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Old 09-25-2003, 11:30 PM
StarvingButStrong StarvingButStrong is online now
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Qs about hospital 'admiting privileges'

What exactly does it mean when a doctor has 'admitting' privileges at a given hospital? Does it mean he has somehow 'joined' with that hospital? Passed some exams, gotten gold stars, been given the key to the emergency room?

Is it a bad sign if a doctor DOESN'T have admitting privileges? As in, he wasn't 'good enough' to qualify? Or is it just some financial thing or maybe he's not part of the right 'old boys club'?

Is this true for all specialties? I mean, maybe it's vital that your ob-gyn has them, but not so much for your psychiatrist?

What if you end up in a hospital where your doctor doesn't have admitting privileges? Say, you were in an accident and were ambulanced to the nearest emergency room. I somehow don't think they'd leave you to bleed to death on the curb because your doc isn't on the list (at least, I hope not) but would they allow your doctor to come in and treat you, say during the followup period? Or would you have to be treated by someone affiliated by the hospital until you got transferred?

Mostly idle curiosity, but I just accidentally learned that my gp doesn't have admitting privileges at the hospital closest to my home. I'm not expecting to need hospital care in the foreseeable future, but I'd always assumed I'd go there, since it's significantly closer than the next choice.
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Old 09-26-2003, 12:10 AM
t-bonham@scc.net t-bonham@scc.net is offline
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Re: Qs about hospital 'admiting privileges'

Quote:
Originally posted by StarvingButStrong
What if you end up in a hospital where your doctor doesn't have admitting privileges? Say, you were in an accident and were ambulanced to the nearest emergency room. I somehow don't think they'd leave you to bleed to death on the curb because your doc isn't on the list (at least, I hope not)
No, when you arrive at an emergency room, you are treated by the doctors on duty in the ER. They would definately not wait for your doctor to arrive (it's an emergency, after all!)

When you doctor does arrive, he/she will almost always be allowed to consult with the doctor that treated you. But your doctor can take over your treatment only if they are affilitated with that hospital. Sometimes they will be granted temporary privileges (for you only). more often they will move you to a hospital they practice in (when your helath permits moving), or they will leave you in that hospital under the care of a different doctor.
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Old 09-26-2003, 12:40 PM
paperbackwriter paperbackwriter is offline
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Most hospitals have a credentialling process to determine admitting privileges. The standards differ based on hospital, location, state standards, the local reimbursement situation, the specialty, and other factors.

Most doctors also pick and chose at which hospitals they will apply for privileges. Furthermore, not all specialists need admitting privileges in order to pursue a successful practice. So it becomes situation of mutual selection.

I know that you sometimes read consumer health magazines saying things like "make sure the doctor you pick has admitting privileges at your preferred hospital." But I don't think it's an automatic necessity. Most of us pick our doctors based on the panels provided by our HMO anyway.

There are (generally) two ways to be admitted to a hospital:
1) You take yourself, or are taken, to the emergency department and they say, "You're a mess, we're keeping you here."
2) Your doctor tells the hospital "This person's a mess, you'd better take him."

Having admitting privileges basically means that, for instance, my wife can send her patients to inpatient treatment at one of the local hospitals, but not its competitor. If one of her patients is admitted through the emergency room at the competitor, the patient's care will be co-ordinated by another doctor. She usually can, however, consult on the case.
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Old 09-26-2003, 04:01 PM
Ferret Herder Ferret Herder is offline
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It is also important to note that applying for admitting privileges isn't a trivial task. I used to help the doctors I worked for at my last job fill those forms out, and they can be dozens of pages long at times, requiring all sorts of documentation. They also tend to cost a fair chunk of change ($50 to a few hundred I think) just to apply for consideration, and then yearly fees around the same amount just to continue being allowed to admit there. So if there are a lot of your hospitals in your area, the doctor might well want to pick and choose.

