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ECFMG calls out a ‘certification’ organization

disclosureThe Educational Commission for Foreign Medical Graduates (ECFMG) is cautioning international medical graduates (IMGs) about organizations that represent themselves as having a role in certifying the qualifications of IMGs to enter U.S. residency and fellowship programs.

ECFMG issued a statement yesterday about the American Medical Residency Certification Board (AMRCB), which “professes to receive its educational authority from an entity named the New England Consortium on International Medical Education,” according to ECFMG.

“The AMRCB website states that it provides ‘certification’ for international medical schools and for international medical students and graduates, primarily through one-day seminars … AMRCB goes on to represent that although AMRCB certification is not currently mandated, it is expected to be ‘required of all international graduates in the future.’ To the contrary, AMRCB ‘certification’ has no official standing with the medical licensing authorities in the United States, nor is such a requirement being considered,” the ECFMG stated.

ECFMG certification is required for IMGs seeking to enter ACGME-accredited residency and fellowship programs in the U.S. ECFMG certification is also required before IMGs may apply for Step 3 of the United States Medical Licensing Examination. “No other certifications are currently required for IMGs’ eligibility to apply for residency and fellowship programs accredited by ACGME or for unrestricted medical licensure in the United States,” the statement reads.


Monday memo: Revisit privileging for ambulatory settings

TIPPhysician privileges have jumped from the medical staff services department to front-page news, as Becker’s ASC Review noted:

“An ear, nose and throat (ENT) specialist present in the New York City-based Yorkville Endoscopy operating room where Joan Rivers was undergoing an endoscopic procedure on her vocal cords did not have privileges to practice at that clinic, according to a report from The New York Times.”

The ENT physician examined Rivers both before and after the gastroenterologist performed an upper endoscopy, according to the report. Neither physician has been accused of wrongdoing by the New York State Department of Health.

National Public Radio subsequently aired a story that looked at privileging in outpatient surgical centers in general.

Although I usually prefer it when privileging stays out of the public eye, a higher degree of scrutiny might give more people outside the medical staff services department an inkling of why privileging and other MSP tasks are so important.

That’s my 2-cent tip for Monday. You can add yours here.

Thanks for reading!


‘Upcoding’ investigation snared physician and CEO

Medical-SymbolAre you looking for a short diversion from work? If so, consider the potential credentialing issues lurking in the following recent news story, in which fraud allegedly made house calls. There’s no test and no prize for the best answers.

According to the Chicago Division of the FBI, a physician and the CEO of Chicago-based Mobile Doctors, which manages physicians who make house calls in six states, were arrested late last month on federal healthcare fraud charges. Federal agents also executed search warrants at Mobile Doctors’ offices in Chicago, Detroit, and Indianapolis, along with warrants to seize more than $2.5 million in alleged fraud proceeds, the FBI reported.

The charges allege a scheme to fraudulently increase (also known as “upcoding”) Medicare bills for in-home patient visits that Mobile Doctors falsely claimed were longer and more complicated than they actually were. The charges also allege that Mobile Doctors’ physicians falsely certified that patients were confined to their homes, enabling home healthcare agencies to claim fees for additional services for patients who were not actually qualified to receive them.

The FBI and other law enforcement agencies executed the arrest, search, and seizure warrants in connection with the charges, as well as a broader ongoing investigation that includes allegedly illegal billing practices for medically unnecessary tests and services not performed by a physician, the FBI reported.

Thanks for reading!

Monday memo: Check out the newest issue of CRCJ

TIPThe newest issue of the Credentialing Resource Center Journal has been posted on the CRC website, and includes the first installment of our look at credentialing practitioners in hospital-owned clinics. This was the topic of a recent Credentialing Resource Center Insider Editor’s Note that generated a high level and variety of responses, despite hitting inboxes on a Friday in the middle of the summer. Thank you to all who have contributed insight or just curiosity to this challenge! This is a topic that will be revisited.

