BENCHMARKING REPORT. Read the results of a survey on cardiac CT angiography privileging. Help us to help you. The mission.

Size: px

Start display at page:

Download "BENCHMARKING REPORT. Read the results of a survey on cardiac CT angiography privileging. Help us to help you. The mission."

Damian Dawson
5 years ago
Views:

1 BENCHMARKING REPORT Read the results of a survey on cardiac CT angiography privileging Earlier this year, the Credentialing Resource Center (CRC) surveyed medical staff professionals (MSP) regarding which specialties should be granted privileges to perform cardiac computed tomography (CT) angiography. This benchmarking survey is a direct response to interest among MSPs in the issue of privileging disputes related to this practice area. We d like to thank all of the respondents who completed the survey. The pages that follow detail the survey s results. Help us to help you We re continually striving to bring you the most helpful information in our benchmarking survey reports. If you have any suggestions for future benchmarking surveys or comments about how we could improve the survey or report, please them to Managing Editor Margot Suydam at msuydam@hcpro.com. We welcome and value your feedback. TABLE OF CONTENTS I. The issue at hand II. A bird s-eye view III. Number of physicians on the active medical staff at your hospital IV. Number of cardiac CT angiography procedures performed per year at your hospital V. Number of beds at your hospital The mission With the arrival of 64-slice CT scanners, cardiac CT angiography has become a hot privileging issue for many hospitals. The question is not only which practitioners should hold privileges to perform cardiac CT angiography, but also what education, training, and experience a physician must have to be competent to interpret cardiac CT scans. Our objective is to provide you, the MSP, with the detailed information that you need to learn about the cardiac CT angiography privileging practices of your peers at hospitals with demographics similar to those of your facility. The design In our survey, we requested various demographic data, including geographic region, what type of facility a respondent represents, and whether the hospital is part of a healthcare system or is a stand-alone facility. According to a previous CRC survey, however, the demographics most requested by respondents are the number of physicians practicing at the facility, the annual number of procedures performed at the facility, and the facility bed size. Consequently, we have carefully cross-referenced all data so you can gain knowledge of the privileging trends of your colleagues in terms of these specific demographic criteria. Each facility demographic has its own section that starts with a general statistical overview. A series of charts following the overview drill into the privileging trends of respondents. In > continued on p. 2

2 Page 2 Benchmarking report vember 2006 Survey < continued from p. 1 each demographic section, we address the following questions: 1. Which of the following specialties are granted privileges at your hospital for cardiac CT angiography? 2. Have your medical staff experienced privileging disputes regarding which specialties should be granted privileges for cardiac CT angiography interpretation? 3. In terms of cardiac CT interpretation, how does your facility determine who does the official read? 4. Does your hospital require physicians to have documented privileges at the facility before they can interpret cardiac CT angiograms? 5. To be granted privileges for cardiac CT angiogram interpretation at your facility, must physicians document that they have participated in special education/training? 6. To be granted the privilege for cardiac CT angiography in your facility, how many procedures must a physician have performed in the past 12 months for competency? 7. Has your facility created a multidisciplinary team related to cardiac CT interpretation? I. The issue at hand: Hospitals nationwide are installing 64-slice CT systems. At 64-slice, CT technology can now produce images sharp enough to be used for coronary angiography studies. Consequently, the emergence of noninvasive cardiac diagnostic imaging has brought about a turf battle between cardiology and radiology. For facilities faced with cardiologists and radiologists battling it out over cardiac CT angiography privileges, the issue is twofold. Who is qualified to interpret cardiac CT angiography and what minimum qualifications are required to be granted clinical privileges? Although the radiology department tends to own the equipment and traditionally interprets test results, cardiologists claim that they are the only clinicians who are qualified to read cardiac CT studies. Meanwhile, radiologists maintain that it is necessary that they read scans to catch any other noncardiac-related findings. Approaches to resolve this issue include dual reads, whereby both a radiologist and cardiologist do official reads; split reads, whereby a cardiologist interprets the cardiac scan and a radiologist does an overread for noncardiac findings; or alternating official reads between radiology and cardiology. Consequently, medical staff offices are faced with the task of setting privileging criteria for both specialties to interpret cardiac CT angiography. One facility reports that their cardiologists and radiologists each wanted exclusivity, and so members from each group asked for and received privileges. Representatives from both groups sat with members of the credentials committee to create separate privileging criteria based on review of recommendations made by the American College of Cardiology (ACC) and American College of Radiology (ACR). Both of these associations have determined education, training, and experience criteria for cardiac CT angiography. It is recommended that practicing cardiologists get handson training in CT, whereas radiologists are required to add cardiac diagnostics to their CT expertise. According to this month s benchmarking survey on cardiac CT angiography privileging trends, almost half of respondents say they have experienced a privilege dispute. One hospital describes the dispute as such: Cardiology has developed criteria for privileging. Radiology s interpretation is that if they are granted privileges for CT, interpreting cardiac studies should be included. The issue has been resolved so that cardiology will read cardiac images and radiology will overread. Although some facilities have found ways to resolve the issue, reaching a resolution is not so easy for many hospitals. One facility says the topic is still being discussed between its radiology and cardiology departments. The hospital explains that cardiologists want privileges for cardiac CT angiography, even though it falls under an exclusive contract for radiologists. In addition, they say > continued on p. 3

