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Does any one know for sure if a primary care physician is required to maintain active hospital privelage to stay on insurance network or even medicare or medicaid.
In our hospital a number of primary care physicians are not interested in providing acute care to inpatient any more. They would like to stay only on hospital staff to fullfile insurance requirement. They interested only in office based practice. The question is; do they need to maintain hospital previlage to continue caring for the patient without being disqualified by medicare , medicaid and other insurance company?

Most will allow you to stay on insurance if you have a signed agreement with hospitalists for their hospital coverage. The dilemna is that call and other requirements for the hospital can be onerous.

Hi Mohamed,

I think this may vary geographically, I can speak only for Maryland and
Pennsylvania. I am a Family Physician, not admitting patients to the hospital. Hospitalists take care of our inpatients.

I have "Courtesy" or "Affiliated staff" privileges at one Md and 2 Pa hospitals. Typically the insurance companies require this, and an "agreement" with a participating physician to admit our patients. We identify a Hospitalist for this.

So my guess is that they would have to maintain some type of hospital priveleges, but not actually admit.

Hope this helps!

Gene

Steven
Thank you for your quick reply.
This is what I thought. As you said the call schedule is still required by the hopital . Most our primary care physicans has signed agreemend or have notified the hospital that they would like the hospitalist on call to take care of their patients.The hospital still ask them to be on the call schedule because of the bylaw, which means The hospital still requires a list of the oncall physicans separate form the Hospitalist (other group of PCP being paid by the hospital) to be able to pay the hospitalist as being as a back up. Which is a weared situation . It is not an issue for the hospital for those physician not to take care of there patient but they want to maitain 2 lists of oncall. Basically the hospital is promoting one group of physicans over others and would like to keep paying them.
I would like to change the bylaw to allow the senior physicians with 20 years of service and over the age of sixty will be exempted for the call schedule.
Wich is going to be another battle with the hospital.
Any other idea to help these doctors who would like to keep there office based practice and there hospital prilivage without warrying about insurance and hospital bugging them?

Hi Mohamed,

In Cumberland, Md:

Active medical staff admits, takes ER call, has to attend department meetings, serve on hospital committees, etc.

Affiliate (Courtesy) do not admit, do not take ER call, do not have meeting or committee responsibilities.

Most departments exempt physicians from ER call at age 55.

I am on telephone call for our patients close to 24/7. Typically only a few calls a week. And telephone call is much easier when you know all of the patients.

Gene

Courtesy staff which allows them to admit a very limited number of admissions/consults and then decreasing call requirements also seem like it could work.

I live in a small town and so call is always expected but our Courtesy staff live more than 30 min away and we do not expect them to take call.

The problem with courtesy staff is being conditional requires to be active staff in different hospital to monitor physician performance and all other quality issues for credentialing and reapointment. The same is true for associate staff (which we do not have in our hospital). Unless the hospital drop that provision in the bylaw, Those physican have no option except to resign from the medical staff, which is quite traumatic to them since they have been practicing for 25 to 35 years. However they are willing to resign if no other option if they medicare and insurance will allow them as I mentiened before.

Hi Mohamed,

We went through this. Courtesy staff status did require active staff status at another hospital. So the hospital created a new category, "Affiliated" staff. No requirement for active status elsewhere. The insurance companies are accepting this.

This is a matter for your hospital Bylaws Committee. They can change it.

Gene

Gene
Thank you very much for the information. I think this will be another excellant alternative. I know for sure they prefere to be active staff to keep there vote. So I think we will try to change the bylaw to allow exemption of medical staff older then 60 years and more than 20 years of service and to add associate or affiliated staff membership for those how would like to keep loose association with the hospital without voting right and participation in committee meeting and also being accepted by insurance company.
Exellant . Thank you very much for your good idea and sharing your experience.