Another highlight in the new edition is Rosemary Dragon’s prescription for a successful pre-survey boot camp for physicians and medical staff leadership. (Don’t spare the chocolate.)

Thanks for reading!

Driving a ‘Compact’ for speedier physician licensing

The Federation of State Medical Boards (FSMB) has completed the drafting process for its model legislation to create an Interstate Medical Licensure Compact. State legislatures and medical boards can consider adopting the model legislation to establish a compact that would expedite the licensing process for physicians who wish to practice in multiple states.

The model establishes the location of the patient as the jurisdiction for oversight and patient protections. Participation in the compact would be voluntary for both states and physicians, and member states would maintain control “through a coordinated legislative and administrative process,” according to an FSMB press release.

The Interstate Medical Licensure Compact could significantly reduce barriers to the process of gaining licensure in multiple states, and would help facilitate licensure portability and telemedicine, particularly in underserved areas of the nation, the FSMB states.

You can see the Interstate Medical Licensure Compact model legislation here.

What do you think? Would an interstate medical compact expedite credentialing and privileging processes as well? You can let me know at

Thank you for reading!


Tune in on Thursday

admin01_11184880When CMS seems to want one thing and accreditors want something else, you need to cut through the confusion. Fortunately, there’s still time to join us for Verify and Comply: Meet Your Top Credentialing Challenges! Tune in on Thursday, September 4, from 1:00 to 2:30 p.m. Eastern Time for this 90-minute webcast. Carol S. Cairns, CPMSM, CPCS, will help clarify the differences among CMS and accreditors, and their expectations for medical staffs. In addition to specific requirements, best practices in credentials verification will be highlighted.

We will also identify and solve several common problematic credentialing standards that can plague your organization.

After this program, participants will be able to:

  • Describe credentialing best practices
  • Identify the similarities and differences among regulators and accreditors (including CMS, The Joint Commission, DNV, HFAP, and NCQA)
  • Differentiate current requirements from old medical staff standards language and “urban legends”
  • Clarify vague standards and unclear terminology
  • Know what must be done to ensure compliance, what is actually being done, and how to do it better

Click here to learn more about this webcast.


Take a break?

Beach picI thought about work while I was on vacation last week: I wondered, “When CRC readers get a break, what do they do?”

Our most recent MSP Salary Survey found that 50% of respondents handle credentialing and privileging for as many as 400 practitioners, and 21% reported that their department credentialed 1,000 or more. In interviews this year I’ve spoken with MSPs who handled all or most of the credentialing and privileging for multiple facilities—all while keeping MEC meetings on track, keeping their part of hospital operations as survey-ready as possible, and putting out the myriad little fires that go with the territory.

So, as we head into a three-day weekend, what will you do to unwind? Will you think about work? Let me know.

Happy Labor Day and thanks for reading!

Help (really!) wanted

HelpWantedSign[1]Is your organization looking for family medicine practitioners or internal medicine physicians? Wondering why the search is taking so long? The 2014 Merritt Hawkins Review Of Physician and Advanced Practitioner Recruiting Incentives spots some interesting trends that might already be affecting your organization.

The annual review is based on the demand for the physician search and consulting firm’s services. During the 12 months from April 1, 2013 to March 31, 2014, Merritt Hawkins/AMN Healthcare conducted or were engaged to conduct 3,158 permanent physician or advanced practice professional (APP) search assignments.

The review indicates which types of physicians are in the greatest demand and which are the most challenging to recruit. Notable among the Merritt Hawkins’ most recent findings: Family medicine, internal medicine, and hospitalists were the most in-demand specialties among the company’s clients. Psychiatry landed was the fourth most sought-after.

APPs—nurse practitioners (NP) and physician assistants (PA)—made the survey’s top five for the first time

Prior to 2011, there were “few” requests to recruit APPs, Merritt Hawkins reported. Since then, however, APP demand has come on strong. Last year, NPs and PAs made the list of the company’s top 20 most requested search assignments for the first time. “In the 2014 survey, NPs and PAs combined rank as our fifth most requested search. The number of search assignments Merritt Hawkins conducted for NPs and PAs grew 320% from 2011/12 to 2013/14.”

