La Pine: News from The Joint Commission – MS.1.20 Implementation Delayed

Not so long ago, MSPs were confused, frustrated and concerned about The Joint Commission’s Standard MS.1.20. For months it seemed like major effort and expense would be required by almost every TJC accredited hospital to comply with this standard. Thanks to a number of interested organizations, TJC heard the concerns and formed a Task Force to look into the many issues regarding the impact of this revision to the standard.

A recent “special bulletin” by the American Hospital Association stated that the concerns being addressed include:

•The MS.1.20 language was a surprise to the field
•The language of the standard was confusing
•The responsibility and authority of the hospital board and medical executive committee were diminished

The standard was to go into effect January 1, 2009. That date has been delayed because of the recommendation of the Task Force. It is anticipated that the Task Force will present a report to TJC Board at the August meeting.

Carole La Pine, MSA, CPMSM, CPCS

La Pine: Is There a Universal Credentialing Application in the USA?

Some may say that the Council for Affordable Quality Healthcare’s (CAQH) Universal Credentialing Data Source (UCD) is such a tool.

On May 28, 2008, Mr. Sorin Davis, Executive Director, CAQH, presented an update to a group of Michigan Association Medical Staff Service members. To get all participants at the same knowledge level, Mr. Davis gave a brief overview of the development of CAQH which began in 1999 as a non-profit business entity. The philosophy of development of the UCD is credentialing is a 3-step process: 1) application, 2) primary source verification (PSV), and 3) review and decision. UCD is the answer to providers’ problems which were identified as: redundancy – how many applications are 1 too many?, the lengthy process, and no consistent recredentialing cycle. For those who may be thinking that the “process” time is not all that long, let me explain the issues involved. The necessary follow-up required to complete an application may be based on omissions, or data elements not completed, problems with legibility, use of unfamiliar abbreviations, and incomplete work history dates.

All these require contact with the provide to clarify or complete the application before PSV can be completed. How much time does this take? It depends on the success in contacting the provider. The time could be short with a mere telephone call or significantly long if the provider is relocating. On average, the processing of an application is about 60 days. According to statistics provided by Mr. Davis time and expense is broken down into 40% data collection (completing an application), 25% PSV, and 35% review and decision.

CAQH’s goal is to use technology to ease the credentialing by creating a single on-line data source tool to import data into a central database, allowing providers to own their data. CAQH requires that updates to the information be at least every 120 days. As of May 22, 2008, 590,000 providers are registered with 505,000 complete applications (along with required documents) already in the database. Four hundred healthplan organizations are currently using the CAQH application. All Vermont hospitals and George Washington University are current users.

News Items:

CAQH is looking into the possibilities of allowing facilities to upload provider information into the CAQH database. The issue will be how to maintain current information and how to resolve the issue of providers attesting to the accuracy of the data.

Hospitals are now considering participation and several state Medicaid programs are in the discussion stage of requiring providers to enroll in UCD. An interesting incentive for hospital participation is the “association model” where several hospitals could form an arrangement to pool their responsibilities for the administrative charge ($5,000 for the first year, and $3,000 for every following year). This cost would be divided among the participating hospitals at a considerable savings to all.

CAQH will be conducting a number of quality evaluations to determine the accuracy of the data in the database.

Considering that the UCD is up and running, that providers are voluntarily participating, several payors are requiring participation, will the CAQH UCD become the universal application?

What’s your opinion?

Carole La Pine, MSA, CPMSM, CPCS

La Pine: Whiners are not leaders

May 20, 2008

I’m a big fan of Dan Mulhern, spouse of Michigan’s Governor Jennifer Granholm. Dan has a weekly newsletter about leadership and this week’s article was especially meaningful to me. The theme of this week’s message is about “leaders” and “whiners.” Whiners are not leaders.

My take home message from this article is:

“When faced with a difficult situation, ask: Will I lead? If I want to lead, then I ask: Do I Act or Accept? If I act, I stimulate change. If I accept, I acknowledge that the problem lies outside of my influence.”

Makes it easy to make a decision, doesn’t it?

Visit Dan’s web site: www.danmulhern.com

Carole La Pine, MSA, CPMSM, CPCS

La Pine: More temp physicians may be on the way. Is this good patient care?

Locum Tenens – The “temp” physician
Carole La Pine, MSA, CPMSM, CPCS

An article is The Ann Arbor News the other day caught my eye: Doctors find temp work plentiful and rewarding, Two physicians were quoted as saying they liked the temporary work. It gave them an opportunity to set a limit on the number of hours worked and escape some of the downsides of a medical practice. It also gave them a chance to try out working in different types of practices and different geographic areas. Sounds good? Not if you are responsible for the credentialing and privileging of these types of practitioners!

At times there is a need to seek immediate physician coverage because of some unexpected event and the use of a locum tenens practitioner can certainly fill that need. The problems occur when the application hits your desk and you see the long list of hospitals where this physician has worked, often through a temporary staffing organization. Not only does it take a great deal of time to verify all the hospital affiliations, often the dates do not match, there is no one who can attest to clinical competency, and there is no proof of how many procedures the physician has actually done at each facility.

