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Privileging Process - Core or Bundled Privileging Model

Are they any specific considerations when using a core/bundle model for privileging ?

Any examples are for illustrative purposes only.

The Joint Commission does not define or prohibit the use of a core/bundled privileging model. Organizations adopting this model must consider the following:

Defining the process:
The core/bundled privilege must clearly and accurately define the specific activities/procedures/privileges to be included in the core/bundle and reflect only activities/procedures/privileges performed at the organization from which privileges have been requested. 

Implementation:
The applicant's education, training and current competence to perform each activity listed in the core/bundle must be evaluated as required per the standards in the Medical Staff Chapter of the manual. There also needs to be a clearly defined method for the applicant to request deletion of specific privileges if they don't wish for them to be granted. 

If the organization's evaluation determines that the applicant is not competent to perform certain activities, then they must modify the core/bundle that is granted to reflect only the specific privileges 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 to be notified of the granting decision, i.e., whether the full core/bundle or a modified bundle has been granted (see MS.06.01.09 EP 3). If the core/bundle was modified, the notification must detail the specific modifications.

CMS Position:
In November 2004, CMS issued their position on privileging which addresses the concept of core/bundle privileging and remains current.  It is in line with the Joint Commission expectation.  Organizations are also encouraged to determine if any state-specific law/regulation exist that address the use of a core/bundled privileging model.

Additional Resources:
CMS Survey and Certification Letter - November 12, 2004: Centers for Medicare & Medicaid Services (CMS) Requirements for Hospital Medical Staff Privileging. Ref: S&C-05-04
Last updated on March 04, 2021
Manual: Critical Access Hospital
Chapter: Medical Staff MS

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