Coping with economic credentialing.(GUEST EDITORIAL)

In communities all over the country, hospitals and hospital systems have taken strong defensive (or, from the physicians' perspective, offensive) actions to counter the conflicts of interest and economic threats posed by the physician owners of specialty providers.

Hospitals believe that these measures are justified because failure to respond to the unfair competition of physician-owned specialty providers will ultimately hinder hospitals' abilities to meet their charitable and other institutional obligations.

These countermeasures reportedly include aggressive use of the certificate of need process, refusal to cooperate with single-specialty hospitals, adverse publicity campaigns, and aggressive lobbying at the state and federal level.

With increasing frequency, hospitals also have responded by refusing to credential physicians with conflicts of interest who compete against them through the for-profit specialty providers in which they are shareholders.

This last tactic, commonly referred to as "economic credentialing," has significantly raised tensions between hospitals and physician-owners in the communities in which it has occurred.

Debates about the merits of economic credentialing are often confused by a lack of clear-cut definitions. Physicians generally refer to economic credentialing as the exclusion of physicians from the medical staff based on criteria unrelated to the physicians' qualifications and in consideration of some economic factor.

Such actions may include the following: