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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.

Solving the low- and no-volume issue

If you read this week’s Credentialing Resource Center Connection e-newsletter, you know there is an upcoming webcast regarding low-and no-volume practitioners. And hopefully you all immediately clicked on the link to sign up! If you did, unfortunately, you were taken to a link for a previous webcast.
Here is the correct link. Now you have no excuse not to sign up!
Here is a reminder of what this webcast will offer:
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. And one more time, here is the correct link to sign up.

Clarification needed for this week’s credentialing e-newsletter

This week’s issue of Credentialing Resource Center Connection, HCPro’s credentialing e-newsletter, referred to an out-of-date standard. The “Ask the Expert” segment discussed whether CMS and Joint Commission standards ever vary. The answer is yes; there are standards that vary between the two. CMS requires that The Joint Commission (and other accrediting bodies) develop standards that meet CMS regulations; however, these standards can also exceed CMS regulations.

The “Ask the Expert” segment referred to telemedicine  as an example of a CMS and Joint Commission standard that varies.  Unfortunately, since Ready, Set, Credential! published, CMS and The Joint Commission have developed new guidelines regarding telemedicine.

A little play, a little work

Happy National Medical Staff Services Awareness Week! I hope you have had a chance to celebrate all of the hard work produced from your MSSD. This week is not just about celebrating though, it is also about teaching. This is your opportunity to show someone new (or remind someone a bit more seasoned) all of the great things that happen on a daily basis in your office. Practitioners and patients need to recognize that without the MSSD, their lives would be very different. How would practitioners prove they are competent and know how to provide quality care to patients? And how would patients get access to those exceptional practitioners?

Since this is your week, I have a suggestion: Take 10 minutes each day this week to explain your job to someone you have never explained it to before. Not sure what to say or how to condense your duties into a 10-minute conversation? Here is a cheat sheet from NAMSS. (For the quieter MSPs out there, print out a copy of the fact sheet and leave it on someone’s desk.)

MSPs:

  • Are employed by hospitals, managed care organizations, group practices, and other healthcare settings across the United States
  • Are experts in provider credentialing and privileging, medical staff organization, accreditation and regulatory compliance, and provider relations in the diverse healthcare industry.
  • Credential and monitor the ongoing competence of the physician and other practitioners who provide patient care services in hospitals, managed care organizations, and other healthcare settings
  • Attain certification in one or both of the following:
    • Certified Professional in Medical Services Management (CPMSM). This certification is directed toward the broader responsibilities of MSPs and those who are charged with managing, improving, and implementing processes. Certification focuses on professionals who deal with governance, bylaws, medical executive committee responsibilities, and the overall compliance with internal policies and procedures as well as state, federal, and accreditation agencies.
    • Certified Provider Credentialing Specialist (CPCS). The CPCS certification focuses on the responsibilities of credentialing specialists in various healthcare environments (i.e., hospitals, CVOs, PHOs, physician groups, ambulatory facilities, and managed care/health plans). The CPCS exam is for those professionals who specialize in processing initial and recredentialing applications, who perform primary source verification, and who ensure compliance with appropriate accrediting agencies.

This is obviously just the tip of the iceberg, but it serves as a great starting point.

And don’t forget, HCPro is offering you and your colleagues a 15% discount on all of HCPro’s medical staff and credentialing products through Nov. 12. Visit the HCMarketplace and enter EO107658A during check out to receive your discount.

Apply to be a speaker at CRC Symposium 2012

The Credentialing Resource Center is excited to put the call out for speakers to present at the 15th Annual Credentialing Resource Center Symposium, May 10-11, 2012 at the Hilton Walt Disney World Resort in Orlando, Fl.

That’s right, to celebrate the 15th year of this two-day conference for MSPs and medical staff leaders, we’ve decided to shake things up a bit. We’re leaving Las Vegas and bringing the show to Orlando, right on the Walt Disney property!

In addition to a new location, we’re looking for speakers who can present interactive workshops on topics such as privileging, legal issues, accreditation, best practices for measuring physician competency, and just about anything else medical staff-related.

