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Featured free webcast: ACOs influence on MSPs

By now, you’ve probably heard the acronym ACO a few times at your organization. Although there are still many questions, one thing is for sure: ACOs will create changes throughout the healthcare industry, including the medical staff office. For MSPs, what this most likely means is a change to how practitioners are credentialed.

Bruce D. Armon, Esq., a legal expert in corporate healthcare law, will present a free 30-minute webcast next week about the MSPs role in an ACO formation. Armon is managing partner of Saul Ewing LLP’s Philadelphia office and co-chair of its health law group. He is also a member of our panel of highly-respected experts presenting at the 15th Annual Credentialing Resource Center Symposium, May 10-11, in Orlando. For more information on the symposium, click here.

To sign up for this free webcast, call 781/639-5599 or click here.

Get creative, get 50% off price of CRC Symposium

One thing I’ve learned quickly in this role as credentialing editor is that MSPs love to share their great ideas with other MSPs. They know the stress their MSO faces and if they have a solution to a common medical staff problem, they don’t want to keep it a secret. With that said, HCPro wants to provide MSPs with a way to share their knowledge at the 15th annual Credentialing Resource Center Symposium. As part of the conference offerings, a poster session will be held; it’s an informal way for hospitals to share their medical staff office successes with each other, network, and exchange ideas and information.

Accepted poster presenters will receive a 50% discount off the price of two symposium admissions. Sorry, but those already registered for the symposium are not eligible for the 50% discount (but you could send someone else from your organization).

Any and all ideas are welcome. Some poster topics to consider include the following:

  • How to train or incentivize medical staff leaders
  • How to avoid negligent credentialing and malpractice claims
  • How to conduct OPPE and FPPE
  • How to develop a thorough and efficient credentialing processes
  • How to develop privileging criteria and delineation of privileges

If you have a great idea for a poster and want to present it at this year’s conference, please download the attached CRC poster application, complete it, and e-mail it to kkondilis@hcpro.com. Thanks, and I look forward to receiving your application.

Patient Satisfaction Blog Series for CRC 2012

Easier?  It can make my job easier?

You are now experts at improving the three physician-specific questions on the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey:

  • During this hospital stay, how often did doctors treat you with courtesy and respect?
  • During this hospital stay, how often did doctors listen carefully to you?
  • During this hospital stay, how often did doctors explain things in a way you could understand?

I mentioned last week that this would make your job easier. How can that be? The following are some of the benefits that come from having satisfied patients:

  • Fulfills patient priorities and wants
  • Improves professional standing
  • Improves compliance with recommended treatments and follow up
  • Reduces liability risks and costs
  • Improves staff retention and satisfaction
  • Improves physician satisfaction
  • Reduces unnecessary calls, returns to the ED, and professional aggravation
  • Improves clinical outcomes and measures

There are other benefits as well. If you think back, you can probably find an example for each of the above from your own journey in the medical profession (as either a patient or provider). Happiness (satisfaction) is contagious!

Hopefully this series has whetted your appetite to do further reading, research, and reflection on improving patient satisfaction. Although “because the government says so” may be adequate motivation for some, the real motivation should come from our desire to provide the best patient care possible. After all, isn’t that what we are all about?

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.

Patient Satisfaction Blog Series for CRC 2012

Blah, Blah, Blah?

As I mentioned in my last post, there are three physician-specific questions on the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey:

  • During this hospital stay, how often did doctors treat you with courtesy and respect?
  • During this hospital stay, how often did doctors listen carefully to you?
  • During this hospital stay, how often did doctors explain things in a way you could understand?

This post will deal with tips to improve your scores on the explanation question. By now, I’m sure you would make Emily Post proud of how polite you are. (For those much younger than I, she was the queen of etiquette.) I also expect you have made some brilliant diagnoses as a result of your improved listening skills. Now it is time to focus on how you explain things to patients and increase those scores at the same time. Your patient shouldn’t feel like Charlie Brown talking to his parents and just hear “blah, blah, blah,” when you are explaining important health related issues.

