All Entries in the "practitioners (general)" Category
Free product demonstrations for peer review and physician performance
HCPro invites you to join us for two free, live product demonstrations in March. The first, on Tuesday, March 19 at 12:00 p.m. (Eastern) will demonstrate the Physician Profile Reporter, a tool that enables you to generate reliable performance reports that can easily be distributed to medical staff members. The Physician Profile Reporter will help you compile data from multiple sources, measure various dimensions of physician performance using numerous indicators, and set targets for performance that recognize physician excellence as well as opportunities for improvement. The tool can help create a medical staff culture that encourages physicians to accept performance data feedback and use it to improve performance.
The second webcast on Wednesday, March 20 at 12:00 p.m. (Eastern) will demonstrate the Peer Review Case Tracking Database. This database will provide searchable access to case review and rule indicator forms and simplify case tracking and data storage. Designed to save you time and effort, the Peer Review Case Tracking Database automatically generates reports to demonstrate productivity and case outcomes, and provides data about cases screened, submitted, or pending review.
To learn more about the Physician Profile Reporter, please click here.
To learn more about the Peer Review Case Tracking Database, please click here.
Who should pay for medical education?
It’s no surprise that debt is one of the largest issues facing medical school students after graduation. It’s even less surprising that with an average debt of $162,000, these grads seek some sort of loan repayment program as part of their recruitment package.
World-renowned Princeton University economics professor Uwe Reinhart evaluates the subject in a recent post with the New York Times Economix blog and references a Cejka Search survey. In Dr. Reinhart’s article, he discusses the range of physician compensation and whether or not medical education should be government subsidized as a public good.
According to our annual Resident and Fellow Survey, recent graduates are looking for loan repayment in their starting compensation packages. In fact, 48% of respondents ranked educational loan repayment as important or very important when deciding upon a practice opportunity.
According to the 2011 Cejka Search and AMGA Physician Retention Survey, about 60% of medical groups offer loan repayment, a majority of who believe this incentive acts as a differentiator.
But size matters. For many medical groups, this is not a practical incentive to offer. Midsize groups were much more likely to offer this incentive as a part of their compensation package. Half of respondents from both small groups and large groups reported that loan payment isn’t applicable within their organization.
This mirrors the trends our search consultants are seeing in the field. We’ve found that small group clients often don’t have the resources to offer loan repayment. Large groups, on the other hand, don’t have to offer loan repayment because they are either in a desirable location or they are the primary employer in the area, so their job openings aren’t as difficult to fill.
Medical education debt load can thus be seen as a contributing factor to the demise of the small, independent medical practice. It’s apparent that the cost of medical education deters students and exacerbates the growing physician shortage.
Part of the current debate in the medical community revolves around the size of the role the government should play in subsidizing medical education. This debate will surely continue as the industry and government formulate solutions to offset the high cost of medical care.
Should America continue to let the private sector address the high cost of medical education in this way or follow the lead of other countries that make medical education affordable or free? In essence, who should pay for medical training?
Keys to improving physician competency and professional development
These days, everyone is talking about how helpful reducing stress, having a positive mental attitude, and being mindful can be for people with health challenges. But when was the last time you heard anyone say that reducing stress, having a positive mental attitude, and being mindful of personal actions can actually increase a physician’s effectiveness while promoting health, healing and well being? It can and it does.
I don’t have to tell you that physicians and all medical professionals working in hospitals or other medical settings are under a great deal of job-related stress. What you might not be aware of is that left unchecked, negative stress is a workplace contaminant that can have a deleterious effect on your health, well-being and effectiveness. Imagine that you are being assisted by a person who is agitated, stressed out, preoccupied or in a bad mood. Now imagine that that person is you. How do you think your attitude and mood will impede your effectiveness and work experience as well as all you are in contact with? Remember that when physicians are stressed out, their patients and colleagues are more likely to be stressed out too.
A positive attitude and focused attention set the tone for how you work (and also how you play, which is important for a good work-life balance). This can be accomplished through simple mental exercises. Briefly, the key to transforming negative stress into positive stress is found within one’s “internal connections;” the way one perceives, experiences, and relates to the internal and external stressors of daily life. Instead of unrelenting pressure, you can sense productive excitement. Instead of helplessness and hopelessness, you and your patients can sense practical action and confidence. Instead of fatigue, you, your staff/employees can find mutual satisfaction. Once these mental re-connections are in place and operating automatically, you can feel robustly challenged by stressful situations rather than incapacitated, drained or debilitated by them.
