This is the last day to participate in our 2014 MSP Salary Survey. We’ve gotten a terrific response, and have heard from all 50 states and five countries, but we’d welcome your input in our snapshot of the MSP salary/location/task terrain in 2014. Click here, or copy this into URL https://www.surveymonkey.com/s/2014mspsurvey into your browser. Thanks for your input!
I’ve been looking for a memorable quote about the value of a broad data sample, and what a survey can show. However, the two that resonate most for me are reminders that data alone can’t tell an entire story:
“We are drowning in information but starved for knowledge.”
“Intuition becomes increasingly valuable in the new information society precisely because there is so much data.”
—John Naisbitt, author
Look for our Salary Survey results in the next issue of CRCJ.
Thanks for reading!
The newest issue of Credentialing Resource Center Journal is here! Read about the new Healthcare Facilities Accreditation Program (HFAP) standards for OPPE and FPPE in acute care and critical access hospitals. Most facilities conduct competence assessment and peer evaluation in one form or another. Now, however, HFPA-accredited facilities must implement structured ongoing and focused processes for assessing physician competence.
Also in this issue, Steven Miller, MD, MPH; and Elizabeth “Libby” Snelson, JD, answer questions concerning legal and clinical considerations for late practice physicians; and Guenther Baerje describes what happens when a medical staff has a health center, loses it during a disaster, and then gets it back again—a sense of devotion he calls the “Northridge Effect.”
Many readers had a familiar credentialing question to the 2013 MSP Survey Salary: “Can you be more specific?” We tried in the 2014 edition, and I asked CRCJ readers to take the retooled, sharpened MSP Salary Survey and enter to win a credentialing best-seller from the HCPro book roster. There’s still time, but don’t delay—April 18 is the final day for input.
Best regards and thanks for reading!
The MSP Salary Survey is still open, so these results may shift, but a clearer salary picture is emerging as MSPs weigh in. Early unofficial tabulation shows California has more MSPs making more than $100,000 than any other state by a margin of more than two to one. So far, 29% of California respondents say their salaries are north of $100K. Texas put 10% of respondents in that bracket, and New Jersey respondents round out the top of the top, at 8%.
The maximum response was raised from last year’s upper limit of $70,000 as we sought some sharper details in this question. However, if you don’t fall into the top compensation category (yet), you’re not alone. The top earners comprise only 7% of survey participants. Also, in Wisconsin, which boasts one of the top participation rates, no MSP among its 43 survey respondents reports making that much.
(By the way, we’ve heard from MSPs in several countries and in every U.S. state except Alaska.)
Check this space for more details, and watch for the complete survey story in a future issue of CRCJ. And as always, thanks for reading!
Well, maybe next year. It appears the government has decided to delay the implementation of ICD-10 until “at least” October 2015. For some this is great news and to others, an amazing disappointment. As stated in Health Management Technology, “It has been estimated that another one-year delay of ICD-10 would likely cost the industry an additional $1 billion to $6.6 billion on top of the already incurred costs from the previous one-year delay. This does not include the lost opportunity costs of failing to move to a more effective code set.”
A little history: ICD-10 was endorsed by the Forty-Third World Health Assembly in May 1990 and came into use in 1994. The 11th revision of the classification has already started and will continue until 2017. ICD-10 is available in the six official languages of the World Health Organization (Arabic, Chinese, English, French, Russian, and Spanish) as well as in 36 other languages. More than 100 countries are currently using ICD-10, including the vast majority of industrialized countries. But most likely, these are the countries that are using the metric system, so we shouldn’t judge too hastily.
In the end, the ICD-10 codes will be a benefit to physicians, patients, and everyone who works to promote quality healthcare around the country and the world. The codes are much more specific than their previous counterparts and as you know, the number of diagnostic codes has almost quadrupled. This will allow the healthcare industry to understand more clearly the nature of patients’ illness and determine the cost of treatment. While making the transition will take time, money, and additional resources, the long-term benefits are significant. So the current plan is to take more time and spend more money.