Mind you, one of the things that is looked at is the physician's appearance of competence - the hospitals will ask about things like previous malpractice insurance cases brought up (not the ones the doctor lost, but any time someone brought a case against them). So, it's possible this might be why a doctor doesn't have admitting privileges at a particular hospital, but far from the only reason.
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Old 09-26-2003, 04:57 PM
KP KP is offline
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A physician can also lose admitting privileges or have them suspended for a variety of reasons.

I knew a general surgeon who was asked to give up 'hand privileges' (hand surgery can be tricky, and loss of function can lead to lawsuits, so, especially in specialist-rich Massachusetts, some hospitals may not wish to take any risks) This would have mean that he couldn't so much as sew up a hand laceration - which students and residents are allowed to do in some cases. He refused and ended up either losing his privileges or not having them renewed. Naturally, he moved. A surgeon without an OR is up a creek.

I've known a couple of neurosurgeons who seemed to be on the 'no admit' and 'no Op' list every week because they hated doing OR or discharge summaries (both, oddly, did laminectomies [removal of part of a vertebra to release possible pressure on a spinal nerve root] almost exclusively) When they wanted to do an admission or surgery, they'd go down to Medical Records and complete exactly enough discharge or OR summaries to bring them current - which for these two meant "30 days behind" (exactly at the cut-off)

Does this necessarily mean they're bad doctors? I don't know. I was always puzzled that they didn't finish off the whole stack while they were down there, and buy themselves a month of breathing room (or learn their lesson, and dictate it at the time of the procedure or discharge) Dictating a discharge is pretty darn easy, and it's a lot easier when the case is fresh in your mind. Clearly, there was something going on there.

Just a couple of random tales from the trenches for your amusement
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Old 09-26-2003, 10:48 PM
ftg ftg is offline
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I "know someone" who has worked in the underbelly of hospitals. (But the current "Rule of the HMOs" may have changed a few things.)

Some hospitals grant priv. if the doctor will bring in enough patients, i.e., bring in money. Small practice/not the right kind/already in with another hospital, and they say no thanks. Nice to know that $ has priority over patient care.

The worst case I have ever heard was an elderly doctor in Seattle who went thru all the regular hospitals in town and got thrown out/turned down by them all. He didn't believe in washing his hands between visiting patients and a lot of them died from "hospital" acquired infections. Yeah, we know who's at fault but the hospital gets sued anyway. He ended up at a tiny DO hospital, and was still killing people, when we moved.

So it is quite important to know if your doctor has lost priv. (but being turned down may not be so bad). Unfortunately, this isn't something they hang on their wall next to their diplomas.
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Old 09-26-2003, 11:09 PM
StarvingButStrong StarvingButStrong is online now
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This is all fascinating, and I thank you for all your answers...but I'm left feeling the 'medical services consumer' is a bit at sea. (No kidding, that's how they put it on the last insurance form I filled out. What happened to 'patient'??) Maybe your doctor never applied to the hospital you wanted to use. Maybe they turned him down for reasons unrelated to his medical skill. Maybe he's like the sweetheart in Mass. who left a patient lying on the operating table mid-op so he could run a check over to his bank and got chucked out on his hiney. How are you to know?

If you aren't the confrontational type, flat out asking your doctor "Have you ever lost admitting privileges, where and why?" isn't going to be tough. Especially if you're in pain or bleeding and question the wisdom of irritating the guy you're about to trust your body to.

And I'll bet all those records are confidential or at least not accessible to prospective patients.
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Old 09-26-2003, 11:40 PM
KP KP is offline
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While in-house disciplinary actions and Mortality and Morbity reviews are often confidential to some degree (i.e. from patients, but not always the State Board), in many states you can at least get information on State Board disciplinary actions. I'm pretty pleased at this, because I played a role in getting the MA records on the internet ca 8 years ago. We could have been the first, but we were second or third because of delays in authorization and implementation. *sigh*

Last I checked, you could see State Board disciplinary actions, medical training, affiliations, honors, etc. from the comfort of your home. It ain't a whole lot, but it's a lot more than patients used to have.
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