There is no short cut to credentialing and privileging a locum tenens practitioner if your organization maintains a mission to provide safe patient care. The temp physician should be processed as completely and thoroughly as any other applicant applying for medical staff membership and privileges.

The sad message in this article was that as we face the continued shortage of primary care physicians we could expect to see more temp physicians. Many doctors will be moving into semi-retirement and may enjoy setting their own schedules. Other may be younger physician who want to try other various geographic locations before settling down.

BIG QUESTION: Is this good patient care?

La Pine: Could these be the answer to the physician shortage?

Paid Tuition: Cleveland Clinic Lerner College of Medicine announced it will offer full tuition scholarships for all students beginning July 2008. It is reported that the average student dept for medical students graduating from private US schools is more than $150,000. This plan hopes to invest in the future of medicine by attracting outstanding students to its program. Currently Cleveland Clinic Lerner College has over 1,400 application for approximately 32 student positions.

Dr. Nurse: Early in April the Wall Street Journal reported that the shortage in primary care physician may be solved by launching a doctorate of nursing practice program. The new program was described as a two-year program, with a one-year residency, to provide more training than a nurse practitioner with a master’s degree. The new program would award a DNP to individuals who have the education and the certification to be offered by National Board of Medical Examiners. The article states that by 2015, the American Association of Colleges of Nursing aims to make the doctoral degree the standard for all new advanced practice nurses, which includes nurse practitioners.

The pushback comes from physicians who fear this will create confusion for patients and may negatively impact patient care. Bottom line: Doctorate Nurses are NOT equal to physicians. Interesting comment…..when was the last time a patient was seen by the physician and NOT a Nurse Practitioner or Physicians Assistant?

More Medical School Programs: This is only my question…. why don’t we increase the number of available medical student slots?

Carole La Pine, MSA, CPMSM, CPCS

La Pine: It seems we are protecting the practitioner, but are we harming the patient?

By now many MSPs have heard that the Fifth Circuit Court ruling released the Louisiana hospital from the duty to disclose negative information while saying the hospital has the duty not to make “affirmative misrepresentations.” To put this into reality, here’s how this now plays out: When you receive a letter requesting verification of medical staff membership, you need only tell the basics — date on staff, date of resignation/termination. Often the letter will ask if the physician was “in good standing.” If the physician is one of those rare practitioners whose clinical competency was in question, do you leave the question blank? How does this response help the investigating facility to ensure the practitioner candidate will deliver safe patient care to its patients?

This latest ruling on the Kadlec appeal is going to result in some very interesting debates among MSPs. It further raises more questions about the “right” response. While audio conferences will soon be presenting opinions on what information can and should be provided to requesting entities, I wonder if thought will be given regarding the patient. Seems we are protecting the practitioner, but are we harming the patient?

La Pine’s Law: Patient safety first.

Kadlec court ruling overturned

Breaking news from HCPro…

We’re sending out an email to our subscribers today alerting them that the ruling in the landmark Kadlec court case has been overturned. However, this information is too important not to share with everyone. Here’s what we know about the case:

A previous court ruling which held that a hospital had a duty to disclose to another facility evidence of a prior staff member’s impairment has been overturned. On May 8 The U.S. Court of Appeals for the Fifth Circuit ruled that a healthcare facility has no special relationship with another hospital to disclose information, says Michael R. Callahan, a lawyer in the healthcare department of Katten Muchin Rosenman LLP in Chicago. If a hospital chooses to respond to a questionnaire with neutral information that is acceptable, but it is not acceptable to disclose misleading information.

In 2001, Robert Berry, MD, an anesthesiologist at Lakeview Regional Medical Center in Covington, LA, was fired by his Lakeview Anesthesia Association (LAA) colleagues for working under the influence of prescription painkillers. Neither the medical center nor LAA reported his behavior to the National Practitioner Data Bank, the hospital board of trustees, or to the Louisiana Board of Medical Examiners. Berry then applied for a job at Kadlec Medical Center in Richland, WA, through a staffing agency. The medical center provided neutral information about Berry’s employment to Kadlec, while LAA provided a positive review of Berry that was misleading and did not reveal his drug impairment.

In 2002, Berry caused serious harm to a patient while providing care under the influence of Demerol. Kadlec settled a lawsuit with the patient’s family for $8.5 million. Then, Kadlec brought a lawsuit which included claims for intentional and negligent misrepresentation against Lakeview Regional Medical Center and LAA. The jury found the medical center and LAA at fault, and awarded $8.2 million to Kadlec, an amount that was later reduced to $5.5 million.

Callahan says the recent ruling is important for hospitals. “Although the Fifth circuit held that there was no duty to disclose, clearly hospitals have to be truthful and objective if they decide to provide a response to another hospital as part of the appointment and reappointment process,” he says. “Misleading information will serve as a basis for a potential liability claim.”

Click here to read the entire court ruling. http://www.ca5.uscourts.gov:8081/isysquery/irl2e8f/1/doc

What’s your reaction to this ruling? How much information does your hospital share with other facilities?