ACR Policy on Medical Staff Privileges, Exclusive Contracts, and Economic Credentialling
Medical Staff Privileges
The American College of Radiology believes that radiologists with hospital medical staff appointments and clinical privileges have the same rights as any other members of the hospital's medical staff. Clinical privileges comprise the right of medical staff members to provide specific patient care services in a manner consistent with licensure, education, and expertise. These rights include not only the right to provide the delineated services to patients but also the right of access to hospital resources, including equipment, facilities, and personnel necessary to exercise those privileges effectively. Any physician who has gone through the credentialing process and obtained medical staff privileges is entitled to full procedural due process before those privileges are curtailed, as provided by the fair hearing plan in the medical staff bylaws.
Hospital governing boards should abridge a physician's privileges only upon recommendation of the medical staff for reasons related to professional competence, adherence to appropriate standards of medical care, health status, or other parameters agreed on by the medical staff.
Exclusive Contracts
The American College of Radiology has traditionally endorsed the independent practice of radiology in an open-staff setting because hospitals have attempted to use radiology services contracts as a way of maintaining control over the radiology department. However, the College recognizes that today the exclusive contract is a widely used method of establishing an administrative relationship between a hospital and an individual radiologist or group of radiologists.
When a professional services contract is proposed between a hospital and an individual physician or group of physicians, the hospital medical staff should review and make recommendations to the hospitals governing body regarding the appropriateness of closing the radiology department and its impact on the quality of care. Such a review by the medical staff should take place before any decision is made to formally execute an exclusive contract in a previously open department or service or to terminate an exclusive contract in a particular department or service. Except in those teaching settings where radiology chairmen are selected through a formal search process, an exclusive contract should be negotiated between a hospital and a radiology group. The selection of the department chairman should be made by the radiology group and not dictated by the hospital as a contract provision.
Exclusive contractual arrangements should not be used to circumvent the peer-review procedures or medical staff bylaws by denying a member of the medical staff his or her full due process rights. A medical staff member providing professional services under contract with a hospital should not have his or her medical staff privileges terminated without the same rights of hearing, appeal, and due process available to all other members of the medical staff. Hospital governing bodies have contractual obligations, and in some jurisdictions, statutory obligations, to abide by the medical staff bylaws, and thus act only on the recommendation of the medical staff, before modifying, restricting, or revoking a physician's medical staff membership and clinical privileges.
Economic Credentialing
To protect the integrity of the credentialing and peer review process and to insure high-quality patient care, decisions to grant or terminate clinical privileges should not be based on economic considerations that do not legitimately relate to a physician's professional competence. When economic criteria, such as the perceived profitability of, or the types of patients in, a physician's practice, take the place of valid basis for granting privileges, for example, the licensure, education, and expertise of an individual physician, both patient welfare and physicians' rights are compromised.
In the view of the American College of Radiology, "economic credentialing" includes not only the award of clinical privileges on the basis of financial considerations but also practices by which hospitals attempt to share in the revenues derived by radiologists in providing professional services to patients. Examples of economic credentialing include demands that radiologists contribute a portion of their professional fees to the hospital in exchange for the right to provide radiology services, requirements that radiologists purchase billing or other services from the hospital at prices that exceed the fair market value of those services, hospital attempts to set or approve radiology fee schedules, and exclusive contracts that provide for the automatic termination of radiologists' medical staff appointments and clinical privileges at the end of the contract period. Any other arrangement that would base clinical privileges primarily on factors other than quality can be construed as a form of economic credentialing.
Because the hospital medical staff is an independent, self-governing entity that has the primary responsibility for assuring quality patient care within the hospital, the College believes that it is the responsibility of the medical staff to assure that suspect economic criteria do not influence the credentialing process or the provision of medical services.
Support for State Legislation
The American College of Radiology supports efforts to enact legislation at the state level that prohibits the practice of any form of economic credentialing and exclusive contracting decisions that deprive physicians of their due process rights.
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Revised: 12 April, 1997
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