Types of Clinical Privileges in Healthcare

Clinical privileges define the scope of practice for individual practitioners within a healthcare organization. Understanding the types of privileges and the processes for granting, monitoring, and modifying them is fundamental knowledge for CPHQ candidates and quality professionals involved in credentialing and privileging.

Core Privileges

Core privileges (sometimes called general privileges) represent the fundamental procedures and patient care activities that a practitioner in a given specialty is expected to be competent to perform. They are typically defined by specialty and are based on training, certification, and demonstrated competence. For example, core privileges for a general internist would include history and physical examination, management of common medical conditions, and interpretation of standard diagnostic tests. Core privilege delineation should reflect the organization's scope of services and be developed with input from the relevant specialty departments.

Special or Specific Privileges

Special privileges (also called specific or additional privileges) cover procedures or activities that require training or experience beyond the core privilege set. These are requested separately and require additional documentation of competence. Examples include laparoscopic surgery for a general surgeon, conscious sedation for a non-anesthesiologist, or cardiac catheterization for a cardiologist. The criteria for granting special privileges typically include specific training requirements, case volume thresholds, and proctoring or supervision requirements.

Temporary Privileges

Temporary privileges may be granted in specific circumstances. Emergency temporary privileges allow a practitioner to provide care during an emergency when the normal privileging process cannot be completed. Temporary privileges for specific patient care needs may be granted to a visiting specialist who has a unique skill not available on the current medical staff. Temporary privileges pending full application review may be granted to a new applicant whose application is complete but pending committee and board action. The Joint Commission requires that temporary privileges be granted only after verification of current licensure and that they have a defined time limit.

Disaster or Emergency Privileges

During declared disasters or emergencies, organizations may grant disaster privileges to volunteer practitioners who are not members of the medical staff. These privileges allow volunteers to provide care when the organization's resources are overwhelmed. CMS and the Joint Commission have specific requirements for disaster privileging, including identification verification, oversight of volunteer practitioners, and a process for terminating disaster privileges when the emergency ends.

Monitoring and Evaluation

Once privileges are granted, organizations must monitor practitioner performance through Ongoing Professional Practice Evaluation (OPPE) and Focused Professional Practice Evaluation (FPPE). OPPE involves routine monitoring of all practitioners using data such as clinical outcomes, complications, patient complaints, and peer evaluations. FPPE is triggered by specific concerns (such as a pattern of complications) or when a new privilege is granted (to confirm competence in the new area). Both OPPE and FPPE data inform reappointment decisions. Quality professionals often play a central role in collecting, analyzing, and presenting this data to medical staff leadership.