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Fighting back: How to win the war against economic credentialing

Knowing the ins and outs of your hospital's rules and regulations can arm you for battle against the restriction of privileges for economic factors.

By Katherine Vogt, amednews staff. March 28, 2005.

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Carl Berasi, DO, and his colleagues knew they could be headed for trouble when they decided to build their own hospital near Columbus, Ohio.

The physicians had been negotiating with OhioHealth, a nonprofit hospital system, to create some sort of joint venture in orthopedic care. But Dr. Berasi said that after roughly two years, no agreement could be reached. So the orthopedic surgeon and nearly 30 other physicians decided to build their own musculoskeletal specialty hospital, the New Albany Surgical Hospital.

"They had made it very clear to us that if we attempted to do anything that competed with them, they would do everything they could to kick us off staff," he said.

In the end, many of those physicians did lose their privileges at OhioHealth's three Columbus-area hospitals. The system's board in July 2002 voted to kick out any physician who had invested in a competing facility, and at the time, OhioHealth representatives were explicit about saying the move was needed so it could protect itself again nonprofit competitors.

Some observers say the situation was a textbook example of economic credentialing, which is generally defined as hospitals granting privileges based on financial decisions instead of other qualifications. It also serves as an illustration of the different ways in which physicians can fight back in similar situations.

Experts say that although economic credentialing situations can be warded off by using the right prevention tactics, physicians should be aware of how hospital appeals procedures work and what legal action entails in case the occasion arises.