §482.12 and Medical Staff at §482.22.
Per CMS, Only the Hospital’s Governing Body May Grant Privileges
While CMS will permit hospitals to grant temporary privileges (as long as doing so is permitted by state law, medical staff bylaws, and the CoPs), the medical staff must evaluate the applicant and the medical staff must make a recommendation to the hospital’s governing body. The governing body then determines whether privileges will be granted, denied, continued, revised, discontinued, limited, or revoked. Further, the CMS CoPs state that only the hospital’s governing body may grant privileges. So, the governing body may not delegate or designate its authority to others.
Temporary Privileges and Patient Care
We are concerned with how this will affect patient care. In the past, hospital presidents have granted temporary privileges to fulfill an urgent patient care, treatment, or service need while awaiting review and approval by the governing body. Hospitals that use the Joint Commission accreditation for deemed-status purposes have established a process in their bylaws for granting temporary privileges as outlined in the TJC medical staff standards. It appears that CMS has now raised the bar on how it is interpreting this CoP. Stipulating that only the governing body can grant privileges (standard or temporary) may cause delays in the provision of patient care or treatment.
So, we ask, is there any value to temporary privileges?
Contact Your State Hospital Association
We urge you to contact your state hospital association and ask them to bring this issue forward to the American Hospital Association (AHA). Perhaps the AHA can serve as an advocate for hospitals and work with CMS to reconsider their interpretation and reduce this burden to hospitals.
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