Platform / Privileging

Privileging starts in the bylaws, not in a form.

Your medical staff bylaws already name every clinical activity you grant and the criteria for each one. Bip reads that document and produces the delineation, instead of asking somebody to retype it.

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Medical staff bylawsRev. 2024 · PDF

Article VI
Delineation of clinical privileges

§ 1. Each applicant for appointment or reappointment to the Medical Staff shall request specific clinical privileges on the form approved by the Medical Executive Committee for the department in which membership is sought. Privileges shall be granted only for those activities in which the applicant has demonstrated current competence, and shall be exercised only at the facility to which they are granted.

§ 2. Core privileges. The core in Obstetrics and Gynecology comprises those procedures customary to the specialty, including antepartum and intrapartum management, cesarean delivery, and abdominal and vaginal hysterectomy. An applicant requesting the core shall hold current certification by the American Board of Obstetrics and Gynecology, or shall be within five years of completing an ACGME-accredited residency and actively pursuing certification.

§ 3. Special privileges. Procedures beyond the core, including operative vaginal delivery by forceps, fetal echocardiography and robotic-assisted laparoscopic surgery, shall be requested individually and supported by documentation of training and of not fewer than twenty (20) cases in the preceding twenty-four (24) months, together with five (5) proctored cases. Each grant shall be subject to a period of focused professional practice evaluation determined by the department chair.

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Facility Portal · Delineation matrixReading

Specialty scope · Obstetrics and Gynecology — MFMSource · Article VI, §§ 1–3

Reading Article VI…0 of 42 privileges

Left: the article as it arrives. Right: the same article as a delineation matrix, with each privilege carrying the criteria the text attached to it — the first seven rows of forty-two. Privileges and criteria shown are illustrative of the structure, not of any one facility’s bylaws.

Why there is no standard form

Bylaws are a document. Privileges are data.

No two of those documents agree. The same procedure is core at one hospital and special at the next, named differently in each, with different case minimums behind it.

There is no national delineation to map to, which is exactly why the work has stayed manual.

Facility	What the bylaws call it	What it takes to hold it
Community hospital, 180 beds	“Cesarean section — primary and repeat”	Inside the OB/GYN core. No separate case minimum.
Academic medical center	“Cesarean delivery”	Inside the core, with FPPE on the first cases performed.
Critical access hospital	“Operative obstetrics”	A special privilege. Case minimum plus proctoring.

One procedure, three bylaws. Composite, drawn from the shapes these documents take — the divergence is the point, not the particular numbers.

How it works

Upload the article. Get the delineation.

Four steps, and the first one is the whole trick: the source of authority is the document, so that is what Bip reads.

01
Upload the bylaws
Article VI as it exists — the PDF the medical staff office already has, revision and all. There is no template to complete first, and no clean copy to prepare.
02
Read out the delineation
Bip parses the document into named privileges, core and special, with the eligibility criteria the text attaches to each one. What was prose becomes rows.
03
Map to the specialty
The matrix is scoped to the appointment in front of you, so a maternal-fetal medicine applicant sees the privileges that bear on their specialty rather than the whole book.
04
Attach the evidence
Each privilege draws on the credential file underneath it — board status, training, case volume, proctoring. Evidence attaches to the privilege it supports, never to one undifferentiated pile.

The bylaws stay the authority. Bip holds a structured reading of them that the medical staff office can correct, and that every appointment afterwards starts from.

What makes it a matrix

Eligibility is not a checkbox.

A privilege is not granted because a provider is qualified in general. It is granted because they meet the criteria the bylaws set for that privilege, and those criteria differ from one row to the next.

Bip keeps the criteria on the privilege. They are part of the row, the evidence points at the credential it comes from, and a privilege that is not yet supported says which criterion is missing rather than simply failing to be ticked.

