​Statement on Economic Credentialing and Contracting

Developed By: Committee on Quality Management and Departmental Administration
Last Amended: October 23, 2024 (Original Approval: October 15, 2003)

The American Society of Anesthesiologists (ASA) opposes the practice known as “economic credentialing,” by which decisions related to granting and renewing medical staff membership and privileges are based on economic considerations instead of clinical qualifications. The ASA believes that the granting, renewal, and termination of medical staff membership and privileges should only be based upon quality of professional care considerations and should occur pursuant to procedures set forth in the medical staff bylaws.

Examples of economic credentialing may include the conditioning of medical staff membership and privileges on: 1) the making of direct or indirect payments to the hospital, facility, or their agents in amounts that exceed the fair market value of facilities or services provided to medical staff members; 2) the requirement that members of a particular department of the medical staff accept less than fair market value for the provision of care to patients in the hospital or facility; 3) the requirement not to provide professional services or hold an ownership interest in a competing hospital, facility, or organization; 4) the requirement for medical staff to mandatorily participate in network affiliations with health plans or governmental payors without fair market compensation; or 5) the requirement of charging a separate fee for credentialing at each individual facility within a health system that has multiple facilities, even when the system utilizes a standardized credentialing process. Such duplicative fees create an undue financial barrier, representing costs that significantly exceed the fair market value.

Furthermore, the Office of the Inspector General has indicated that agreements between hospitals and physicians requiring the performance of uncompensated or under-compensated services may violate federal anti-kickback laws. Physicians are encouraged to consult their legal counsel before responding to proposals for such arrangements.

The Society asserts: 

Anesthesiologists should not, as a condition of being granted medical staff membership and privileges, be compelled to provide their services at less than fair market value, or to purchase goods or services at more than fair market value.

Quality of care issues involved in the credentialing and privileging process should be exclusively dealt with by the medical staff, and medical staff membership and privileges should be granted, renewed, or terminated only upon the recommendation of the medical staff.

Restrictions on the right to practice at or hold an ownership interest in a competing facility should not be a precondition for the granting of medical staff membership and privileges.

Contracts between anesthesia practices and facilities should explicitly describe any and all services required beyond routine anesthetic care, especially those for which no professional fees may be charged and assign fair market value to such services.