SPECIALTY OF HEMATOLOGY & ONCOLOGY Delineation of Clinical Privileges

Transcription

1 SPECIALTY OF HEMATOLOGY & ONCOLOGY Delineatin f Clinical Privileges Criteria fr granting privileges: Current bard certificatin in Internal Medicine by the American Bard f Internal Medicine r the American Ostepathic Bard f Internal Medicine and subspecialty certificatin in Hematlgy and/r Onclgy. Or Current bard certificatin in Pediatrics by the American Bard f Pediatrics and subspecialty certificatin in Hematlgy and Onclgy. Or Successful cmpletin f an accredited ACGME r AOA accredited pst-graduate training prgram in Internal Medicine r Pediatrics and cmpletin f an accredited ACGME r AOA accredited pst-graduate training prgram in Hematlgy and/r Onclgy and bard certificatin within 5 years f prgram cmpletin. Applicants will be requested t prvide dcumentatin f practice and current clinical cmpetence as defined n the attached cmpetency grid. Applicants have the burden f prducing infrmatin deemed adequate by the hspital fr a prper evaluatin f current clinical cmpetence, and ther qualificatins and fr reslving any dubts. Current Clinical Cmpetence - MLH In additin t the required educatin, experience and/r training specified n each DOP (Delineatin f Privilege) frm, dcumentatin f current clinical cmpetence is required. Current clinical cmpetence is described as having perfrmed the privilege recently and perfrmed it well. Current clinical cmpetence is assessed prir t granting privileges initially and is reassessed when renewing privileges at reappintment fr maintenance f privileges. Current Clinical Cmpetence (CCC) may be lcatin specific (acute hspital care/surgery center (ASC) and/r age specific (adult, pediatric, nenatal). This shuld nt be cnfused with Fcused Prfessinal Practice Evaluatin (FPPE) FPPE is an evaluatin f clinical cmpetence f all new privileges perfrmed at the specific licensed MLH facility (MHMH, MHOBH). This applies t privileges fr all new applicants as well as new/additinal privileges fr current members. Bth FPPE and current clinical cmpetence assessments are privilege-specific. FPPE is cnducted during the perid after granting new/additinal privileges. FPPE must ccur at the MLH facility(ies) where privileges/membership are held. Current clinical cmpetence may be evaluated frm case lgs prvided by nn-mlh facilities. Current Clinical Cmpetence: Requirements fr New Applicants If applying directly frm training, r based n the training received in a frmal training prgram, prvider shuld submit case* lgs frm the prgram authenticated by the prgram directr alng with their recmmendatin attesting t the cmparable training, experience and qualificatins relative t the criteria fr the clinical privileges requested. Bard apprved: March, 2011, Revised 6/17/13, 4/16/14, 12/20/17, 8/15/18 1

2 If applying mre than 1 year after training cmpletin, submit the fllwing: Aggregate data frm acute care r surgery center facility fr the previus 12 mnth time perid, identifying the tp 10 diagnsis cdes and the number f patients per cde. Prcedure list frm acute care r surgery center facility fr the previus 12 mnth time perid, identifying the tp 10 CPT/ICD cdes and the number f prcedures per cde. Case lgs (see specificatins belw) fr any special privileges requested that meet the criteria specific fr the number f prcedures defined fr current clinical cmpetence. Current Clinical Cmpetence: Maintenance f Privileges fr Current Members Fr active staff members: MLH surce data will be aggregated t review cases and prcedures perfrmed. and/r special privileges, the practitiner will be required t submit additinal case lgs frm ther facilities. If this des nt meet the minimum requirement fr cre Fr curtesy staff members with lw activity and fr certain active staff with activity that has diminished and is nw lw: Department chair recmmendatin shuld be btained frm their primary facility; and the practitiner shuld submit the fllwing: Aggregate data frm acute care r surgery center facility fr the previus 12 mnth time perid, identifying the tp 10 diagnsis cdes and the number f patients per cde. Prcedure list frm acute care r surgery center facility fr the previus 12 mnth time perid, identifying the tp 10 CPT/ICD cdes and the number f prcedures per cde. Case lgs (see specificatins belw) fr any special privileges requested that meet the specific number f prcedures defined fr current clinical cmpetence. Case Lgs All required case lgs and/r prcedure lists must cntain the fllwing infrmatin at a minimum: Date, patient identifier, CPT/ICD prcedure cde, diagnsis, cmplicatins, and dispsitin, and the facility name, name/title f the persn authenticating the lg, signature, date signed, and cntact infrmatin. If the infrmatin requested is nt available, please prvide an explanatin. *A case is defined as an episde f care either cgnitive r prcedural. Fr interpretive care, case is interpretatin f ne diagnstic study. Onging Prfessinal Perfrmance Evaluatin (OPPE) OPPE is reviewed peridically (mre frequently than annually) in the facility where membership/privileges are held. T assure OPPE requirements are satisfied, the practitiner must peridically exercise the privileges in the MLH facility(ies) where he/she has membership. OPPE must ccur regularly n patient encunters in the MLH facility(ies) where privileges/membership are held. Bard apprved: March, 2011, Revised 6/17/13, 4/16/14, 12/20/17, 8/15/18 2

