Understanding Advanced Practice Providers and their Medical Privileging Processes

Understanding Advanced Practice Providers and their Medical Privileging Processes

May 24, 2022
  • Author:
    Noelle Abarelli

Privileging healthcare providers can be complex, especially when it comes to Advanced Practice Providers (APPs). APPs have backgrounds, training, and scopes of practice that can vary significantly, impacting how to grant privileges. As always, privileging plays a vital role in validating the competency of a provider and determining appropriate practice permissions to ensure the best in patient care.

As privileging experts, we must review as much background information about all the different specialties and providers in order to build the most effective privileging process. We believe it’s important to have a comprehensive understanding of it all, from education and training, to certification and regulatory requirements for licensure, so that we can grasp how every piece of the privileging puzzle comes together to define competency. Our webinar series, Privileging 101 – provides all the information you need to become a privileging pro, from basic education on the history and fundamentals of clinical privileging to how to navigate all the regulatory and legal aspects involved.

In this post, we’ll examine the different types of APPs and associated privileging requirements.

What is an Advanced Practice Provider?

An Advanced Practice Provider (APP) is an individual permitted by law and by the organization to provide care, treatment, and services without direction or supervision. They can also be a licensed independent practitioner who operates within the scope of his or her license, consistent with individually granted clinical privileges. There are a variety of titles used to classify APPs, such as:

  • Specified Professional Personnel
  • Physician Extenders
  • Mid-Level Providers
  • Dependent Practitioners
  • Medical Associates/Assistants
  • Advanced Practice Professionals or Advanced Practice Providers
  • Licensed Practitioner

Regardless of the term used, it is the responsibility of the privileging organization to determine, based on law and regulation, if they meet the definition of a licensed provider. Simply put, APPs are members and non-members of a medical staff who are granted privileges. Examples are, Physician Assistants (PAs), Advanced Practice Registered Nurses (APRNs), psychologists, registered radiology assistants, and certified surgical first assistants.

History of Advanced Practice Providers

The concept of an APP, specifically as a physician assistant, was lauded early on and gained federal acceptance and backing as early as the 1940s. It was considered a creative solution to help alleviate the difficulties associated with physician shortages, especially in rural areas. In 1968, The American Academy of Physician Associates was established and incorporated in the state of North Carolina as the American Association of Physician Assistance. Official membership was made up of the first students and graduates of the Duke University PA program. The medical community helped support the new profession and spurred the setting of accreditation standards. This led to the establishment of a national certification process, standard examination, and the development of continuing medical education requirements.

Where do Advanced Practice Providers Focus?

There are a variety of different APPs, and within those are different sub-specialties. As a PA, for example, you may complete an additional 2-3 years of schooling requiring different state certifications and state licensing requirements to choose an area of focus, such as:

  • Radiology
  • Urgent care
  • Mental health
  • Dermatology
  • Emergency medicine
  • Hospital medicine
  • Geriatric medicine
  • Internal medicine
  • Occupational health
  • Gastroenterology
  • Neurology
  • Surgery
  • Cardiothoracic surgery
  • Neurosurgery
  • Orthopedic surgery

Advanced Practice Registered Nurses (APRN) were established in 1965, with the goal of increasing the number of medical care providers, especially in underserved areas. Registered Nurses were trained in clinical care so they could perform testing, routine exams, and immunizations. This helped provide physicians with more time to see patients who needed special attention specifically from a physician.

APRNs can also choose different sub-specialties, like:

  • Clinical care
  • Acute care
  • Family nurse practitioner
  • Pediatric Primary Care
  • Mental Health Specialist
  • Primary care or Acute care certified pediatric nurse practitioner
  • Anesthetist
  • Emergency room or trauma care
  • Oncology
  • Cardio-pulmonary medicine
  • Neonatal nurse practitioner
  • Psychologists
  • Registered Radiologist Assistant (RRA)
  • Certified Surgical First Assist (CSA)

Other APPs to privilege include Psychologists, Registered Radiologist Assistants (RRAs), and Certified Surgical First Assistants (CSAs). To learn more about the specifics, visit our Privileging 101 page and sign up to attend our bonus Q&A session on May 19!

Accreditation Requirements Related to the Credentialing and Privileging of Advanced Practice Providers

As always, with privileging and credentialing comes the need to fulfill different accreditation requirements, and that’s no different when it comes to privileging APPs. Both the CMS and Joint Commission mention “medical level of care,” which refers to care provided for which physicians are paid.

CMS Requirements The Joint Commission Requirements

Providers who provide a “medical level of care” must be credentialed and privileged through the Medical Staff process. These services are “traditionally” provided by physicians, with skills and tasks that are routinely performed by physicians, including diagnosing, admitting, managing, treating, or discharging patients.

These requirements are generally applicable to PAs and APRNs, but can also include other types of APPs.

Those who provide a “medical level of care,” including PAs and APRNs, must use the medical staff process for credentialing and privileging, making all MS standards applicable. This includes recommendations by the organized medical staff and approval by the governing body, OPPE, and FPPE, along with ongoing and focused professional practice evaluation.

APRNs should request privileges only for those responsibilities involving medical level of care and not those responsibilities already allowed under an RN scope of practice.

VerityStream can Help Organizations Remain in Compliance with These Regulations

Our suite of offerings was created to ensure your organization is not only compliant with state laws pertaining to regulations and standards, but to empower your team to continually provide the appropriate care, treatment, and services to all patients. CredentialStream includes everything you need to request, gather, and validate information about Advanced Practice Providers in one centralized location. With a modern, continuously updated platform, best-practice content libraries, and industry-leading data sets, CredentialStream is the most comprehensive provider lifecycle management solution available. For more information, or to schedule a demo, reach out to us. We’re here to help!

Whether you are new to privileging or looking to add to your skills, we recommend taking a look at our webinar training sessions to help keep you up-to-date with the latest!