3 vember 2006 Benchmarking report Page 3 angiograms to show competency. Although 44% of hospitals say they have experienced a privilege dispute regarding cardiac CT angiography, 35% of respondents claim to have set up a multidisciplinary CT team to resolve the dispute. Geographic regions 18% 15% 2% 6% 24% 35% Network or stand-alone facility 64% Type of facility 54% 36% 24% 22% rth central 35% Southeast 24% South central 18% rtheast 15% Pacific 6% West 2% Part of a network 64% Stand-alone facility 36% Academic medical center/ teaching hospital 24% Rural community hospital 22% nacademic acute-care hospital 54% Survey < continued from p. 2 now that the radiology department is leading the race in credentialing its physicians, whereas cardiology is questioning the criteria. Hospitals have tried to resolve the issue by forming multidisciplinary committees to hash out their differences. One facility reports that criteria was developed and agreed upon by both specialties. Another says that it has formed a credentials subcommittee to create the credentialing criteria. The committee consists of radiologists, cardiovascular surgeons, cardiologists, and vascular surgeons. II. A bird s-eye view: Before we analyze each demographic, let s take a bigpicture look at the MSPs who responded to the survey. Most of the respondents hail from the rth central and Southeast regions of the country. The majority of respondents represent nonacademic acute-care hospitals and are part of a national healthcare system. Most respondents work at hospitals with more than 500 physicians who perform fewer than 25 or more than 100 cardiac CT angiography procedures per year, and have more than 200 beds. Nationally, radiologists and cardiologists are most likely to hold privileges for cardiac CT angiography, followed by nuclear physicians. Other specialties performing cardiac CT angiography are cardiovascular surgeons and interventional radiologists. According to the survey, 35% of hospitals perform less than 25 cardiac CT angiography procedures per year, and 25% perform more than 100. Ninety-two percent of hospitals responding to the survey require clinicians to hold privileges at the hospital to interpret cardiac CT angiography. Moreover, 84% of respondents require physicians to participate in a special training/education program before they perform and interpret cardiac CT angiography. In terms of the number of cardiac CT angiography procedures for competency, 51% of medical staff offices say they do not require a specific volume of cases. However, 40 % of respondents say they require a physician to perform and interpret more than 25 cardiac CT > continued on p. 4

