Ever wonder what the working conditions are like for the President’s doctor? Connie Mariano, MD, sheds some light on the position in her new book “The White House Doctor: My Patients Were Presidents — a Memoir.”
Mariano looked after three Presidents, starting with Bill Clinton. She says medical staff members are never far from the President’s side, staying overnight in the White House and riding nearby in motorcades.
Who credentialed Marino for her role? Her book doesn’t focus on that, but she has a Navy background, and most of her successors have been military physicians. Wherever her credentialing application came from, chances are it had a few more background checks than most.
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?
It seems that one of every three commercials on TV is about car insurance. The Gecko, Flo, and Mayhem characters have all become popular subjects for discussion at the office water cooler. Most of us are familiar with how insurance premiums work. In general, the less you pay, the less coverage you receive.
This strategy isn’t so different from the background check industry.
In today’s competitive background screening and credentialing markets, the new strategy has become, “How low can you go?” Budget is important but it is just as important for medical staffing and HR professionals to know that just like car insurance, a low price on a criminal records check can equate to very limited research being performed on your practitioner.
Understand what you are getting before implementing a criminal history check in your credentialing process. There is no great pie in the sky in the form of an all inclusive national criminal database. Criminal record research begins at the county and federal district level where completed criminal records originate. Cast a broader verification net and you’ll find state repository and national criminal databases that provide greater area coverage, but more often than not miss important details regarding criminal records and in many cases, miss them altogether.
What’s the solution for MSPs? Do your research. Know what information you need, and which sources can deliver. And don’t be shy about paying for it, or like the Meyhem commercials by the insurance company All State, you’ll be left in a challenging situation.
Have you ever received a request from a person interested in shadowing or observing a practitioner? If so, who made that request?
This week’s Free Form Friday giveaway is a focused professional practice evaluation (FPPE) form for newly requested privileges. It was submitted by Angela Stokes-Middleton, CPCS, manager in the office of medical staff affairs at Hoboken (NJ) University Medical Center.
Angela says that she uses this form for physicians in all departments and specialties, but has a separate FPPE form for NPs and PAs.
Looking for other FPPE resources? Check out these HCPro books. Each one comes with customizable forms selected by experts from The Greeley Company.
What did I do today? How many medical staff service professionals (MSSP) ask themselves that after a day full of application processing, interruptions, committee meetings, interruptions, phone calls, interruptions, privilege form reviews, interruptions, bylaws revisions, interruptions and, oh yeah, did I mention interruptions?
I ask “How do you handle interruptions?” when I interview new members for my team. The key to the “right” answer is briefly describing everything I spoke of in the first sentence and then talk to prioritization, urgent vs. emergent, nice to have vs. need to have and the requirement for a GIANT sense of humor.
When an MSSP advances in their career to a management role the question of “What Did I Do Today” becomes even harder to grasp as we are no longer on the front line processing the files but are left with the intangible tasks. These may include churning out reports, budget planning, educating other hospital personnel to what the MSSP does, personnel issues, time cards, paid time off requests, auditing our teams work, and attending management meetings at which we are now a part of the voting voice. Yet none of these contain the intimate experience and satisfaction of pouring through a physician file to find gaps, confirm that the applicant’s education meets privileges requested, finding a LLPOF (Liar, liar pants on fire) applicant, etc. We are left with the “vapor.”
In Schelling v. Humphrey (2009), the Supreme Court of Ohio ruled that a plaintiff can bring a negligent credentialing claim against a hospital without filing a malpractice claim against an individual practitioner.
However, in Plaisance et al., v. Our Lady of Lourdes Regional Medical Center, Inc., et al. (2010), an appeals court in Louisiana ruled that the plaintiffs had to establish a malpractice claim before they could establish that the medical staff knew about the pattern of alleged malpractice behavior and went ahead with its credentialing, thus negligently credentialing the practitioner.
These rulings show that in some states it’s more difficult to prove a negligent credentialing claim if a malpractice claim has to be established first.
The goal for MSPs remains the same: process applications with due diligence to avoid negligent credentialing or even the appearance of it. Ultimately credentialing best practices will help keep the medical staff out of the court room, for malpractice or negligent credentialing cases.
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.
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.
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.