Hospital Privileging: Understanding Clinical Privilege Categories and Delineation

Hospital privileging determines what specific clinical activities physicians can perform within a healthcare facility. While credentialing verifies qualifications, privileging authorizes specific procedures and treatments based on demonstrated competency.

The Relationship Between Credentialing and Privileging

Credentialing confirms a physician meets baseline qualifications for medical staff membership. Privileging goes further, authorizing specific clinical activities based on training, experience, and competency in particular procedures or patient populations.

A physician may be credentialed at a hospital but not privileged to perform certain procedures. Understanding this distinction is essential for physicians seeking comprehensive practice authorization.

Clinical Privilege Categories

Core Privileges

Core privileges represent the fundamental clinical activities associated with a specialty. For example, an internal medicine physician receives core privileges for diagnosing and managing adult medical conditions, prescribing medications, performing basic bedside procedures, and admitting and managing inpatients.

Special Privileges

Special privileges authorize procedures or treatments beyond core privileges, requiring additional training or demonstrated competency. Examples include advanced cardiac procedures for cardiologists, complex surgical techniques, specialized diagnostic procedures, and high-risk medication administration.

Temporary Privileges

Hospitals grant temporary privileges in specific circumstances including locum tenens physicians covering short-term needs, physicians awaiting full credentialing completion, and disaster or emergency situations requiring additional providers.

The Privilege Delineation Process

Developing Privilege Forms

Medical staff offices maintain privilege delineation forms for each specialty. These forms list specific procedures and treatments, required training and experience thresholds, competency assessment criteria, and supervision requirements for new privileges.

Department Review

Specialty departments review privilege requests, assessing whether training documentation supports requested privileges, case volume demonstrates competency, peer recommendations support the request, and continuing education maintains current knowledge.

Requesting Privileges

Initial Privilege Requests

New medical staff members submit privilege requests during initial credentialing. This includes reviewing available privilege categories, selecting appropriate privileges based on training, providing supporting documentation, and requesting proctoring for new procedures if needed.

Adding New Privileges

Physicians seeking additional privileges after initial appointment must demonstrate additional training or certification, provide case logs showing competency, complete any required proctoring, and obtain department approval.

Competency Assessment

Focused Professional Practice Evaluation

New privileges typically require FPPE, a period of enhanced monitoring to confirm competency. During FPPE, proctors observe procedures, chart review assesses documentation quality, and outcomes are tracked.

Ongoing Professional Practice Evaluation

OPPE provides continuous monitoring of privileged activities through quality metrics, peer review findings, and patient outcome data.

Maintaining Privileges

Privileges require reappointment, typically every two years. Maintenance requires demonstrating continued competency through case volume, maintaining relevant certifications, completing required continuing education, and satisfactory performance evaluations.

Special Considerations

Telemedicine Privileges

Physicians providing telemedicine services need privileges at originating sites or through credentialing by proxy arrangements.

Multi-Site Privileges

Physicians practicing at multiple facilities need separate privileging at each location, though some health systems offer system-wide privileging.

Professional Support

Navigating privilege requirements across multiple facilities benefits from professional credentialing support. Expert services ensure complete applications, appropriate privilege requests, and timely processing for full practice authorization.