Allied Health Providers – Changing the Dynamics of Healthcare

I’m often asked credentialing questions about allied health providers and the questions are valid because allied health providers have come onto the healthcare scene with a prominent presence.  Every state has different laws and parameters for the scope of practice of allied health providers.  The parameters identify what level of providers are Licensed Independent Providers (LIPs) or licensed dependent providers.  Independent providers are able to practice without physician supervision while dependent providers require physician supervision.  The level of credentialing is not based upon the definition recognized by the state.  The level of credentialing required of any provider depends on what level of care the facility is permitting that provider to practice within the facility.  For example, if social workers are licensed to practice independently, but within the facility they are required to practice with physician supervision, then they may be credentialed as dependent practitioners.

Another level of allied health providers has recently emerged.  This level is called Advanced Practice Providers (APPs).  Typically these providers are allowed to practice independently and thus are granted clinical privileges.  If a “medical level of care” has been defined by the facility, the providers must be granted clinical privileges.  CMS has never defined a “medical level of care.” CMS has stated that it includes functions performed by Physician Assistants (PA) and Advance Practice Registered Nurses (APRN) as those requiring clinical privileges and hence credentialing.  Thus, PAs and APRNs must be credentialed and granted privileges through the Medical Staff process, regardless of whether they are employed by the hospital or by a private physician.

Where does this leave us with other providers (RNs, dental assistants, ophthalmic assistants, scrub techs, etc.).  The credentialing accreditation and licensing standards defer the judgment to the individual facility.  Some facilities are adopting the term Certified Assistants or CAs.  The depth of verification is specific to each facility.  However, basic data sets are similar in requiring licensure/registration/certification and insurance.

I am certain we will continue to see more and more allied health providers on the healthcare scene.  Credentialing these providers will require a thoughtful approach to the requirements adopted.  I look forward to this credentialing challenge as we continue to shape the requirements.  The credentialing file is, after all, the first line of defense in patient care.

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