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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.

Mark your calendars for ICD-10

calendarThe U.S. Department of Health and Human Services formally has set October 15, 2015 as the new implementation date for ICD-10. By this date, healthcare providers, plans, and clearinghouses must transition to the new medical classification system.

ICD-10 implementation in the U.S. has been previously delayed twice. Most recently the date was set for October 1, 2014, until President Obama signed a bill into law on April 1 delaying implementation for a year.

The final rule, Administration Simplification: Change to the Compliance Date for the International Classification of Disease, 10th Revision (ICD-10-CM and ICD-10-PCS) Medical Data Code Sets, is scheduled to be published in the Federal Register on August 4.

Monday memo: Plan for September

TIPAllegations of physician misconduct and negligence. “Assistant physicians” in Missouri. Expanding NP practices in Kentucky. This week’s Credentialing Resource Center Insider news roundup showcases several potential credentialing challenges. Learn how to handle some of the toughest issues your department will face by tuning in to Verify and Comply: Meet Your Top Credentialing Challenges, a webcast slated for September 4, from 1:00 to 2:30 p.m. Presenter Carol S. Cairns, CPMSM, CPCS will help you cut through the confusion when CMS seems to want one thing for medical staffs and accreditors want something else.

I know you’re probably not ready to think about September, but if you put this web presentation on your radar, you could start fall with a better understanding of credentialing best practices.

Thanks for reading!

Mary Stevens, editor, Credentialing Resource Center Insider

Monday memo: Register for Wednesday’s webcast

TIPWith the changing demographics of the hospital medical staff comes growing challenges to collecting and assessing information on physician competence. When physician leaders do have this information, they often don’t know what to do with it. What steps should they be taking with this information? Can they work with the physician to help him or her improve (collegial intervention) or should they suspend/limit the physician’s privileges (corrective action)? This program will walk medical staff leaders through the steps of collegial intervention through corrective action and discuss how to do so while protecting patients, the physician, and the organization.

After this program, participants will be able to:

  • Identify why the change in demographics will eventually create an increase of issues with physician competency
  • Comprehend the range of assessment tools for evaluating the competence of clinically suspect practitioners
  • Understand the full range of disciplinary tools available to problem physicians
  • Conduct peer review while minimizing legal liability

Click here to learn more about this webcast.

CPRLI readers, we want to hear from you

Medical-LawWhat would you change in Credentialing and Peer Review Legal Insider? What should we keep on doing? We’re asking CPRLI readers to take a short survey to help make this publication an even more valuable asset for medical staff services departments, medical staff leaders, and legal teams in healthcare organizations.

Please take a few minutes to complete this short survey. Click here to get started or type https://www.surveymonkey.com/s/N8PJT6R in your browser. Respondents can be included in a drawing to win a copy of “Resolve Practitioner Turf Conflicts: Medical Staff, AHP, and Offsite Disputes,” by Jack Cox, MD, MMM; Rosemary Dragon, CPMSM, CPCS; and Christine Hearst, CPMSM.

Thanks for reading!

Monday memo: Know what data can show

TIPProPublica’s analysis of recently released Medicare data has gleaned some interesting findings—a significant number of physicians with “unusual” Medicare billing patterns have been disciplined by their state medical boards or have had challenges to their licenses. The article sheds light on the challenges of using data to identify potentially suspect physicians.

If physician leaders in your organization have collected data, assessed physician competence information, and found issues, what should their next steps be? Tune in Wednesday, July 9, 1:00-2:30 p.m. Eastern for Assessing and Managing Clinically Suspect Practitioners: From Collegial Intervention to Corrective Action, a webcast presented by Todd Sagin, MD, JD, former vice president and national medical director of The Greeley Company, Inc.

This program will walk the audience through steps for handling clinically suspect practitioners while protecting patients, the physician, and the organization. Audience members will learn to identify when working with the physician to help him or her improve (collegial intervention) is the best option, and when they should suspend or limit the physician’s privileges (corrective action).

Click here to register or learn more about this webcast.

Thanks for reading!

Monday memo: Revisit the cost of credentialing

DollarSignsA recent visit to the Credentialing Resource Center archive yielded questions and an article about the cost of credentialing practitioners. The original story, published in 2010, reported that costs ranged from approximately $430 to $800 per practitioner, including labor.