With luck, we can implement ICD-10 just in time to implement ICD-11. Since ICD-9 was adopted in 1979, who knows? We may get 40 to 50 years out of that coding set before a change is made. Luckily, there hasn’t been much change in healthcare over the past 35 years. But for now, back to life as usual with our good friend, ICD-9.
Forget the eagle as our national bird—I’m voting for the ostrich.
Editor’s note: The following post is by Rosemary Dragon, CPCS, CPMSM, medical staff coordinator at St Anthony Hospital/Ortho Colorado Hospital in Lakewood, Colo. It first appeared in the April issue of Credentialing Resource Center Journal in the “MSP’s Voice” column. Enjoy!
April 1, 2017-After 10 years of OPPE and FPPE, The Joint Commission released a press release announcing that the whole professional practice evaluation program was actually a study in the sheer willpower of MSPs. The notification came after a confidential email had been leaked to the press regarding the true intent of the standards.
The Office for Human Research Protections and the FDA are currently investigating The Joint Commission because the study had not met human subject research requirements. The Joint Commission had not submitted the study through an institutional review board, had not provided informed consent to the participants, and didn’t give participants the right to withdraw from the study.
Anonymous sources at the OIG have labeled the punishment inflicted by The Joint Commission through OPPE and FPPE as “draconian.” The commission has officially rescinded the standard, which will be replaced with Peer-Optimized Occupational Probe.
Responses to the announcement have varied widely. Linda Rending, CPMSM, began tearing her OPPE and FPPE policies to shreds when she heard the announcement. “While it in no way makes up for the torture I’ve endured trying to get OPPE on low-volume practitioners, the sound of the policies ripping brought me unparalleled joy,” she said.
Jennifer Ash, CPCS, was indignant. “Within the first two years of OPPE and FPPE, my hair had gone from a lovely raven black to salt-and-pepper. Now, my hair is completely gray. I want to know what TJC’s plans are for reimbursing me for all the money I’ve had to fork over to my colorist over the years.” She has hired an attorney and will be filing a lawsuit to recover pain and suffering damages later this week.
Julie DeNial, CPMSM, CPCS, chided her fellow MSPs when she learned that they planned to deviate from their OPPE and FPPE policies. “I began my career as an MSP when these standards were rolled out. This is the way I’ve always done things, and no fabricated news story is going to change my process! How would I fill my nights and weekends if I wasn’t working overtime to complete my FPPE and OPPE?”
Actor and director Ron Howard has been approached about directing a gritty and hard-hitting documentary on The Joint Commission’s deplorable tactics. The film’s working title is OPPE, It’s Not Exactly the Andy Griffith Show, Now Is It? When asked whether he would consider the project, Howard said it was highly unlikely.
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April Fools aside, are your OPPE and FPPE policies bringing meaningful information about your providers to your medical staff leadership? If not, it may be time to consider tapping into the resources around you and revamping these programs. The purpose of your facility’s professional practice evaluation shouldn’t be merely to meet a standard, but to ensure quality care. Ask your fellow MSPs what they’re doing to create a meaningful program. Check out the publications and educational offerings that are available from HCPro, NAMSS, and your state association.
While the standards may feel draconian at first glance, many of your colleagues have worked with their medical staff leadership to develop programs that not only positively impact patient care, but also are not oppressive or burdensome to the MSP. OPPE and FPPE do not have to turn your hair gray or fill your nights and weekends.
Our very early MSP Salary Survey results may speak to the stability of the field as a career choice, the changes it’s undergone in the past two decades, or an increasing volume of work. Maybe all three … maybe none of these. We’ve had great responses so far, and plenty of them, but results will change as more people take the survey. I’m looking forward to analyzing what’s behind the final numbers, but there’s still time to take the MSP Salary Survey. You can click here to access it, or connect by copying this URL into your browser: https://www.surveymonkey.com/s/2014mspsurvey. In the meantime, here are some of the early results:
- In what is currently a statistical dead heat, roughly 20% say their department credentials 101-200 practitioners; another 20% pin the number at 201-400. So far, the highest response—closer to 21%—say their department credentials more than 1,000 practitioners.