Supply and demand

A familiar trend driving the physician shortage is the graying of the workforce. More than 40% of active physicians are 55 years old or older, which means “a major wave” of physician retirement during the next five to 10 years, according to the company. However, the review also cited a couple of less-mentioned factors behind the physician shortage.

  1. Evolution of physician practice styles. Physician productivity is decreasing as more physicians choose employment and opt for controllable schedules. According to a separate survey conducted by Merritt Hawkins for The Physicians Foundation, physicians worked 6% fewer hours in 2012 than in 2008, a drop in productivity equivalent to the loss of 46,000 full-time equivalent (FTE) physicians from the workforce.
  2. The emergence of aligned care delivery models. These include Accountable Care Organizations (ACOs), primary care medical homes/integrated delivery systems, and others. Organizations are recruiting or acquiring physicians en masse, rather than on an ad hoc basis, as was common in the past, Merritt Hawkins reported. This change in recruiting has evolved to meet ACO staffing requirements, to manage the health of large population groups, and to secure market share.

Is your medical staff dealing with these issues? How scarce are family practitioners in your area? Has your organization hired a recruiter to find NPs, PAs, or physicians? Tell me at

And thanks for reading!


Meet your credentialing challenges

shutterstock_139733149 (2)There’s still time to register for our webcasts, Verify and Comply: Meet Your Top Credentialing Challenges, on Tuesday, September 4, from 1:00 to 2:30 p.m. Eastern Time.

Join Carol Cairns, CPMSM, CPCS, for this webcast if you’re struggling to understand what CMS, The Joint Commission or other accrediting bodies are looking for, or if you’re just striving to develop the best practices for credentialing and privileging.

After this program, participants will be able to:

  • Describe credentialing best practices
  • Identify the similarities and differences among regulators and accreditors (including CMS, The Joint Commission, DNV, HFAP, and NCQA)
  • Differentiate old medical staff standards language and “urban legends” versus current requirements
  • Clarify vague standards and unclear terminology
  • Distinguish between what must be done to ensure compliance, what is actually being done, and best practices

Click here for more information or to register.

Thanks for reading!

Son Hoang, associate editor, Credentialing & Peer Review Legal Insider

An insider’s view of a practitioner turf conflict

Jack Cox, MD, MMM, one of the authors of Resolve Practitioner Turf Conflicts: Medical Staff, AHP, and Offsite Disputes, sat down with HCPro to share his personal experience with turf conflicts as both a physician and physician executive:

It seems like a small issue, but sometimes what appears on the surface as an inconsequential turf battle among well-meaning physicians trying to maintain market share can result in everyone losing.

Recently we had an issue that has not fully played out, but I can speculate on the outcomes if we don’t resolve it. In developing a comprehensive cancer program for melanoma, we have run into an issue of different specialties all claiming expertise in the field, especially in the area of surgical intervention. The health system is looking to invest heavily in this new comprehensive program, and success—which it has had in other areas like breast and GI cancer—would mean an increase in patient volumes for all the affiliated physicians.

But back to the issue: The general surgeons, the plastic surgeons, the dermatologists and even an ENT physician all claim to have expertise with melanoma surgical excision. We recently recruited a fellowship-trained melanoma/sarcoma surgeon who is willing to help train others, but the turf lines have been drawn.

The challenge is, of course, the short-sighted nature of everyone wanting to protect their “slice of the pie” when the focus should be on how to increase the size of the pie. This is not an uncommon scenario, especially in this time of major healthcare transformation, when everything feels unstable and we regress to protecting what we can see today. Strategic thinking is out.

Now more than ever, we need to anticipate potential turf conflicts, be willing to view solutions in a different way, and think of a more strategic outcome that will be better for all. Otherwise, we all suffer the consequences of holding onto our preconceived notions of what is fair. Preparation and developing a process in advance, as well as having the right people at the table, goes a long way in avoiding the above scenario.