Maybe that range matches what you see in your organization—but with so many changes in hospital systems, information technology, and the economy in general, maybe the range has moved higher. (Or lower?) So perhaps it’s time to ask again: Does your medical staff services department track how much it costs to credential each individual physician at your organization? Do you track how much it costs to perform primary source verifications for advance practice professionals?

If you’d like to participate in a Credentialing Resource Center Journal article about this topic, please let me know.

Thanks for reading!

Intervention? Corrective action? Know your options

physdoc01_2834090Collecting and assessing information on physician competence are daunting tasks. But when physician leaders have this information, deciding what to do with it can be even more challenging. What steps should they be taking? Can they work with the physician to help him or her improve (collegial intervention) or should they suspend/limit the physician’s privileges (corrective action)?

Tune into our webcast Assessing and Managing Clinically Suspect Practitioners: From Collegial Intervention to Corrective Action, on July 9, from 1:00 p.m. to 2:30 p.m. Eastern for answers. Todd Sagin, JD, MD, will walk medical staff leaders through their options, from collegial intervention through corrective action, and discuss how to do so while protecting patients, the physician, and the organization.

After this program, participants will be able to:

  • Identify why the change in demographics will eventually create an increase of issues with physician competency
  • Comprehend the range of assessment tools for evaluating the competence of clinically suspect practitioners
  • Understand the full range of disciplinary tools available to problem physicians
  • Conduct peer review while minimizing legal liability

Click here for more information or to sign up for this webcast.

 And thanks for reading!

CMS Physician Compare, HCAHPS, and physician leaders

disclosureAs a physician leader, when you think about publicly reported quality data, do you wince at potentially bad news, or do you welcome the newly available data as another tool for improving patient care? Here is some information you should know about CMS’ Physician Compare website and Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS).

Physician Compare is a CMS website that was developed with the purpose of allowing consumers to make informed choices about selecting and/or comparing Medicare providers. Consumers can not only search for physicians or other healthcare professionals enrolled in the Medicare program but can also determine whether or not a provider participates in CMS quality programs, such as the following:

  • Physician Quality Reporting System (PQRS), including the Group Practice Reporting Option (GPRO);
  • Electronic Prescribing (eRx) Incentive Program; and
  • Electronic Health Record (EHR) Incentive Program.

In 2014 CMS included quality of care ratings for group practices and in the future will be adding information related to individual provider quality of care ratings.

CMS’ Hospital Compare website for Medicare-certified hospitals publicly reports quality data such as unplanned readmission and death rates. The Hospital Compare website also reports hospital-specific results from a national patient satisfaction survey.

Please follow the links below for additional information:

http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/physician-compare-initiative/Physician-Compare-Overview.html

http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/HospitalQualityInits/HospitalCompare.html

Public reporting of patient experience survey data for adult hospitals has been in place since 2008 through Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS). The survey is intended to report patients’ perspectives of the care they received in order to allow consumers to have objective, meaningful data for comparing hospitals and making informed decisions about where they choose to receive care.

The federal Agency for Healthcare Research and Quality (AHRQ) and CMS have funded a pediatric version of HCAHPS (Child HCAHPS) that is being developed and field tested by Boston Children Hospital’s Center of Excellence for Pediatric Quality Measurement in collaboration with the Consumer Assessment of Healthcare Providers and Systems Consortium.

Public reporting of quality data initiatives and pay-for-performance programs have also created new incentives for hospitals and providers to improve quality of care, and are intended to provide better transparency and accountability.

All physicians, particularly those in medical staff leadership roles, should become very familiar with these programs and how you can help lead performance improvement initiatives in your organization based on these measures, and how monitoring of this data to measure change can be used for other quality activities, such as maintenance of certification initiatives.

Put your best form forward

chklist_paperAs we update our Clinical Privilege White Paper library, I’m often amazed at how much one procedure or specialty can change in a short period of time. New techniques and technologies are emerging, established best practices are evolving, and there are some changes that we have yet to address. It’s a fascinating challenge.

If you want to help your fellow MSPs and learn how other MSPs tackle their privileging dilemmas, Credentialing Resource Center is looking for member-submitted privileging forms, policies, and procedures to share with our subscribers.

Whether it’s credentialing criteria for nurse practitioners or sample bylaws language for delineating medical staff categories, we want to see the forms that have helped your organization address credentialing issues. Examples of these member-submitted forms can be found when you log in.

To share your privileging forms, please email documents, along with a brief explanation of the contents, to CRCJ editor Mary Stevens. Thank you for subscribing to Credentialing Resource Center.

And thanks for reading!