Abstract Book of the 3rd World Conference on Business, Management, and Economics
Year: 2025
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The Great Divorce: When Hospitals Use Economic Grounds to Deny or Curtail Medical Staff Privileges
Mark Cwiek, Elizabeth Hoff, Emily McDonald, Vincent Maher
ABSTRACT:
Hospitals worldwide face ongoing challenges in determining whether individual physicians should be credentialed to practice medicine within hospitals or otherwise and to what extent clinical privileges should be granted. In the USA model, clinical privileges in a hospital can be lost due to poor clinical performance with patients, usually as determined in a peer-review process. In addition, clinical privileges can occasionally be lost due to non-clinical reasons, such as the physician’s noncompliance with organizational rules or violating civil and/or criminal laws. Economic factors can bring the curtailment or denial of hospital privileges, such as with the completion of a contract term with a group practice or the facility, and where the hospital seeks to protect itself from unfair competition by medical staff with the hospital’s business interests. These latter conditions are often referred to as “economic credentialing,” something that the American Medical Association categorically condemns. Gaining and maintaining hospital clinical privileges are usually critical to the professional and economic well-being of the physician. As such, a physician who has lost privileges frequently challenges the adverse decision within the hospital medical staff’s internal appeals process and then through the court system, if necessary. In countries with co-existing public and private insurance systems that pay providers more in the private model, including Germany, Switzerland, and the United States, a form of “cream skimming” occurs, leading to easier access for the more affluent patients. The authors employed qualitative legal research in this study, and recommendations are included herein to balance public policy and the rights, needs, and goals of the physician, the hospital, and the local communities whose medical needs are being served.
Keywords: clinical privileges, economic credentialing, litigation, medical peer review, physician credentialing