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Words to live by

news01I’ve been poring over my notes from the 2014 NAMSS Educational Conference and Exhibition, and discovered a quote from Hugh Greeley’s Tuesday presentation, “This is What We Live For: Effectively Dealing with Our Most Complex Applicants and Re-Applicants,” that stands out. Describing the MSPs’ role in protecting the patient, facilitating clinical practice, and supporting organizational improvement, Greeley said, “You don’t live for validating the licensure or processing the paperwork … you live to make it better.”

In a three-day span that offered so much MSP and medical staff leadership insight, and plenty of other words to live by, his statement resonated because it acknowledges the medical staff services department’s potential contributions to process improvement. The goal is to create and execute the best processes possible—but changes are often necessary, there’s always room for improvement, and MSPs are in a unique position to influence that improvement. Greeley also noted that it can be better to influence than to command.

If your medical staff leadership listens when you ask the questions that can move care forward at your organization, I’d like to know. And if you were at the NAMSS event this week, was there one educational session that stuck out for you? I’d be interested to know about that, too.

Thanks for reading!

Verify and Comply meets Medical Staff Standards Crosswalk

Verify and Comply: Credentialing and Medical Staff Standards Crosswalk, Sixth EditionVerify and Comply, Credentialing and Medical Staff Standards Crosswalk, Sixth Edition, combines both credentialing and medical staff standards and regulations into one easy-to-navigate manual, giving MSPs one book that answers all their accreditation questions. This expanded guide includes CMS, Joint Commission, NCQA, DNV, HFAP, and AAAHC standards side by side in an easy-to-read grid.

Subject matter experts Carol S. Cairns, CPMSM, CPCS, and Kathy Matzka, CPMSM, CPCS, have compiled a one-stop resource for answering your acute care, managed care, and ambulatory care medical staff/credentialing questions.

This side-by-side compilation of accreditors’ standards will help you:

  • Understand the differences between the stages of the credentialing process: appointment, reappointment, and ongoing assessment
  • Determine which verifications are necessary to obtain in the credentialing process
  • Assess ambulatory standards for your ambulatory facilities
  • Define the structure of your medical staff and its responsibilities
  • Determine the appropriate area in medical staff governance documentation to include specific items required by accreditation standards and regulatory requirements
  • Explain your medical staff’s involvement in organizational leadership functions

Click here for more information and thanks for reading!

Monday memo: Delegated credentialing and authorized agents

TIPHospitals are federally mandated to query the National Practitioner Data Bank (NPDB) when an eligible practitioner applies or reapplies for medical staff appointment or clinical privileges. “A hospital may not delegate its own responsibility to query or credential practitioners because of the federal requirement that hospitals must query. A hospital’s query must be submitted to the NPDB either directly by the hospital or through the hospital’s authorized agent,” the NPDB states.

The differences between delegated credentialing entities and authorized agents can be confusing, but in the September online issue of Data Bank News, the NPDB provides a side-by-side comparison/explanation (as well as the bolded text in each field):

Authorized agent

Delegated credentialing

An entity selects an authorized agent to report and/or query the NPDB on its behalf, without making credentialing decisions. The authorized agent simply performs the assigned tasks. An entity gives another entity the authority to
make final credentialing (i.e., hiring or privi-
leging) decisions, such as when a health plan
uses a hospital’s credentialing decision as the
basis for permitting a practitioner to partici-
pate in its network.
An entity that uses an authorized agent to report and/or query on its behalf still retains responsibility for making credentialing determinations for its practitioners. The entity that delegates credentialing is not
considered part of the credentialing process
and is prohibited from receiving NPDB query
Hospitals may not delegate their responsibility to query because of the federal mandate for
hospitals to query the NPDB when a practitioner applies for a medical staff appointment or
clinical privileges and every two years thereafter. Health plans are the most common
delegators of credentialing, most often to hospitals.

Check out the NPDB page for more information about the differences between delegated credentialing entities and authorized agents.

And as always, thanks for reading!

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!


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!

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.

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 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!