Credentialing and Medical Staff Privileging

The ACNM Department of Professional Practice & Health Policy frequently receives member requests for assistance with securing credentialing and medical staff privileging. Midwives who are not credentialed and do not have medical staff privileges are often required to admit clients under a physician colleague's name and to have the physician co-sign client history and physical examination documentation.This limitation may impact liability and designated responsibility.

The following is a suggested general approach. Please use as appropriate to your practice.

• Review federal regulations and state statutes as they apply to midwifery.

• Plan your goals in line with the current law or investigate legislative changes.
• Engage the appropriate stakeholders, such as: medical director, medical staffing director, chair of OB/GYN department, and your physician consultants.
• Prepare and present a proposal to the Credentialing Committee.
• Include all pertinent documentation (see listed resources below).
• Request credentialing as full members of medical staff or as allied health professionals with admitting and discharging privileges.
  

Below is a list of resources prepared by Barbara Hughes, CNM, MS, FACNM, and presented at the 2008 ACNM Annual Meeting. It includes a number of resources that are useful to presenting an application for credentialing and medical staff privileging.

Background Information about CNMs/CMs

• Definition of Midwifery and Scope of Practice of CNMs/CMs
  
• Independent Midwifery Practice
• Core Competencies for Basic Midwifery Practice
• Standards for the Practice of Midwifery
• Expansion of Midwifery Practice and Skills Beyond Basic Core Competencies
  

CNMs/CMs and Physician Relationships

• Joint Statement of Practice Relations Between OB/GYNs and CNMs/CMs
• Collaborative Management in Midwifery Practice for Medical, Gynecologic and Obstetric Conditions
• Collaborative Agreement between Physicians and CNMs/CMs (if required in your state)
  

Credentialing CNMs/CMs

• Principles for Credentialing and Privileging CNMs and CMs
• Credentialing CNMs and CMs article

Other Resources

• Centers for Medicare and Medicaid Services
• The Joint Commission Hospital Accreditation Standards - This publication is available electronically or in print from Joint Commission Resources.
  
  

The following are examples* to assist you during your credentialing process.

• CNMs at St. Anthony Central Hospital
• CNMs at St. Anthony Central Hospital Clinical Practice Guidelines
• St. Anthony Central Hospital Credentialing Process
  
  

*Note: ACNM is not suggesting that this sample document from an individual Colorado institution represents a nationwide model to which CNMs and CMs should aspire. It is important to bear in mind when negotiating regarding privileges, that local practice and state law parameters may be more constraining than would be ideal, though progress on each front can still be made.

Guidance from Charting A Course for the 21st Century: The Future of Midwifery, a joint report from the Pew Health Professions Commission and the University of California, San Francisco Center for the Health Professions (1999), is also instructive:

• "Health care systems should develop hospital privileging and credentialing mechanisms for midwives that are consistent with the profession's standards, recognize midwifery as distinct from other health care professions, and recognize established processes that permit midwives to build upon their entry-level competencies within their statutory scope of practice." (Executive summary recommendations on Regulation and Credentialing, p. iii)
  
  
• "At all points during the career of a health care professional, practice responsibilities should be in accord with education, training, background, experience and competence." (p. 22)

For further information, please contact the Department of Professional Practice & Health Policy via email or at 240-485-1842.