- 41% of respondents say their department reports to the chief medical officer/vice president of medical affairs.
- Among those who oversee other departments or services, close to 50% oversee continuing medical education.
- More than a third of early respondents report their organization has only one full-time MSP.
- 27% of respondents have five to 10 years in their current position, and 22% have been on the job for more than two to just less than five years. Sixteen percent have held their current job for 11 to 15 years.
- 39% have been in the medical services field for more than 20 years; 20% reported five to 10 years in the field. Another 17% have been in the field for 16 to 20 years.
As always, thanks for reading!
Yes, it’s that time of year… Taxes, March Madness, and once again, the MSP Salary Survey! We at the Credentialing Resource Center want to know how the financial field is for MSPs in 2014. Please take a few moments to complete our updated salary survey. You’ll see some new questions and more answer options as well. It’s all part of our efforts to make this survey as complete and relevant as possible.
I hope you’ll add your input to this effort. We’ll put the results in a future issue of Credentialing Resource Center Journal.
In return for taking part in this survey, we will enter your name into a drawing to win Resolve Practitioner Turf Conflicts: Medical Staff, AHP, and Offsite Disputes, by Jack Cox, MD, MMM, Rosemary Dragon, CPMSM, CPCS, and Christine Hearst, CPMSM; OR The Medical Staff’s Guide to Overcoming Competence Assessment Challenges, by Sally Pelletier, CPMSM, CPCS, Carol Cairns, CPMSM, CPCS, Anne Roberts, CPMSM, CPCS, and Frances Ponsioen, CPMSM, CPCS. Note that your name will not be connected with the information you provide in the survey.
Please click here or enter this URL into the address bar of your browser to connect to our survey: https://www.surveymonkey.com/s/2014mspsurvey. I appreciate your time, and look forward to gaining more insight into the current state of the medical staff services profession.
Appropriate disclosure is essential to ensure that medical staffs that are granting clinical privileges to practitioners have sufficient information to make informed decisions. Following is the third installment of my three-part blog series on proper disclosure and sharing of information.
What to disclose and when
It is important for MSSDs to work in close collaboration with their legal departments to determine what information they will disclose and when. For the most part, organizations only disclose formal corrective action taken by the MEC; however, how your organization defines formal corrective action may vary, so you should ensure that legal counsel weighs in. Some organizations may choose to be more liberal and disclose any disciplinary action that is taken, even if it is not considered formal corrective action taken by the MEC; rather action taken by the department chair.
I highly recommend challenging the legal team and the credentials committee members at your institution (who should also be involved in this discussion) with this question: “What would we want another organization to disclose to us?” This is a great way to determine what you will disclose to other organizations upon receipt of a request and appropriate third-party release form.
General verification letters and online queries
Responding to affiliation verification requests can be burdensome for MSSDs who have a large medical staff. However, it is important to remember the significance of these verifications and the liability that your organization may face if appropriate disclosure is not made. For most organizations, the number of providers who have had corrective action that warrants disclosure is small. Keeping a running ‘reportable actions list’ of those who have action that fits your hospitals criteria for disclosure and ensuring that the MSPs who respond to the verification requests are aware of which providers are on the reportable actions list, is essential to protecting the organization from potential liability for failing to disclose pertinent information to other entities.
As a general rule of thumb, if a verification letter comes in regarding someone on the reportable actions list, it is best to limit who can respond to such requests to either the legal team or the department director, to ensure appropriate and consistent disclosures.
A general affiliation verification letter is fine for the practitioners who are not on your reportable actions list. If a general affiliation letter is used, however, it should indicate that the practitioner is not only in good standing, but that there have not been any quality or behavioral concerns that have risen to the level of corrective action. If an MSP receives a verification that does not confirm that there have been no quality issues or corrective action against the practitioner, the MSP should follow up with the third party and obtain further confirmation/clarification. Failure to receive a sufficient response from the third party may lead to the organization determining that the application is incomplete and the burden to obtain the sufficient information is on the applicant.