3 Specialty/Prcedure Delineatin f Privilege Frm Hematlgy Cre Educatin/Training Dcumentatin fr Initial Granting Current bard certificatin in Internal Medicine by the American Bard f Internal Medicine r the American Ostepathic Bard f Internal Medicine and subspecialty certificatin in Hematlgy Or Successful cmpletin f an ACGME r AOA accredited pst-graduate training prgram in Internal Medicine and cmpletin f an ACGME r AOA accredited pst-graduate training prgram in Hematlgy and bard certificatin within 5 years f cmpletin. Initial Applicatin (Prf f current clinical cmpetence) Aggregate data frm primary mnth time perid indentifying the tp 10 diagnsis cdes and the number f inpatients per cde. Prcedure list frm primary mnth time perid identifying the tp 10 CPT/ICD9 cdes and the number f prcedures per cde. FPPE Validatin f cmpetence after appintment and/r granting f a new r additinal privilege (T be cmpleted within ne year) First 5 cases Maintenance Requirements (Nte: Satisfactry OPPE required fr all privileges) MHMH Data will be btained, applicant shuld supply additinal case lgs frm ther facilities if necessary t meet the minimum requirement(s) MLH Data will be btained fr active members when available, the applicant shuld supply additinal case lgs frm ther facilities HIM departments, if necessary, t meet the minimum requirement(s) t be cnsidered fr the privilege. Curtesy members shuld supply case lgs frm ther facilities HIM departments t meet the minimum requirement(s) t be cnsidered fr the privilege. Aggregate data submitted shuld include the tp 10 diagnsis cdes, with the number f inpatients per cde, and prcedure lists indicating the tp 10 CPT/ICD cdes, with the number f prcedures per cde fr the previus 12 mnths. shuld be delineated and Onclgy Cre Current bard certificatin in Internal Medicine by the American Bard f Internal Medicine r the American Ostepathic Bard f Internal Medicine and subspecialty certificatin in Onclgy Or Successful cmpletin f an ACGME r AOA accredited pst-graduate training prgram in Internal Medicine and cmpletin f an ACGME r AOA accredited pst-graduate training prgram in Onclgy and bard certificatin within 5 years f cmpletin. Aggregate data frm primary mnth time perid indentifying the tp 10 diagnsis cdes and the number f inpatients per cde. Prcedure list frm primary mnth time perid identifying the tp 10 CPT/ICD9 cdes and the number f prcedures per cde. First 5 cases Department chair recmmendatin will be btained frm primary practice facility. MLH Data will be btained fr active members when available, the applicant shuld supply additinal case lgs frm ther facilities HIM departments, if necessary, t meet the minimum requirement(s) t be cnsidered fr the privilege. Curtesy members shuld supply case lgs frm ther facilities HIM departments t meet the minimum requirement(s) t be cnsidered fr the privilege. Aggregate data submitted shuld include the tp 10 diagnsis cdes, with the number f inpatients per cde, and prcedure lists indicating the tp 10 CPT/ICD cdes, with the number f prcedures per cde fr the previus 12 mnths. shuld be delineated and Department chair recmmendatin will be btained frm primary practice facility. Hematlgy & Onclgy Current bard certificatin in Pediatrics Aggregate data frm primary First 5 cases Sickle MLH Data will be btained fr active members when Bard apprved: March, 2011, Revised 6/17/13, 4/16/14, 12/20/17, 8/15/18 3