Patients (those are the horizontal people in hospitals) are often not at their intellectual peak while hospitalized. Remember this is our workplace—not theirs—so we need to be a little more diligent when explaining complex, emotionally charged issues.  Here are a few pointers that will help you with your ability to explain what’s going on in a way that the patient may understand:

  • Provide more information than you believe is necessary
  • Provide the option of having another person in the room to hear the information, take notes, and ask questions
  • Encourage patients to write down their questions in between visits. This allows them the opportunity to think about the previous interactions and formulate questions that specifically address their fears and concerns
  • Ask patients if they need any more information

Remember that we often get caught up in our jargon and patients “appear” to understand as they don’t want to disappoint their physician or appear not so bright.  Ask follow-up questions that probe their understanding. You may be surprised by how much your patient did not understand once you start asking them these questions.

So go forth and improve the satisfaction of those we serve, while simultaneously improving quality, publicly reported measures and making your job easier. I couldn’t resist. This will make your job easier. Read next week’s post to see how.

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.

Featured webcast: Assessing the competence of low- and no-volume practitioners

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. To learn more or to register, click here.

Patient Satisfaction Blog Series for CRC 2012

I’m Sorry, What Did You Say?

As I mentioned in my last post, there are three physician-specific questions on the Hospital Consumer Assessment of Healthcare Providers and Systems HCAHPS survey. They are:

  • During this hospital stay, how often did doctors treat you with courtesy and respect?
  • During this hospital stay, how often did doctors listen carefully to you?
  • During this hospital stay, how often did doctors explain things in a way you could understand?

This post will deal with tips to improve your scores on the listening question.  Hopefully you have tried to be a little more respectful (as discussed in my last post) and have found it rewarding.  So let’s improve your listening skills now.

You have probably figured out this is a perception issue, and you are correct. The following tips have been shown to improve the patient’s perception that you are listening:

  • Sit down during the conversation portion of the visit
  • Ask open-ended questions and listen with empathy
  • Use “reflective” listening (paraphrase, clarify, ask for understanding)
  • Offer a physical gesture, such as a handshake, a touch on the shoulder, or a pat on the knee
  • Make eye contact with the patient and family
  • Pay attention to the patient and not the chart or cell phone

Although these tips improve the perception that you are listening, you actually do need to listen carefully.  Remember back to medical school when the wise attending said that the patient will tell you what is wrong with them if you will only listen?  My experience is that they were right.  How about your experience?

 

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.

Patient Satisfaction Blog Series for CRC 2012

Courtesy and Respect? Don’t have to; I’m the Physician!

As I mentioned in my last post, there are three physician-specific questions on the Hospital Consumer Assessment of Healthcare Providers and Systems HCAHPS survey:

  • During this hospital stay, how often did doctors treat you with courtesy and respect?
  • During this hospital stay, how often did doctors listen carefully to you?
  • During this hospital stay, how often did doctors explain things in a way you could understand?

This post will deal with tips to improve your scores on the courtesy and respect question.  Hopefully you have bought into the concept that improving patient satisfaction improves quality.  If you haven’t yet, then try these suggestions and see what happens.

Since approximately 85% of communication is non-verbal, pay particular attention to your body language. We have all been in situations where the body language was so loud, that the spoken words could not be “heard.”  Clear your mind prior to beginning the encounter.

Brush up on your polite behaviors such as:

  • Knocking on the door before entering
  • Making eye contact with the patient and visitors
  • Introducing yourself and the members of your team
  • Addressing the patient by their preferred name

Also, do not discuss the patient in the third person when they are present.  They are not just the “gallbladder in room 203” but actually a person, too.

These are just a few of the proven methods to improve patient satisfaction and your score on this question.  Try these out this week; next week I’ll be sharing about listening skills.

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.

Holy Moly, He Wants to Come Back!

Okay, here are the questions:

  • What do you do when the physician requests his privileges be restored after he returns from rehab for his cocaine and sexual addictions?
  • What do you do when the 67-year-old internist, who retired five years ago, has just been hired by administration to be your new hospitalist?
  • What do you do when your favorite cardiologist returns from a medical leave of absence after suffering a significant stroke?

Of course, these scenarios cause more questions than answers. You suddenly wish you had declined the invitation to be chief of staff of your medical staff. The fact remains that demographics apply to physicians as well as the general public.