Many organizations are implementing online verifications, which make the verification process more efficient. However, a process must still be in place to identify providers who are on the reportable actions list—and for whom you shouldn’t be issuing a general form letter. There should be a trigger in the database that will flag a provider who is on the reportable actions list to ensure that the general verification letter is not available online—instead, there should be a message that indicates that a written request is required for that practitioner, along with a third-party release form.
As disclosure issues continue to arise, MSPs and medical staff leaders must be aware of the importance behind not only ensuring that all pertinent information is received during the credentialing process, but also that they themselves are disclosing relevant information to other entities. I always recommend conferring with legal counsel whenever there is a question regarding what to disclose. Be good stewards and remember: What would you want to know?
This week and next, HCPro will offer resources that can help you meet current and future medical staff challenges. First, tune into Practicing Medicine Longer: Legal and Clinical Considerations for an Aging Physician Population on Tuesday, March 11, from 1:00 to 2:30 p.m. Eastern. Speakers Stephen H. Miller, MD, MPH, and Elizabeth “Libby” Snelson, JD, tackle the cultural, clinical, and legal considerations that medical staffs must address to help physicians who want to stay in practice longer.
This program has been approved by the National Association Medical Staff Services for 1.5 continuing education units. You can find more information about the webcast here.
Next Tuesday, March 18, from noon to 1:00 p.m. Eastern, Marla Smith, MHSA, will offer a free demo of HCPro’s Physician Profile Reporter. Log in to find out how Physician Profile Reporter can help you compile all sources of relevant data to produce a single, reliable performance report for a low price. The webcast will explore indicator types—review, rule, and rate-based definitions; acceptable and excellence targets; and regulatory vs. optional physician profile information.
I hope you’ll join us for either or both of these Tuesday events. And as always, thanks for reading!
Appropriate disclosure is essential to ensure that medical staffs have sufficient information to make informed decisions when granting clinical privileges to practitioners. Following is the second of my three-part blog series on proper disclosure and sharing of information.
Steps to ensure appropriate disclosure during credentialing
MSPs can play a direct role in keeping patients safe from practitioners with known competency issues in a number of ways, from making sure their bylaws require specific disclosure from practitioners, to thoroughly reviewing credentialing information from practitioners applying for membership and/or privileges. MSPs must also follow up when other entities, evaluators, or peer references do not provide complete information, or when the information provided is vague or raises additional questions or concerns.
Step 1. Ensure that the questions on your credentialing application are thorough. It is important that you ask the practitioner the right questions to ensure that all possible scenarios are covered for which he or she would be required to disclose information to your organization during the credentialing process.
You must also ensure that your attestation form (as well as your bylaws) indicates what the practitioner must disclose to you, and within what time frame, whenever something occurs after he or she has signed the application. For example, you would want to the practitioner to attest that, if any pertinent information on the application changes (including but not limited to licensure complaints, changes to affiliations, sanctions, etc.) he or she is required to notify you within a specified number of days.
Step 2. Ensure that the third-party release form (which should be a part of your credentialing application) is worded appropriately to allow the other entity or individual to disclose all pertinent information without the fear of retribution. A third-party release form should indicate that the practitioner who signs it grants permission and waives liability against all parties who release any information relevant to his or her credentialing and/or competence, so long as the information is provided in good faith.
Entities that are responding to inquiries should not provide detailed information without first receiving such release signed by the practitioner.
Step 3. Ensure that your competency verification forms or affiliation verification forms ask the right questions as well. If your verification request does not ask the right questions, you may not get full disclosure. For example, if you ask whether action has been taken ‘within the past two years’, the answer may be no; however, perhaps action was taken more than two years ago and the entity did not disclose it previously because it was not the policy at the time to disclose specific information.
Another example would be if you ask a clinical evaluator or peer reference if they are aware of any disciplinary action that “may impact his or her ability to exercise the requested privileges”—the answer may be no. However, these provider may be aware of disciplinary action that was taken, but they are not disclosing it to you because they do not feel that it would impact the applicant’s ability to exercise the requested privileges. Instead, you should ask questions that are open and applicable to any situation and are not limited.
In Part 3, we’ll explore the essential questions of information sharing: What should we disclose? And when?