Learning how to de-stress and focus your attention can help you put the zest back into your life and your practice and diminish the destructive impact of negative stress. It is enlightening to realize that reducing stress, having a positive mental attitude and being mindful will improve patient care along with your competency and professional development. And keep in mind, that these same techniques can help your patients take the suffering out of pain.
Michael Ellner, CHT, is a certified medical hypnotist in private practice in New York City. He teaches advanced courses in medical hypnosis at schools throughout North America and South Africa and is a featured instructor of Hypnotic Pain Relief, Effective Medical Communication and Stress Management at the annual PAINWeek conference. Ellner is the lead author of a peer-reviewed paper “Hypnosis in Disability Settings,” IAIABC Journal, Vol. 46 No. 2; the co-author of “HOPE is Realistic – A Guide to Helping Patients Take Suffering Out of Pain,” co-written with Kelley T. Woods; and he is the author of “BEDSIDE MANNERS – The Pain Clinicians’ Guide to Effective Medical Communication” To contact Ellner, visit his website: www.nycanxietyhypnosis.com or email michaelellner@verizon.net.
What’s new with CRC?
Dear readers,
Welcome back to the revamped Credentialing Resource Center blog. I know on first glance everything looks the same. And aesthetically speaking, it is. What changed is the scope of content on the blog. Some of you may be familiar with our sister blog, Medical Staff Leaders. The original intent was to have one blog for physicians to focus on medical staff issues and another for MSPs to focus on credentialing and privileging issues. What we continue to see at HCPro, Inc. is that these two areas are becoming more entwined as the two groups form a strong relationship. For this reason, we want MSPs and medical staff leaders to be exposed to the same news alerts, tips, and best practices to excel in their roles.
The blog will still feature posts from experts in both the medical staff and credentialing fields, now in one central location. I hope that you give all entries a read; even if at first glance you think it is not relevant to your job function, read it and pass it along to one of your colleagues!
Patient Satisfaction Blog Series for CRC 2012
Easier? It can make my job easier?
You are now experts at improving the three physician-specific questions on the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey:
- During this hospital stay, how often did doctors treat you with courtesy and respect?
- During this hospital stay, how often did doctors listen carefully to you?
- During this hospital stay, how often did doctors explain things in a way you could understand?
I mentioned last week that this would make your job easier. How can that be? The following are some of the benefits that come from having satisfied patients:
- Fulfills patient priorities and wants
- Improves professional standing
- Improves compliance with recommended treatments and follow up
- Reduces liability risks and costs
- Improves staff retention and satisfaction
- Improves physician satisfaction
- Reduces unnecessary calls, returns to the ED, and professional aggravation
- Improves clinical outcomes and measures
There are other benefits as well. If you think back, you can probably find an example for each of the above from your own journey in the medical profession (as either a patient or provider). Happiness (satisfaction) is contagious!
Hopefully this series has whetted your appetite to do further reading, research, and reflection on improving patient satisfaction. Although “because the government says so” may be adequate motivation for some, the real motivation should come from our desire to provide the best patient care possible. After all, isn’t that what we are all about?
Editor’s note: William Mills, MD, MD, MMM, CPE, FACPE, CMSL, FAAFP, is a featured speaker at the 15th annual Credentialing Resource Center Symposium, May 10-11. He will be speaking on using patient satisfaction scores to drive improvement as well as how to privilege low- and no-volume practitioners. For more information, click here.
Featured webcast: Assessing the competence of low- and no-volume practitioners
Create strategic solutions to privileging low- and no-volume practitioners with advice from two leading medical staff and credentialing experts. In this online program, Yisrael M. Safeek, MD, MBA, CPE, FACPE, an experienced physician leader and former Joint Commission surveyor, and Sally Pelletier CPMSM, CPS, a national credentialing and privileging expert, walk medical staff leaders and medical services professionals through steps to develop a working strategy to establish competency for low- and no-volume practitioners.
Take a peek at the agenda:
- Contributing factors to the increase of low- and no-volume practitioners
- Governance documents that hamper the hospital’s ability to effectively manage low- and no-volume practitioners (i.e. link membership and privileges)
- How does low volume affect competence
- Matching privileges with competence
- Building a strategic approach to low- and no-volume practitioners (e.g. intended practice plan, medical staff development plan)
- Working strategies to address low- and no-volume
- A medical staff culture that feels an obligation to the low- and no-volume practitioners
- Types of data sources
- How to compile and present the data in a meaningful way
This webcast will be presented on Tuesday, February 21 at 1 p.m. To learn more or to register, click here.
Patient Satisfaction Blog Series for CRC 2012
Pat Sat/HCAHPS/P4P – Huh?
