Taming Hospital Credentialing, Privileging Disputes

AAFP Commissions Legal Opinion to Aid Family Physicians

November 14, 2017 04:27 pm News Staff

AAFP members struggling to gain hospital privileges for which they are qualified have a new resource in the form of a legal opinion(1 MB PDF) written by the law firm Seigfreid Bingham.

[Caduceus used as balance ]

The AAFP commissioned the Kansas City, Mo., firm to review applicable law to "determine the extent to which hospitals and physicians may be liable for the denial of medical staff membership or privileges to perform specific procedures based on factors other than demonstrated experience, training and competencies of the physician in question."

Academy leaders took the action on behalf of members soon after delegates to the AAFP's 2017 National Conference of Constituency Leaders adopted a resolution that asked the Academy to "further prevent the restraint of trade of family physicians by providing a sample legal opinion in favor of family physicians practicing within emergency departments."

It's not unusual for family physicians to contact the AAFP asking for assistance with credentialing and privileging issues in various practice situations.

AAFP Revamps Hospital Privileging Resources

Hospital privileging information long available to members on the AAFP's website has undergone a complete overhaul to ensure that it is a complete and up-to-date resource for family physicians.

The materials are intended for educational purposes only and should not be considered legal advice.

Be sure to check out new content related to credentialing -- considered the first step to obtaining privileges -- and take advantage of the addition of AAFP policy statements and position papers intended to further support members should they be confronted with a privileging or credentialing dispute.  

The legal opinion -- which presents an objective, evidence-based position on privileging -- is intended to provide support for members who find themselves in challenging situations with hospital administrators or others in decision-making positions, and it should not be considered legal advice. 

In its executive summary, the law firm notes that "the issue is broader than just emergency medicine and potentially affects family physicians who are competent and experienced in other specialties, as well."

After reviewing accrediting organization pronouncements, as well as legal and regulatory precedent, the opinion concludes that, "the law is straightforward and clear that credentialing decisions regarding medical staff membership and granting of privileges may lawfully be based only on the demonstrated competency, experience and training of the practitioner."

The author adds: "This is the law now and has been the law for many years."

The opinion's findings can be summarized in just four short statements:

  • Hospitals and peer review participants risk liability if decisions to grant or deny staff membership or privileges are based on factors other than a family physician's "demonstrated experience, training and competence."
  • Physicians who join together to exclude family physicians from practice may be in violation of antitrust laws.
  • No evidence was found to demonstrate that only board-certified physicians are qualified to practice in specialties such as emergency medicine.
  • Hospital and peer review participants who base credentialing decisions only on a physician's having obtained specialty certification "risk loss of federal and state immunity from liability."

The 12-page document includes numerous examples in the form of court cases, state and federal statutes, case law and Federal Trade Commission orders.

More From AAFP
Summary of actions: AAFP's 2017 National Conference of Constituency Leaders(19 page PDF)