4 Page 4 Benchmarking report vember 2006 Survey < continued from p. 3 Number of cardiac CT angiography procedures per year Number of physicians on the active medical staff Fewer than 25 35% 18% 25% 11% 11% 18% 35% % % % % 8% 25% 15% 18% 14% % % % % Number of beds Specialties granted privileges for cardiac CT angiography 6 15% 17% 8% 15% % % % 82% 16% 64% Cardiologists 64% Radiologists 82% Nuclear physicians 4% Other 16% Facilities experiencing cardiac CT angiography privileging disputes 56% 44% 44% 56% > continued on p. 5

5 vember 2006 Benchmarking report Page 5 Survey < continued from p. 4 Who performs official cardiac CT angiography interpretation Facilities that require physicians to have CT angiography privileges 12% 22% 24% Radiologists only 24% Cardiologists only Dual read 24% Split read 14% 8% 92% 8% 4% 14% 24% Alternating official read 4% Have not yet determined 22% 92% Other 12% Facilities that require physicians to participate in special training Number of cardiac CT angiography procedures for competency volume required 51% 16% 84% 84% 16% 7% 51% 5 9 2% % % 2% Facility that have created a multidisciplinary cardiac CT team 65% 35% 35% 65% > continued on p. 6

6 Page 6 Benchmarking report vember 2006 Survey < continued from p. 5 III. Number of physicians on the active medical staff at your hospital: To begin, 18% of hospitals surveyed have physicians on the active medical staff, 14% have , have , 15% have , 8% have , and 25% have more than 500 physicians. Radiologists are the most likely to hold privileges for cardiac CT angiography at hospitals with, , and more than 500 physicians on medical staff, whereas cardiologists take the lead at hospitals with physicians. Moreover, cardiologists hold privileges at more than 87.5% of hospitals with physicians on staff. Hospitals with doctors are the most likely (14.3%) to privilege nuclear physicians. The largest percentage of hospitals (7) that experience privileging disputes falls in the physician range; the smallest percentage () falls in the range. For cardiac CT interpretation, most facilities no matter how large their medical staff rely on radiologists to perform the official interpretation of a cardiac CT scan. However, 33% of hospitals with medical staff say that they do a split read, and 37.5% of hospitals with medical staff say that they do a dual read. Significant percentages across the board say 1. Which of the following specialties are granted privileges at your hospital for cardiac CT angiography interpretation? Cardiologists Radiologists Nuclear physicians Other Number of physicians > continued on p. 7

7 vember 2006 Benchmarking report Page 7 Survey < continued from p. 6 they have yet to determine which specialty performs the official read. Moreover, almost all hospitals, no matter how many physicians are on staff, require physicians to have documented privileges before he or she performs cardiac CT angiography. In addition, a majority of facilities of all medical staff sizes require physicians to document that they have participated in a special training/education program. In terms of the number of cardiac CT angiography procedures that a physician must have performed in the past 12 months for competency, a large percentage of hospitals in all ranges do not require physicians to perform a specific volume to be granted privileges. Hospitals in the (14.3%) staff size range are most likely to require five to nine procedures, whereas the largest percentage of facilities to require and procedures falls in the range. According to the survey, hospitals with active medical staffs of and more than 500 physicians are most likely to receive privileges for surgeons who perform more than 50 cardiac CT angiography procedures. Thirty-five percent of all facilities, no matter the number of physicians on staff, say they have created multidisciplinary committees related to cardiac CT angiography. 2. Have your medical staff experienced privileging disputes regarding which specialties should be granted privileges for cardiac CT interpretation? Number of physicians > continued on p. 8

8 Page 8 Benchmarking report vember 2006 Survey < continued from p In terms of cardiac CT interpretation, how does your facility determine who does the official read? Radiologists only Cardiologists only Dual read Split read Alternating official read Have not yet determined Other Number of physicians 4. Does your hospital require physicians to have documented privileges at the facility before they can interpret cardiac CT angiograms? Number of physicians > continued on p. 9