This is the first of a series of five postings that will attempt to make sense of some the above. Patient satisfaction has risen to the top of many a list as the government and other payers are establishing pay for performance (P4P) initiatives. One of the reasons everyone is working on this is there is a clear connection between patient satisfaction and quality. Check out the New England Journal of Medicine for more information on this (2008; 359:1921-1931).
Because patients, payers, and politicians now care about patient satisfaction, the next three posts will provide tips for improving scores on the three physician specific questions on the HCAHPS questionnaire. The last post will tie it all together to show physicians and MSPs how patient satisfaction affects physician performance.
To start, what is HCAHPS? The Hospital Consumer Assessment of Healthcare Providers and Systems is a 27-question survey developed by Centers for Medicare and Medicaid Services with the following goals in mind:
- To produce data about patients’ perspectives of care that allow objective and meaningful comparisons of hospitals on topics that are important to consumers
- To create incentives for hospitals to improve quality of care by making public survey results
- To enhance accountability in healthcare by increasing transparency of the quality of hospital care provided in return for public investment (also by making public the survey results)
Although this survey covers a number of areas, my blog posts will cover these three physician-specific questions:
- During this hospital stay, how often did physicians treat you with courtesy and respect?
- During this hospital stay, how often did physicians listen carefully to you?
- During this hospital stay, how often did physicians explain things in a way you could understand?
Until next time, try to get your arms around the fact that improving patient satisfaction will improve quality. For many of us, this fact will be difficult to swallow, but swallowing (internalizing) this will be critical for our success in the future.
Editor’s note: William Mills, MD, MD, MMM, CPE, FACPE, CMSL, FAAFP, is a featured speaker at the 15th annual Credentialing Resource Center Symposium, May 10-11. He will be speaking on using patient satisfaction scores to drive improvement as well as how to privilege low- and no-volume practitioners. For more information, click here.
Free Form Friday: Sample code of conduct policy
This code of conduct policy is referenced in February’s issue of Credentialing Resource Center Journal. With The Joint Commission’s announcement it is replacing the term “disruptive behavior” with “behavior that undermines a culture of safety” in its standards, now is an excellent time for organization’s to review their code of conduct policies. Although organization’s will not be required to eliminate the term from their own policies, they do need to make sure they have well-written standards that do not allow for any loopholes or misinterpretation.
R. Dean White, DDS, MS, provided HCPro with this sample policy, which can also be found in the book A Practical Guide to Managing Disruptive and Impaired Physicians, by White and Jonathan H. Burroughs, MD, MBA, FACPE, CMSL.
1.0 Policy
1.1 It is the expectation of the [hospital/entity] board of trustees that all members of the medical staff act in a professional and cooperative manner at the hospital, treating all patients and persons involved in their care with courtesy, dignity, and respect. These expectations are defined by the code of conduct.
1.2 Each member of the medical staff (individually, “physician”) granted privileges at the hospital shall be required to acknowledge and agree to be bound by the code of conduct at the time of appointment/reappointment to promote and focus awareness of the essential elements of this policy.
1.3 This policy sets forth procedures for reviewing and addressing behavioral incidents when a member of the medical staff conducts himself or herself in a manner that is inconsistent with this code of conduct.
2.0 Definitions
Disruptive or inappropriate behavior can be defined as an aberrant style of personal interaction between members of the healthcare team, patients, and/or their family members that interferes with the delivery of excellent patient care. The behavior could take the form of language, personal habits, or physical confrontation. Examples include:
- Using threatening, intimidating, or abusive language or gestures directed at patients, families, members of the healthcare team, or the hospital
- Making berating, degrading, derogatory, or demeaning comments regarding patients, families, members of the healthcare team, or the hospital
- Using profanity or similarly offensive language while speaking with anyone in the hospital
- Engaging in inappropriate or offensive conversations while providing patient care
- Engaging in nonconstructive criticism, addressed to a recipient in such a way as to intimidate, humiliate, berate, undermine confidence, belittle, or imply stupidity or incompetence
- Making physical contact with another individual that is perceived to be threatening or intimidating
- Making derogatory comments about the quality of care being provided at the hospital or by another member of the healthcare team
- Making medical record entries that criticize the quality of care being provided by the hospital or any other member of the healthcare team or that are not relevant to the delivery of care to the patient
- Refusing to abide by medical staff requirements as delineated in the medical staff bylaws, regulations, or policies
- Retaliating against or intimidating any employee or other individual for reporting behavior believed to be in violation of this code or in conjunction with completing any report regarding physician behavior
3.0 Harassment
An effective healthcare environment is one that is free from harassment of any kind, including sexual harassment. Harassing behaviors include:
- Verbal conduct, such as epithets, derogatory remarks, jokes or slurs, unwelcome sexual remarks, invitations, or comments, that is related to gender/sexual orientation, religion, mental or physical disability, medical condition, marital status, or any protected basis such as race, age, color, or national origin
- Visual conduct, such as displays of derogatory or otherwise offensive posters, cards, calendars, photographs, cartoons, graffiti, drawings, mail or electronic mail, or gestures, that is related to gender/sexual orientation, religion, mental or physical disability, medical condition, marital status, or any protected basis such as race, age, color, or national origin
- Physical conduct, such as assault, unwelcome touching, blocking normal movement, or interfering with work, that is related to gender/sexual orientation, religion, mental or physical disability, medical condition, marital status, or any protected basis such as race, age, color, or national origin
4.0 Objective
4.1 The objective of this code of conduct is to promote quality patient care by creating a safe, cooperative, and professional healthcare environment and to prevent or eliminate to the greatest extent possible conduct that:
- Disrupts the care of patients
- Adversely affects the operation of the hospital
- Affects the ability of others to do their jobs
- Intimidates or demeans any person’s ability or role in the hospital
- Creates a hostile work environment for hospital employees or medical staff members
- Adversely affects the community’s confidence in the hospital and the medical staff
4.2 Examples of both desirable and undesirable behavior are provided in the following subsection. This is a list of examples and is not intended to be all-inclusive.