Operative vaginal delivery — forcepsSpecial privilege

Board statusCertified · ABOGFrom the credential file
TrainingACGME residency, OB/GYNFrom education and training
Case volume20 cases / 24 monthsProvider attestation, on a date
Proctoring5 proctored casesDepartment chair sign-off
EvaluationFPPE from the date of grantScheduled when the privilege is granted

One row of the delineation, opened

Privileges attach to the facility relationship, not to the portable record.

The credential file travels with the provider. The privileges granted from it do not. A board certification means the same thing everywhere; permission to perform robotic-assisted laparoscopy at one hospital says nothing about the next, whose bylaws name the privilege differently and set different criteria behind it.

So Bip models privileges where they actually live — on the relationship between one provider and one facility.

It is the same reason a delineation form cannot be standardised across facilities. The record underneath it can be.

Through to the committee

Ready for the agenda, not assembled the week before it.

Committee review is the governance. It is not the delay, and Bip does not remove it — what changes is the state of the file when the meeting opens.

01 · Bip Sign

Delineation signed

The provider signs the privileges requested. Tamper-evident, with the signing trail written to the same event log as the rest of the file.

02 · From the file

Evidence attached

Every criterion points at the credential, document or attestation that satisfies it. Nothing is gathered a second time for the meeting.

03 · Not rebuilt

Packet assembled

The committee packet is generated from the file as it stands, so it reflects the record on the day it is produced.

04 · Normal cadence

Committee and MEC review

The credentials committee and the medical executive committee meet on the schedule the bylaws set. What changes is that the file is complete when they open it.

05 · Recorded

Board grants the privileges

The grant is written back to the provider’s file: which privileges, on what date, under what conditions, with any FPPE requirement attached to the privilege that carries it. Performance on the privileges held then feeds OPPE and the next reappointment. The committee’s vote and its minutes stay yours; Bip records the grant, it does not stand in for the decision.

A packet that is assembled continuously and one that is assembled the week before the meeting contain the same documents. Only one of them can be produced on a Tuesday.

Questions we get

Privileging, plainly.

How is privileging different from credentialing?

Credentialing verifies qualifications — that a license is current, a residency was completed, a board certification is real, that there are no exclusions or open actions. Privileging is the decision that follows: which specific clinical activities this provider may perform at this facility, drawn from the medical staff bylaws and granted by the governing board. A fully credentialed provider holds no privileges until they are granted. Two decisions, different bodies, in that order — and treating them as one word is how the second one ends up undocumented.

What is a delineation of privileges?

The list of named clinical activities a facility grants, with the eligibility criteria for each. Most are organised as a core — the procedures customary to a specialty, granted together — plus special privileges requested individually because they require particular training, case volume or proctoring.

Where do FPPE and OPPE fit?

FPPE is focused and time-limited: applied when a privilege is granted for the first time, or when a question about performance arises, and closed when the review period ends. OPPE is ongoing — performance on privileges already held, reviewed on a rolling basis and factored into reappointment. Many medical staffs settle on a six-month OPPE rhythm, though the interval is set in your own bylaws and should be read against your accreditor’s current standard. Bip carries an FPPE condition on the privilege that triggered it, so it surfaces when that privilege does rather than in a tracker beside the file.

Do privileges travel with the provider between facilities?

No, and that is the point. Privileges are organization-specific: granted by one governing board, under one set of bylaws, exercisable at that facility only. What travels is everything underneath — identity, licensure, training, board status, case history, attestations and the verification record. A second facility inherits that file rather than rebuilding it, then runs its own delineation against its own criteria. Anyone offering portable privileges is describing something a medical staff cannot accept.

How does this fit the reappointment cycle?

Hospital reappointment typically runs on a 24-month cycle — set in your own bylaws and by your accreditor, some of which permit a longer interval — and re-examines privileges as well as membership: what was granted, what was exercised, and what the performance record shows. When the file has stayed current between cycles, reappointment is a review rather than a rebuild. Temporary privileges stay what the bylaws make them — a limited, time-boxed grant for an important patient care need or a pending application, not a way around the cycle.

Send us one article of your bylaws.

We will read it back as a delineation matrix, criteria attached, and you can tell us what it got wrong.

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