9 vember 2006 Benchmarking report Page 9 Survey < continued from p To be granted privileges for cardiac CT angiogram interpretation at your facility, must physicians document that they have participated in special education/training? Number of physicians 6. To be granted the privilege for cardiac CT angiography interpretation at your facility, how many procedures must a physician have performed in the past 12 months for competency? 10 8 specific required More than Number of physicians > continued on p. 10

10 Page 10 Benchmarking report vember 2006 Survey < continued from p Has your facility created a multidisciplinary team related to cardiac CT interpretation? Number of physicians > continued on p. 11

11 vember 2006 Benchmarking report Page 11 Survey < continued from p. 10 IV. Number of cardiac CT angiography procedures performed per year at your hospital (by all physicians privileged at your location collectively): To begin, 35% of hospitals surveyed perform fewer than 25 procedures per year, 18% perform 26 50, 11% perform 51 75, 11% perform , and 25% perform more than 100 procedures. Radiologists and cardiologists are the most likely to hold privileges for cardiac CT angiography regardless of the number of cardiac CT angiography procedures performed at the facility. Hospitals that perform procedures per year are the most likely () to grant privileges to nuclear physicians. The largest percentage of hospitals (6) to say that they have experienced privileging disputes falls in the procedures per year range and the smallest percentage () in the range. For cardiac CT interpretation, most facilities () in the procedure range rely on radiologists to perform the official interpretation of a cardiac CT scan. The largest percentage of hospitals that say they do split reads perform less than 50 or more than 100 procedures per year, whereas hospitals that perform between 76 and 100 cardiac CT procedures annually are the most likely to perform dual reads. Significant percentages across the 1. Which of the following specialties are granted privileges at your hospital for cardiac CT angiography interpretation? Cardiologists Radiologists Nuclear physicians Other Less than Number of cardiac CT angiography procedures performed > continued on p. 12

12 Page 12 Benchmarking report vember 2006 Survey < continued from p. 11 board say they have yet to determine which specialty will do the official read. Moreover, a majority of facilities no matter how many cardiac CT angiography procedures they perform annually require physicians to have documented privileges before they perform cardiac CT angiography. In addition, almost all hospitals require physicians to document that they have participated in a special training/education program. In terms of the number of cardiac CT angiography procedures that a physician must perform annually for competency, a large percentage of hospitals do not require physicians to perform a specific volume to hold privileges. Twenty-five percent of facilities that perform less than 25 and cardiac CT procedures per year require a physician to perform procedures in order to hold privileges. Thirty-five percent of all facilities, no matter the number of physicians on staff, say they have created multidisciplinary committees related to cardiac CT angiography. 2. Have your medical staff experienced privileging disputes regarding which specialties should be granted privileges for cardiac CT interpretation? Less than Number of cardiac CT angiography procedures performed > continued on p. 13

13 vember 2006 Benchmarking report Page 13 Survey < continued from p In terms of cardiac CT interpretation, how does your facility determine who does the official read? 35% 3 25% Radiologists only Cardiologists only Dual read Split read Alternating official read Have not yet determined Other 15% 1 5% Less than Number of cardiac CT angiography procedures performed 4. Does your hospital require physicians to have documented privileges at the facility before they can interpret cardiac CT angiograms? Less than Number of cardiac CT angiography procedures performed > continued on p. 14

14 Page 14 Benchmarking report vember 2006 Survey < continued from p To be granted privileges for cardiac CT angiogram interpretation at your facility, must physicians document that they have participated in special education/training? Less than Number of cardiac CT angiography procedures performed 6. To be granted the privilege for cardiac CT angiography interpretation at your facility, how many procedures must a physician have performed in the past 12 months for competency? specific required More than Less than Number of cardiac CT angiography procedures performed > continued on p. 15

15 vember 2006 Benchmarking report Page 15 Survey < continued from p Has your facility created a multidisciplinary team related to cardiac CT interpretation? Less than Number of cardiac CT angiography procedures performed > continued on p. 16