4 Specialty/Prcedure Delineatin f Privilege Frm Pediatric Cre Educatin/Training Dcumentatin fr Initial Granting by the American Bard f Pediatrics and subspecialty certificatin in Hematlgy and Onclgy Or Successful cmpletin f an ACGME accredited pst-graduate training prgram in Pediatrics and cmpletin f an ACGME accredited pst-graduate training prgram in Hematlgy and Onclgy and bard certificatin within 5 years f cmpletin. Initial Applicatin (Prf f current clinical cmpetence) mnth time perid indentifying the tp 10 diagnsis cdes and the number f inpatients per cde. Prcedure list frm primary mnth time perid identifying the tp 10 CPT/ICD9 cdes and the number f prcedures per cde. FPPE Validatin f cmpetence after appintment and/r granting f a new r additinal privilege (T be cmpleted within ne year) Cell and/r Idipathic thrmbcytpenic (ITP) Maintenance Requirements (Nte: Satisfactry OPPE required fr all privileges) MHMH Data will be btained, applicant shuld supply additinal case lgs frm ther facilities if necessary t meet the minimum requirement(s) available, the applicant shuld supply additinal case lgs frm ther facilities HIM departments, if necessary, t meet the minimum requirement(s) t be cnsidered fr the privilege. Curtesy members shuld supply case lgs frm ther facilities HIM departments t meet the minimum requirement(s) t be cnsidered fr the privilege. Aggregate data submitted shuld include the tp 10 diagnsis cdes, with the number f inpatients per cde, and prcedure lists indicating the tp 10 CPT/ICD cdes, with the number f prcedures per cde fr the previus 12 mnths. shuld be delineated and Bne Marrw/Stem Cell Transplant CAR-T Therapy Internal Medicine Cre Dcumented fellwship/frmal training in bne marrw/stem cell transplantatin. Maintain Bne Marrw/Stem Cell Transplant privilege Current bard certificatin in Internal Medicine by the American Bard f Internal Medicine r the American Ostepathic Bard f Internal Medicine. OR Successful cmpletin f an ACGME r AOA accredited pst-graduate training prgram in Internal Medicine and bard certificatin within 5 years f cmpletin. Case lg dcumenting the perfrmance f at least 5 prcedures within the previus three years Nvartis dcument that validates the physician is an authrized prescriber fr the CAR-T Center Aggregate data frm primary mnth time perid indentifying the tp 10 diagnsis cdes and the number f inpatients per cde. Prcedure list frm primary mnth time perid identifying the tp 10 CPT/ICD9 cdes and the number f prcedures per cde. Department chair recmmendatin will be btained frm primary practice facility. First 5 cases Case lg dcumenting the perfrmance f at least 5 prcedures within the previus 24 mnths First case N/A Case lg dcumenting the perfrmance f 1 prcedure within the previus 24 mnths. MLH Data will be btained fr active members when available, the applicant shuld supply additinal case lgs frm ther facilities HIM departments, if necessary, t meet the minimum requirement(s) t be cnsidered fr the privilege. Curtesy members shuld supply case lgs frm ther facilities HIM departments t meet the minimum requirement(s) t be cnsidered fr the privilege. Aggregate data submitted shuld include the tp 10 diagnsis cdes, with the number f inpatients per cde, and prcedure lists indicating the tp 10 CPT/ICD cdes, with the number f prcedures per cde fr the previus 12 mnths. Bard apprved: March, 2011, Revised 6/17/13, 4/16/14, 12/20/17, 8/15/18 4