Alcohol and substance abuse is 12-14% in the general population and is the same or somewhat higher in the physician population. (P Hughes, Prevalence of Substance Abuse Among US physicians, JAMA, 1992) Sexual addiction, especially cyber addiction to pornography, is present in 6-8% of the general population and one out of five are women. (Carnes, Am J Prev Psychology Neurology, 1991, 3:16-23) Dementia is present in 13.9% of individuals 71 and older and 9.7% of these have Alzheimer’s disease. (Plassman, et al, Neuroepid, 2007) Stroke recovery is possible, but of course, varies widely depending on age, severity of the injury, rehabilitation efforts, and support to name a few. None of us are immune from these possibilities.

Okay, now a few answers. Patients are more important than physicians. Don’t get caught in the trap of treating physicians as “special people.” First and foremost, you should have a concrete policy for dealing with all of the above possibilities. It must be iron clad, fair and equitable, be consistent with HIPPA and the American Disability Act, should be patient-safety focused but also allow for the physician to return to your medical staff. This begins with a viable and credible Physician Health Committee, an engaged credentials committee, OPPE and FPPE plans on steroids, legal advice, and a “Fitness to Work” evaluation from an objective and independent physician.

Want more from Dr. White? R Dean White DDS, MS, of Dean White Consulting, will be speaking about how to create a physician re-entry process at the 15th Annual Credentialing Resource Center Symposium, May 10-11. For more information, click here. 

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.

Quality differences among hospitals

A recent HealthDay article reports that quality varies in the over 5,000 hospitals reporting outcomes to HealthGrades, a healthcare rating company providing information on physicians and hospital quality outcomes.

The report states that patients are 73% less likely to die at a five-star hospital than a one-star hospital (five-star is the highest rating and one-star the lowest).  As this data came from CMS calculations from this three-year study, it showed that 240,000 less Medicare patient deaths would have occurred if all the patients were treated at a five-star hospital.

Here we go again. Let’s fire up the public using data that may not necessarily be comparable.

Although the data may not be comparable, it does not negate the fact that we need to make our institutions safer and improve quality. We need to be constantly vigilant. We need to embrace evidence-based medicine, patient safety initiatives, and transparency. The public will not allow us to become complacent. Are you, or those at your institution, complacent?

Editor’s note: William Mills, MD, MMM, CPE, FAAFP, CMSL, will be leading a session on how physician leaders and MSPs can use patient satisfaction scores to assess and improve physician performance at the 15th annual Credentialing Resource Center Symposium, May 10-11, in Orlando. For more information on HCPro’s premiere credentialing event, click here.

Want a 50% pay cut?

A recent opinion piece in USA Today responds to a study from Columbia University “blaming” high physician salaries as a significant contributor to rising healthcare costs, including the predicted doubling of family health insurance costs by 2021. Since physicians earn approximately five times the US median income, and earn more than physicians in six other developed countries that were studied, it must be physicians’ fault. Let’s cut physician earnings by 50%; that will fix it, right?

Well, maybe not. What about the educational debt owed by physicians, which is often around $300,000?  What about the 30%50% of gross revenue spent on office overhead?  What about the 60-hour average physician work week? What about the fact that the primary care physician shortage by 2020 is estimated to be 40,000?(I’m sure decreasing earnings will help that!) Lastly, what about the fact that physician take home pay accounts for approximately 10% of healthcare costs?

As a family physician who practiced for 20 years and was forced to juggle many of the above factors, I’m a little offended that folks think physician salaries are to blame for the economic woes of the healthcare system. What do you think?

Is the doctor a ‘doctor’?

A recent article in The New York Times raises some of the issues surrounding the use of the word “doctor.” We are all aware from our undergraduate days that there are many doctorate degrees offered in a large number of academic disciplines.

In the healthcare arena, the word doctor is generally understood to mean a physician with a M.D. or D.O. degree. However, that is now changing. We have doctors of pharmacy, physical therapy, psychology, and nursing to name a few. Yet, when someone wearing a white coat introduces themselves as Dr. Smith to a patient, the patient will most likely assume that person is a physician.

So why the push for so many types of doctorate degrees?  Is it the continual pursuit for knowledge and recognition of the same?  Is it the prestige of the word doctor in the healthcare setting?  Is it motivated by the thought that the word doctor means a higher salary?  Is it an attempt to confuse or mislead patients?  Is it an attempt to allow non-physician healthcare workers an increase in scope of practice and autonomy?

Some states are creating legislation to control the use of the word doctor. Should that have to happen? Or should we, the healthcare providers, decide how to proceed? As you can see, I have raised many more questions than answers. What do you think?