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Was care spread too thin with multi-hospital privileges?

It’s not uncommon for practitioners to hold privileges at more than one facility. But can a practitioner’s ambitions put patient care in jeopardy? Should medical staffs set a limit on how many different facilities they allow their privileged practitioners to practice at, or set limits on patient case load at each facility?

These are some of the questions raised by the case of Eldridge Pearsall, MD, an OB-GYN who was put on probation by the Medical Board of California after several cases were called into question.

In one instance, a hospital contacted Pearsall to assist with fetal distress in a patient carrying twins, according to a news report. Pearsall responded that he was busy working at another hospital, but would arrive in 45 minutes. When Pearsall eventually arrived, it was later than expected and the twins were already delivered.

In another instance, he forgot about a patient and went home to sleep, ignoring calls about the patient.

The Medical Board cited “patient abandonment” and an “extreme departure from the standard of care,” as some of the reasons for placing him on probation.

Do you think the Pearsall case is an isolated and extreme example or does it contain some learning lessons for all medical staffs about stretching practitioners too thin?

Audio clip: More physicians seeking hospital work

The trend for today’s newly minted physicians is to team up with a hospital rather than joining a private practice, according to an October 13 NPR report. Some of the factors for the trend include physicians who want to spend less time on administrative responsibilities that hospitals are willing to take over and who want to shoulder less of a financial burden for their practice.

Click here to listen to the NPR report, “Hospitals Lure Doctors Away From Private Practice.”

After listening to the report, how do you think the trend of more physicians seeking hospital work will change the face of medical staffs? Will more physicians necessarily mean more medical staff members, or will the same factors driving physicians to the ease of hospital practice lessen the physician’s attraction to medical staff leadership roles? Leave your thoughts in the comment boxes below.

$163 million squeezed from Medicare by organized crime, largest case of its kind

The largest Medicare fraud operation conducted by a single group was recently taken down, the Department of Justice announced earlier this week. The accused individuals allegedly stole the identities of physicians and Medicare beneficiaries to set up shadow clinics to bill for unnecessary services and/or procedures that were never performed.

Here are some of the statistics from the case:

  • 73 defendants were charged with various healthcare fraud-related crimes
  • $163 million in fraudulent billing was sent to Medicare
  • 118 alleged shadow clinics submitted Medicare charges
  • 25 states housed the shadow clinics

“The [accused] perpetrated a large-scale, nationwide Medicare scam that fraudulently billed Medicare for more than $100 million of unnecessary medical treatments using a series of phantom clinics,” said Kevin Perkins, FBI Assistant Director of the Criminal Investigative Division, in a press release. “We want to restore the confidence in the nation’s health care system and assure practitioners we will not stand by and let their identities be used for criminal gain.”

This case highlights the important work MSPs do in verifying Medicare and Medicaid sanctions to ensure the proper sanctions are rendered and to stop identity fraud in its tracks.

Florida pediatricians switch hospitals, reasons unknown

A group of 10 Florida pediatricians have switched hospital affiliations, but the reasons behind the move remain murky, according to an October 7, nwfdailynews.com article. The physicians previously held privileges at Fort Walton Beach Medical Center (FWBMC), but as of October 1, they are exclusively seeing patients at White-Wilson Medical Center.

According to FWBMC the physicians left to focus on their primary care role, but other sources told nwfdailynews.com there were other factors at play. Specifically, the pediatricians objected to FWBMC’s plans for pediatric emergency care services that they felt couldn’t be supported by the organization’s pediatric resources.

Question: Do you think the hospitals involved should fully disclose to the general public the reasons behind the physician’s move, or should the organizations’ let the public know a change has occurred and leave it at that? How would your medical staff handle the situation? Leave your answer in the comment boxes below.

Live! from NAMSS, meet Mary Baker, DHA, CPMSM, CPCS

Greetings from beautiful Orlando, Florida! Today was the first day of the annual National Association Medical Staff Services (NAMSS) conference. It was also the first day of work for the newest member of our Greeley consulting team, Mary Baker, DHA, CPMSM, CPCS. Check out the video clip below to get to know Mary. It was shot live from the NAMSS conference (please excuse the background noise).

New technology news: FDA reopens whistleblower investigation on medical devices

A group of scientists at the FDA claiming their managers pressured them to approve some medical devices despite their concerns are having their complaints reexamined, according to a September 30, Wall Street Journal article.

Earlier this year, the Department of Health and Human Services dismissed the allegations of criminal charges against the managers. Now the matter is being reinvestigated as potential administration violations by the managers.

Click here to read more or to forward on to your new technology review committee.

Posing as a practitioner, arrested as a criminal

MSPs are great at spotting red-flags on applications and ensuring that criminals posing as doctors don’t make their way into hospitals. However, some just skip the application process and show up dressed for work.

Police in Danville, VA arrested a man last week wearing a white coat embroidered with “Pediatric Physician’s Assistant Resident.” He was charged with engaging in practicing the profession or occupation of medicine, without holding a valid license, according to a WXII12.com news report.

It’s another reminder for medical staffs to keep their eyes open for practitioner imposters, both in the credentialing process and in their hallways.

Home births on the rise, but not always with the help of hospital-privileged practitioners

Hospital-privileged practitioners may face competition from their peers at a hospital across town or from a specialty-focused ambulatory care organization. Few face competition from unlicensed professionals working in a home setting—except for those practitioners offering labor and delivery services.

Home births increased 5% from 2004 to 2005, and remained steady at about 25,000 in 2006 (the last year for which figures are available) according to data from the National Center for Health Statistics, published in the September 23 New York Times.

Although these figures don’t necessarily mean that labor and delivery physicians in hospitals will suddenly become low-volume providers, there is a potential for a shift in their services. Groups such as the American College of Obstetrics and Gynecology, American Medical Association, and some state medical associations oppose home births assisted by unqualified practitioners due to the medical risks.

ESAR-VHP launches new website for disaster credentialing

The Emergency System for Advance Registration of Volunteer Health Professionals (ESAR-VHP) launched a new website that allows interested providers to register in advance to assist in emergency situations, such as a natural disaster. MSPs can use the information collected by this website to help issue disaster privileges. (Don’t let the terminology confuse you. The Joint Commission uses the term emergency privileges to mean privileges issued for an urgent, specific patient care need. The accreditor uses the term disaster privileges to mean privileges usually assigned to a number of providers to provide services during a wide-reaching emergency, such as a natural disaster.)

Below is a chart from the volunteer sign-up page explaining the different categories volunteers fall into. MSPs may assign disaster privileges to volunteers who meet Level 1 criteria.

Source: www.phe.gov/esarvhp/

Explore the world through credentialing

I recently got an e-mail from Guenther Baerje, BSIT, CPMSM, HACP, director of medical staff management at  Good Samaritan Hospital in Los Angeles, describing how his efforts to credential physicians from foreign countries has led to a hobby in stamp collecting. Here’s what he had to say:

“I’ve had more than one doctor tell me that I would never get primary source verification from his or her home  country, but with the Internet, I’ve collected many. This led me to start collecting some of the more interesting stamps from foreign countries. I had enough to do a mini collage. I framed it and put where the docs wait in our office, and have had enough compliments on it, that I thought I’d share.”