5 Specialty/Prcedure Delineatin f Privilege Frm Educatin/Training Dcumentatin fr Initial Granting Initial Applicatin (Prf f current clinical cmpetence) FPPE Validatin f cmpetence after appintment and/r granting f a new r additinal privilege (T be cmpleted within ne year) Maintenance Requirements (Nte: Satisfactry OPPE required fr all privileges) MHMH Data will be btained, applicant shuld supply additinal case lgs frm ther facilities if necessary t meet the minimum requirement(s) shuld be delineated and Pediatric Cre Current bard certificatin in Pediatrics by the American Bard f Pediatrics r the American Ostepathic Bard f Pediatrics. OR Successful cmpletin f an ACGME r AOA accredited pst-graduate training prgram in Pediatrics and bard certificatin within 5 years f cmpletin. Aggregate data frm primary mnth time perid indentifying the tp 10 diagnsis cdes and the number f inpatients per cde. Prcedure list frm primary mnth time perid identifying the tp 10 CPT/ICD9 cdes and the number f prcedures per cde. N/A Department chair recmmendatin will be btained frm primary practice facility. MLH Data will be btained fr active members when available, the applicant shuld supply additinal case lgs frm ther facilities HIM departments, if necessary, t meet the minimum requirement(s) t be cnsidered fr the privilege. Curtesy members shuld supply case lgs frm ther facilities HIM departments t meet the minimum requirement(s) t be cnsidered fr the privilege. Aggregate data submitted shuld include the tp 10 diagnsis cdes, with the number f inpatients per cde, and prcedure lists indicating the tp 10 CPT/ICD cdes, with the number f prcedures per cde fr the previus 12 mnths. shuld be delineated and Department chair recmmendatin will be btained frm primary practice facility. Bard apprved: March, 2011, Revised 6/17/13, 4/16/14, 12/20/17, 8/15/18 5

6 Hematlgy Cre Privilege: Admit, evaluate, diagnse, treat and prvide cnsultatin t patients, except as specifically excluded frm practice, with diseases and disrders f the bld, bld frming tissues, and the immunlgic system such as anemia, cltting disrders, sickle cell disease, hemphilia, leukemia, and lymphma. Access, stabilize and determine dispsitin f patients with emergency cnditins cnsistent with the Medical Staff plicy regarding emergency r cnsultative services. Privileges include but are nt limited t: Internal Medicine Cre bne marrw aspiratins and bipsy, administratin f chemtherapy immuntherapy and/r bilgical respnse mdifiers, management and care f indwelling venus access catheters, plasmapheresis, therapeutic phlebtmy lymph nde aspiratin, and therapeutic thracentesis paracentesis, skin and subcutaneus bipsy lumbar puncture Onclgy Cre Privilege: Admit, evaluate, diagnse, treat and prvide cnsultatin t patients, except as specifically excluded frm practice, with nclgic disrders. Access, stabilize and determine dispsitin f patients with emergency cnditins cnsistent with the Medical Staff plicy regarding emergency r cnsultative services. Privileges include but are nt limited t: Internal Medicine Cre bne marrw aspiratins and bipsy, administratin f chemtherapy immuntherapy and/r bilgical respnse mdifiers, management and care f indwelling venus access catheters, lymph nde aspiratin needle aspirates and/r bipsy f superficial ndes and masses therapeutic phlebtmy therapeutic thracentesis paracentesis, skin and subcutaneus bipsy Bard apprved: March, 2011, Revised 6/17/13, 4/16/14, 12/20/17, 8/15/18 6

