Q: . Does the Joint Commission endorse or recommend the use of the core/bundle privileging format.
A: Joint Commission's credentialing and privileging standards in all accreditation manuals do not reference the concept of core privileges nor do they suggest or promote a particular format for granting privileges.
Q: Are they any specific issues with using the core/bundle privileging format?
- the definition of the activities that are being covered by the core/bundle terminology, and
- the implementation of an evaluation to determine that the applicant can be granted each of the activities listed the core privileges
Definition:
- the core/bundled privilege must be clearly and accurately defined to reflect specific activities/procedures/privileges to be included in the core terminology, and those activities/procedures/privileges that are outside the core
- the core/bundled privilege must be clearly and accurately defined to reflect only activities/procedures/privileges actually performed at the organization
- the core/bundled privilege must be clearly defined to reflect activities that the organization believes a majority applicants should be able to perform
Implementation:
- before the core/bundle is granted the organization must evaluate each applicant's education, training and current competence to perform each activity listed in the core/bundle, and any that are assigned outside the core/bundle.
It cannot be assumed that every applicant can do every activity listed.
- there needs to be a clearly defined method for the applicant to request deletion of specific activities if they don't wish for them to be granted
- if organization's evaluation determines that the applicant is not competent to perform certain activities, then the organization must modify the core/bundle that is granted to the applicant
- in accordance with the medical staff standards the applicant and all appropriate internal and/or external persons or entities (as defined by the organization and applicable law) are notified as to the granting decision, i.e., whether the full core/bundle or a modified bundle has been granted. If the core/bundle was modified, the notification must detail the specific modifications.
Note: The expectation for the evaluation of each applicant's education, training, and current competence to perform each specific activity would be the same if the organization were to use a "laundry list" format for the applicant to select activities
Q: Is the Joint Commission aware of any issue that CMS might have with the use of core/bundle privileging?
A: In November 2004 CMS issued their position on privileging which addresses the concept of core/bundle privileging. It is in line with the Joint Commission expectation outlined above.