If you’re interested in applying, please download the application and e-mail it to editor Julie McCoy (jmccoy@hcpro.com) by September 14th.

We look forward to seeing you in Orlando!

Extended deal: $100 off CRC Symposium

We all love a deal. HCPro has extended its discount rate for the 14th Annual Credentialing Resource Center Symposium (May 12-13 in Las Vegas)! If you register before April 1, you get $100 off the regular price ($995) at $895 per registration. We hope to see you there!

Utah to no longer recognize negligent credentialing?

Sen. J. Stuart Adams, R-Utah, on February 2, proposed a bill, S.B. 150, in which the state of Utah would prohibit negligent credentialing as a reason for a medical malpractice lawsuit . If passed, the state would no longer recognize negligent credentialing.

In May 2010, Utah courts did, however, recognize negligent credentialing as a valid reason for a lawsuit in the landmark case, Archuleta v. St. Mark’s Hospital.

In that case, “the patient, Tina Archuleta, brought several claims in the case, including negligent credentialing, against St. Mark’s Hospital in Salt Lake City. She claimed St. Mark’s negligently credentialed Dr. R. Chad Halversen, who performed a laparotomy surgery on her. Shortly after being discharged from St. Mark’s, Archuleta was admitted to another hospital for treatment of postop complications. This subsequent treatment included six corrective surgeries.

In its defense against Archuleta’s negligent credentialing claim, St. Mark’s argued that the patient’s claim was not valid because three separate Utah statutes immunize hospitals from liability for various conduct. The Utah Supreme Court rejected this argument, concluding that the language of the three statutes does not bar negligent credentialing claims. However, two of the justices offered dissenting opinions claiming that the language was misinterpreted and that Utah law does not uphold negligent credentialing claims.” (via Briefings on Credentialing, August 2010 [subscription required to view full story)]

Given Utah’s legal history in negligent credentialing, do you think S.B. 150 will pass? Take the poll below.

CA physicians seek to overturn CRNA supervision opt-out rule

California physician professional associations are demanding that certified registered nurse anesthetists (CRNA) practice under physician supervision. In an ongoing legal battle, California Society of Anesthesiologists (CSA) and California Medical Association (CMA) filed a notice of appeal on January 31 in San Francisco Superior Court and a writ petition on February 1 in the First District Court, seeking to reverse a court decision that allows nurse anesthetists to administer anesthesia without physician supervision.

In October 2010, in CSA & CMA v Schwarzenegger, the judge ruled that California Gov. Arnold Schwarzenegger, R-Calif., did have the legal authority to allow nurse anesthetists to administer anesthesia outside of physician supervision, in what was a victory for CRNAs in the state. Under current Medicare rules state governors can choose to opt out of the federal requirement that physicians must supervise nurse anesthetists. California is one of 16 states that have opted out of this rule.

CRNAs argue that administering anesthesia in within their scope of practice and allows for more timely patient care, especially when physician resources are limited. However, physicians argue that the absence of physician supervision jeopardizes patient care.

[via HealthLeaders Media]

Do nurse anesthetists have the training to work unsupervised? Do individual states have the right to decide for themselves? Tell us what you think by commenting below.

TJC changes MS.08.01.01 and MS.08.01.03: ‘Medical’ APRN and PA to be privileged through med staff process

New Joint Commission standards will change the credentialing and privileging process for advance practice registered nurses (APRN) and physician assistants (PA), according to the new Joint Commission Standards BoosterPak™, released in January.

MS.08.01.01 and MS.08.01.03 standards outline focused professional practice evaluation (FPPE) and ongoing professional practice evaluation (OPPE) requirements, respectively. Previous Joint Commission standards afforded APRNs and PAs an equivalent credentialing and privileging process to the medical staff services process. The Centers for Medicare & Medicaid Services, however, does not recognize the equivalent process. The Joint Commission elected to forgo this practice as well. Under the new clarification guidelines, certain APRNs and PAs must now be privileged through the medical staff process.

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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?