16 Page 16 Benchmarking report vember 2006 Survey < continued from p. 15 V. Number of beds at your hospital: Fifteen percent of hospitals surveyed have beds, 17% have , 8% have , and 6 have more than 200 beds. Radiologists and cardiologists are the most likely to hold privileges for cardiac CT angiography no matter the number of beds at the facility. Hospitals with more than 200 beds are the most likely (7%) to grant privileges to nuclear physicians. The largest percentage of hospitals (62.5%) that have experienced privileging disputes falls in the bed-size range and the smallest percentage (44.4%) at hospitals with more than 200 beds. For cardiac CT interpretation, most facilities, no matter the number of beds, still rely on radiologists and cardiologists to perform the official interpretation of a cardiac CT scan. The largest percentage of hospitals (49%) that perform dual reads falls in the bed range, whereas the largest percentage of hospitals (25%) that do split reads are in the bed-size range. Meanwhile, a significant number of respondents say 1. Which of the following specialties are granted privileges at your hospital for cardiac CT angiography interpretation? Cardiologists Radiologists Nuclear physicians Other Number of beds > continued on p. 17

17 vember 2006 Benchmarking report Page 17 Survey < continued from p. 16 they have yet to determine which specialty will do the official read. Moreover, a majority of facilities, no matter how many beds, require physicians to have documented privileges before they perform cardiac CT angiography. In addition, the majority of hospitals of all bed sizes require physicians to document that they have participated in a special training/education program. In terms of the number of cardiac CT angiography procedures a physician must have performed in the past 12 months for competency, a large percentage of hospitals in all bed-size ranges do not require physicians to perform a specific volume to hold privileges. The largest percentage of facilities to require procedures to hold privileges is in the and more-than- 200 bed-size range. Thirty-five percent of all facilities, no matter the number of physicians on staff, say they have created multidisciplinary committees related to cardiac CT angiography. 2. Have your medical staff experienced privileging disputes regarding which specialties should be granted privileges for cardiac CT interpretation? Number of beds > continued on p. 18

18 Page 18 Benchmarking report vember 2006 Survey < continued from p In terms of cardiac CT interpretation, how does your facility determine who does the official read? 5 3 Radiologists only Cardiologists only Dual read Split read Alternating official read Have not yet determined Other Number of beds 4. Does your hospital require physicians to have documented privileges at the facility before they can interpret cardiac CT angiograms? Number of beds > continued on p. 19

19 vember 2006 Benchmarking report Page 19 Survey < continued from p In order to be granted privileges for cardiac CT angiogram interpretation at your facility, must physicians document that they have participated in special education/training? Number of beds 6. In order to be granted the privilege for cardiac CT angiography interpretation at your facility, how many procedures must a physician have performed in the past 12 months for competency? volume required More than Number of beds > continued on p. 20

20 Page 20 Benchmarking report vember 2006 Survey < continued from p Has your facility created a multidisciplinary team related to cardiac CT interpretation? Number of beds 11/06 BR0306 CRC Platinum Privilege Benchmarking Report Group Publisher: Bob Croce, bcroce@hcpro.com Managing Editor: Margot Suydam, msuydam@hcpro.com The information contained in this document is general. It has been designed and is intended for use by hospitals and their credentials committees in developing their own local approaches and policies for various credentialing and privileging issues. This information, including the materials, opinions, and research/data set forth herein, should not be adopted for use without careful consideration, discussion, additional research by physicians and counsel in local settings, and adaptation to local needs. The Credentialing Resource Center does not provide legal or clinical advice; for such advice, the counsel of competent individuals in these fields must be obtained. Reproduction in any form outside the recipient s institution is forbidden without prior written permission. Copyright 2006 HCPro, Inc., Marblehead, MA

CLINICAL PRIVILEGE WHITE PAPER

Vascular Procedure ultrasound 57 Procedure 57 CLINICAL PRIVILEGE WHITE PAPER Vascular ultrasound Background Vascular ultrasound is a noninvasive procedure used to diagnose and locate disorders of the vascular