SPECIALTY OF MEDICAL HOSPITALIST 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. Successful cmpletin f an accredited ACGME r AOA accredited pst-graduate training prgram in Internal Medicine and bard certificatin within 5 years f prgram cmpletin. Current bard certificatin in Family Medicine by the American Bard f Family Medicine r the American Ostepathic Bard f Family Physicians. Successful cmpletin f an accredited ACGME r AOA accredited pst-graduate training prgram in Family Medicine 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) and/r age specific (adult, pediatric, nenatal). This shuld nt be cnfused with Fcused Prfessinal Practice Evaluatin (FPPE) FPPE: an evaluatin f clinical cmpetence f all new privileges as perfrmed at the specific licensed MLH facility (MHMH, MHOBH) fr which they have been initially granted. This applies t privileges fr all new applicants as well as t 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. 1
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. Any cmplicatins/pr utcmes shuld be delineated and accmpanied by an explanatin. 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. Any cmplicatins/pr utcmes shuld be delineated and accmpanied by an explanatin. 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. Any cmplicatins/pr utcmes shuld be delineated and accmpanied by an explanatin. 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. Any cmplicatins/pr utcmes shuld be delineated and accmpanied by an explanatin. 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 evaluated 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. 2
Specialty/Prcedure Delineatin f Privilege Frm Medical Hspitalist 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. Successful cmpletin f an ACGME r AOA accredited pst-graduate training prgram in Internal Medicine and bard certificatin within 5 years f cmpletin. Current bard certificatin in Family Medicine by the American Bard f Family Medicine r the American Ostepathic Bard f Family Medicine Successful cmpletin f an ACGME r AOA accredited pst-graduate training prgram in Family Medicine and bard certificatin within 5 years f cmpletin. Initial Applicatin (Prf f current clinical cmpetence) Aggregate data frm primary practice facility fr the previus 12 mnth time perid indentifying the tp 10 diagnsis cdes and the number f inpatients per cde. Any cmplicatins/pr utcmes shuld be delineated and accmpanied by an explanatin. Prcedure list frm primary practice facility fr the previus 12 mnth time perid identifying the tp 10 CPT/ICD cdes and the number f prcedures per cde. Any cmplicatins/pr utcmes shuld be delineated and accmpanied by an explanatin. FPPE Validatin f cmpetence after appintment and/r granting f a new r additinal privilege (T be cmpleted within ne year) 5 cases including Pneumnia, CHF, Sepsis Management, r first 5 episdes f care. Maintenance Requirements 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. Any cmplicatins/pr utcmes shuld be delineated and accmpanied by an explanatin. Chest Tube Placement Stress Testing Training during an Internal Medicine residency prgram elective and recmmendatin f training directr OR Dcumentatin f infrmal training including didactic curses r thrugh experience gained under the supervisin f a qualified physician prctr Case lg dcumenting the perfrmance f at least 5 prcedures within the previus 12 mnths Current ACLS Certificatin AND Dcumentatin f 50 prcedures during an Internal Medicine residency prgram OR Dcumentatin f 150 prcedures perfrmed during previus 3 years if training was cmpleted infrmally First 5 cases First 5 prcedures Department chair recmmendatin will be btained frm primary practice facility. Case lg dcumenting the perfrmance f at least 10 prcedures within 24 mnths Case lg dcumenting the perfrmance f at least 25 prcedures annually with acceptable utcmes and current ACLS certificatin Bard apprved: August 14, 2013, Revised 4/16/14, 7/31/14
Medical Hspitalist Cre Privilege Descriptin: A medical specialty dedicated t the delivery f cmprehensive medical care t hspitalized patients. Practitiners f hspital medicine include physicians ( hspitalists ) wh engage in clinical care, teaching, research, r leadership in the field f general hspital medicine. Admit, evaluate, diagnse, treat and prvide cnsultatin t patients 13 and abve admitted with bth cmmn and cmplex illnesses f cancer, infectins. diseases and functinal disrders affecting the circulatry, respiratry, endcrine, metablic, musculskeletal, hematpietic, gastrenteric, geniturinary digestive, and vascular systems and treatment f cmmn prblems f the eyes, ears, skin, nervus system and reprductive rgans. May prvide care t patients in the intensive care setting in cnfrmance with unit plicies. In additin t their cre expertise managing the clinical prblems f acutely ill, hspitalized patients, hspital medicine practitiners wrk t enhance the perfrmance f hspitals and healthcare systems by: Prmpt and cmplete attentin t all patient care needs including diagnsis, treatment, and the perfrmance f medical prcedures (within their scpe f practice). Emplying quality and prcess imprvement techniques Cllabratin, cmmunicatin, and crdinatin with all physicians and healthcare persnnel caring fr hspitalized patients Safe transitining f patient care within the hspital, and frm the hspital t the cmmunity, which may include versight f care in pst-acute care facilities. Efficient use f hspital and healthcare resurces 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 Central Venus Line Placement EKG interpretatin Lumbar puncture Paracentesis Thracentesis Fcused Ultrasund Fcused ultrasund is used t diagnse acute life-threatening cnditins, guide invasive prcedures, and treat medical cnditins Fcused ultrasund is the medical use f ultrasund technlgy fr the bedside diagnstic evaluatin f medical cnditins and diagnses, resuscitatin f the acutely ill, critically ill r injured, guidance f high risk r difficult prcedures, mnitring f certain pathlgic states and as an adjunct t therapy Typically, fcused ultrasund is a gal-directed ultrasund examinatin that answers brief and imprtant clinical questins in an rgan system r fr a clinical symptm r sign invlving multiple rgan systems Fcused ultrasund is an medical prcedure, and shuld nt be cnsidered in cnflict with exclusive "imaging" cntracts seen with cnsultative ultrasund Bard apprved: August 14, 2013, Revised 4/16/14, 7/31/14
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: August 14, 2013, Revised 4/16/14, 7/31/14
Medical Hspitalist Clinical Privileges Check belw the particular privileges desired as a Medical Hspitalist fr each facility: Please check () applicable age categries fr each privilege requested. Privilege Descriptin Medical Hspitalist Cre Special Privileges Chest Tube Placement Stress Testing Methdist Healthcare Memphis Hspitals (MHMH) Germantwn, Le Bnheur Medical Center, Nrth, Suth & University, Outpatient Clinics & Diagnstic Facilities Adults & Adlescents (13-& Abve) Methdist Healthcare Olive Branch Hspital (MHOBH) Adults & Adlescents (13-& Abve) 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: August 14, 2013, Revised 4/16/14, 7/31/14