4.2.1 Desirable behaviors include those in which a physician:
- Responds in a timely manner to patient needs
- Supports teamwork among caregivers
- Shows respect to peers, employees, volunteers, caregivers, physicians, hospital staff members, patients, and families
- Discusses problems in a constructive manner
- Demonstrates patience in stressful situations
- Complies with policies and procedures
4.2.2 Undesirable behaviors include those in which a physician:
- Is slow to respond or does not respond at all to patient needs
- Engages in inappropriate nonclinical conversations while providing patient care
- Exhibits extreme frustration and anger
- Belittles or demeans others
- Neglects to communicate effectively
- Makes negative comments to patients about their treatment in the hospital
- Uses threatening language, gestures, profanity, or threats of retaliation
- Displays passive-aggressive behavior
- Fails to comply with bylaws, policies, and procedures
5.0 Procedures
5.1 General guidelines/principles
5.1.1 Issues of employee conduct toward a medical staff member will be dealt with in accordance with the hospital’s human resources policies. Issues of conduct by members of the medical staff (physicians) will be addressed in accordance with this policy.
5.1.2 Every effort will be made to coordinate the actions described in this policy with the provisions of the medical staff bylaws and regulations. In the event of any apparent or actual conflict between this policy and the medical staff bylaws and regulations, this policy shall prevail.
5.1.3 The medical staff policy, “Behavioral Event Review Process,” outlines collegial steps (i.e., counseling, warnings, and meetings with a physician) that can be taken in an attempt to resolve complaints about inappropriate conduct exhibited by physicians.
5.1.4 The medical staff leadership and hospital administration shall provide orientation and education to make employees, members of the medical staff, and other personnel in the hospital aware of policies prohibiting sexual harassment and requiring respectful dignified conduct. The medical staff leadership and hospital administration shall institute procedures to facilitate prompt reporting of conduct that may violate this policy and prompt action as appropriate under the circumstances.
5.2 Procedural guidelines for responding to a concern
5.2.1 Nurses and other hospital employees who observe or are subjected to inappropriate conduct by a physician shall notify their supervisors about the incident. Any physician who observes such behavior by another physician shall notify any member of the behavioral event review committee (BERC), or his or her designee, directly. After learning of the occurrence of an incident of inappropriate conduct, the supervisor/BERC member shall request that the individual who reported the incident document it in writing. As an alternative, the supervisor/BERC member may document the incident as reported.
5.2.2 The documentation should include:
- The date and time of the incident
- A factual description of the questionable behavior
- The names of any patients or patient’s family members who may have been involved in the incident, including any patient or family member who may have witnessed the incident
- The circumstances that precipitated the incident
- The names of other witnesses to the incident
- Consequences, if any, of the behavior as it relates to patient care, personnel, or hospital operations
- Any action taken to intervene in or remedy the incident
- The name and signature of the individual reporting the complaint of inappropriate conduct
5.2.3 The supervisor/BERC member shall forward the report to the BERC. The BERC shall review the report and may meet with the individual who prepared it and/or any witnesses to the incident to ascertain the details of the incident.