7 lumbar puncture Hematlgy and Onclgy Pediatric Cre Privilege: Admit, evaluate, diagnse, cnsult, and prvide treatment t children and adlescents presenting with diseases and disrders f the bld and immune system and prvide treatment r cnsultative services t children and adlescents with cancerus diseases. Access, stabilize and determine dispsitin f patients with emergency cnditins cnsistent with the Medical Staff plicy regarding emergency r cnsultative services. Privileges include but are nt limited t: Pediatric Cre bne marrw aspiratins and bipsy administratin f chemtherapeutic agents and bilgical respnse mdifiers thrugh all therapeutic rutes immuntherapy and/r bilgical respnse mdifiers, the management and care f indwelling venus access catheters, lymph nde aspiratin Internal Medicine Cre Privilege: Admit, evaluate, diagnse, treat and prvide cnsultatin t patients 13 and abve admitted with bth cmmn and cmplex illnesses f cancer, infectins and diseases affecting the heart, bld, kidneys, jints and the digestive, respiratry and vascular systems and treatment f cmmn prblems f the eyes, ears, skin, nervus system and reprductive rgans. Access, stabilize and determine dispsitin f patients with emergency cnditins cnsistent with the Medical Staff plicy regarding emergency r cnsultative services. Inherent in cre privileges are the fllwing areas/prcedures: Arthrcentesis Lumbar puncture Thracentesis Exercise testing EKG interpretatin Pediatric Cre Privilege: Admit, evaluate, diagnse and treat patients ages 0-18 fr cmmn illnesses and injuries including disrders cmmn t general pediatric diseases and cnditins. Access, stabilize and determine dispsitin f patients with emergency cnditins cnsistent with the Medical Staff plicy regarding emergency r cnsultative services. Bard apprved: March, 2011, Revised 6/17/13, 4/16/14, 12/20/17, 8/15/18 7

8 Privileges include but are nt limited t: Bne marrw aspiratin Burns, superficial and partial thickness I&D f superficial abscess Lcal anesthetic techniques Lumbar puncture Management uncmplicated minr clsed fractures and dislcatins Perfrm simple skin bipsy r excisin Peripheral arterial puncture Digital peripheral nerve blcks Placement f anterir and psterir nasal hemstatic packing Pre-perative and pstperative medical care fr surgical patients Remval f freign bdy by speculum, frceps, r superficial incisin Remval f nn-penetrating crneal freign bdy Suprapubic bladder aspiratin Suture uncmplicated laceratins Venipuncture Special: The physician requesting special privileges must meet the minimum criteria fr the specialty cre and demnstrate the apprpriate pst graduate training and/r demnstrate successful cmpletin f an apprved, recgnized curse when such exists, r ther acceptable experience. Administratin f mderate sedatin: See Credentialing Plicy fr Sedatin and Analgesia by Nn-Anesthesilgists. Requires: Separate DOP, ACLS, NRP r PALS certificatin Bard apprved: March, 2011, Revised 6/17/13, 4/16/14, 12/20/17, 8/15/18 8

9 Hematlgy & Onclgy Clinical Privileges Check belw the particular privileges desired in Hematlgy & Onclgy fr each facility: Privilege Descriptin Hematlgy Cre Please check () applicable age categries fr each privilege requested. Nenates (0-28 days) Methdist Healthcare Memphis Hspitals (MHMH) Germantwn, Le Bnheur Medical Center, Nrth, Suth & University Infants (29 days 2 Years) Children & Adlescents (2-18 years) Adults & Adlescents (13 & Abve) Methdist Healthcare Olive Branch Hspital (MHOBH) Adults & Adlescents (13 & Abve) Onclgy Cre Hematlgy & Onclgy Pediatric Cre Special Bne Marrw/Stem Cell Transplant CAR-T Therapy Limitatins Clinical privileges are granted nly t the extent privileges are available at each facility. Darkly shaded areas represent privileges nt available t any practitiner due t the privilege nt being ffered by the facility. Acknwledgement f practitiner I have requested nly thse privileges fr which by educatin, training, current experience and demnstrated perfrmance I am qualified t perfrm and fr which I wish t exercise at the facilities indicated abve, t the extent services are available at each facility, and I understand that: (a) in exercising any clinical privileges granted, I am cnstrained by facility and medical staff plicies and rules applicable generally and any applicable t the particular situatin (b) any restrictin n the clinical privileges granted t me is waived in an emergency situatin and in such situatin my actins are gverned by the applicable sectin f the medical staff bylaws r related dcuments Physician's Signature Date Printed Name Bard apprved: March, 2011, Revised 6/17/13, 4/16/14, 12/20/17, 8/15/18 9