5.2.4 If the BERC determines that an incident of inappropriate conduct has likely occurred, the BERC has several options available to it, including, but not limited to, the following:
- Notifying the physician that a complaint has been received and requesting that the physician provide more information about the event(s)
- Sending the physician a letter of guidance about the incident
- Sending the physician a letter or warning or reprimand, particularly if there have been prior incidents and a pattern may be developing
- Having a BERC member(s), or the BERC as a group, meet with the physician to counsel and educate the individual about the concerns and the necessity to modify the behavior in question
5.2.5 These BERC efforts are intended to be collegial, with the goal of helping the physician understand that certain conduct is inappropriate and unacceptable.
5.2.6 The BERC efforts can be used to educate the physician about administrative channels that are available for registering complaints or concerns about quality or services, if the physician’s conduct suggests that such concerns led to the behavior. Other sources of support or counseling can also be identified for the physician, as appropriate.
5.2.7 The identity of an individual reporting a complaint of inappropriate conduct will generally not be disclosed to the physician during these efforts, unless the BERC members agree in advance that it is appropriate to do so. In any case, the physician shall be advised that any retaliation against the person reporting a concern, whether the specific identity is disclosed or not, will be grounds for immediate disciplinary action pursuant to the medical staff bylaws, regulations, and policies.
5.2.8 If the BERC prepares any documentation for a physician’s file regarding its efforts to address concerns with the physician, the physician shall be apprised of that documentation and given an opportunity to respond in writing. Any such response shall then be kept in the physician’s confidential file along with the original concern and the BERC documentation.
5.2.9 If additional complaints are received concerning a physician, the BERC may continue to use the collegial and educational steps noted in this policy as long as it believes that there is still a reasonable likelihood that those efforts will resolve the concerns. At any point in this process, however, the BERC may refer the matter to the physician health committee (PHC) for review and action in accordance with the medical staff bylaws and policies. When it makes such a referral, the BERC may also suggest a recommended course of action for the physician (e.g., behavior modification course, development of conditions for continued practice for the individual, and suspensions).
5.2.10 Whenever the BERC refers a matter to the physician health committee (PHC) for its review and action, the PHC shall be fully apprised of the previous warnings issued to the physician and the actions that were taken to address the concerns. The PHC may, at any point in the investigation, refer the matter to the credentials committee without a recommendation. Any further action, including any hearing or appeal, shall then be conducted according to medical staff bylaws, regulations, and/or policies.
6.0 Performance monitoring
As an element of the medical staff’s ongoing professional practice evaluation (OPPE) process, behavioral incidents involving physicians shall be tracked on an ongoing basis to identify any trends. Results will be provided to the division chief and the credentials committee as one of the criteria to recommend reappointment of the physician.
7.0 Confidentiality
7.1 All members of the medical staff and all hospital employees involved in the reporting and review of a behavioral incident are responsible for maintaining the confidentiality of information in connection with the incident. In addition, the involved physician must maintain the confidentiality of information relating to the incident. Except as otherwise provided by law, all communications to address the incident between department leadership, medical staff leadership, involved medical staff committees, and hospital executives are confidential and privileged.
7.2 The chief of staff and CEO should be notified of any breach of confidentiality by any person involved in reporting or reviewing a behavioral incident.
Source: R. Dean White, DDS, MS, Texas Health Harris Methodist Hospital HEB in Dallas/Fort Worth. Reprinted with permission.
Contest winner: New practitioner task checklist
Congratulations to Kathy J. Szary, medical staff services coordinator and executive assistant at Grinnell (IA) Regional Medical Center! Kathy is the final winner for the 2011 Credentialing Resource Center Symposium Contest!
Kathy submitted this novel new practitioner task checklist. She writes,
We developed this form recently to help us in preparing for the arrival of new practitioners. We established a “new practitioner task force,” which I keep as a distribution list.
Contest entry: Student clinical rotation policy
Keep those contest entries coming! Just one more week left until the Credentialing Resource Center Symposium contest closes and we announce the final winner.
Thanks to Mary E. Eddy, CPMSM, credentialing coordinator at St. Joseph Health Services of Rhode Island, an affilate of CharterCARE Health Partners, for sending in this medical staff policy on student clinical rotations.The policy states:
“St. Joseph Health Services of Rhode Island will accept students for clinical rotations only if candidates submit appropriate documentation, as may be applicable, to the medical services department. Formal approval must be received from the sponsoring educational institution. An active category member of the St. Joseph Health Services of RI must agree to directly supervise all activities of the individual and accept full responsibility for students his/her activities in the hospital clinic setting. Final approval must be granted by the medical executive committee and the board of trustees.”
You can download the full medical staff policy on student clinical rotations here.
Thank you, Mary. You can enter yourself into the Credentialing Resource Center Symposium. Find all the contest rules here. The deadlines is April 15.
