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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.

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.

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.

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?

Centralization of physician performance data

The structure for collecting and trending practitioner data varies from organization to organization. In many, all FPPE and OPPE data is collected, tracked, and trended by medical staff services departments. Incident reports related to patient grievances or other clinical concerns may be tracked and trended through the risk management department while peer review and individual practice deviations may be tracked and trended through the quality review department. In addition to hospital performance, division chiefs may keep division files on any issues that are reported and/or addressed by them.

It is important for organizations to have a clear picture of a practitioner’s performance. Centralizing where practitioner data is tracked will eliminate the possibility that there is performance data missing when conducting performance reviews. Although different departments may handle and/or address different issues related to performance, there should be one central repository for physician data. Departments should then forward all data to this area for safe keeping and filing in the practitioners quality file.

One of the first steps in developing a central repository for practitioner performance data is education. Organizations should spend time educating their division chiefs on how to address concerns that are brought to their attention; when collegial intervention is appropriate and when an issue must be escalated or forwarded to another department and/or a formal medical staff committee. Division chiefs should be educated on how to document performance issues and how to document the steps that they have taken to resolve the concerns. Ensuring that all concerns are well documented helps protect the division chief as well as the organization should an issue arise later which requires further scrutiny or results in due process.

Should an investigation be initiated, having all data centralized saves time and ensures a more thorough review. Having a one-stop shop for all incident reports, collegial interventions, peer review referrals, and all other clinical performance data allows the committee conducting the review to have a full picture of the practitioner’s performance. Organizations should also include all positive feedback in the quality file and should always respond to a practitioner when a review is conducted and the care he or she provided is deemed to have met or exceeded the standard.

Centralization of practitioner performance data not only benefits the committees or division chiefs conducting performance reviews, but also helps protect the organization from claims of negligence should they conduct reviews without all of the information available.

Palliative care in the emergency department?

A recent Washington Post article titled “Hospitals make palliative care a priority to improve patients’ quality of life,” raises the issue of providing palliative care in the emergency department.  This notion is a far cry from the standard ED mentality of fix it all—and quickly. But when you consider that a large percentage of patients presenting to the ED arrive with a flare up of chronic severe illnesses or significant injury that can be life altering, then maybe discussions about end of life care and the institution of palliative care measures should not be such a foreign concept. If we truly strive to be patient-centric, shouldn’t we be abiding by our patients’ wishes and helping them with the tough decisions?  In the fast-paced world of the ED, shouldn’t we be using a checklist to make sure we are addressing more of the patient’s needs than just the presenting symptom? Is our bias that since palliative care grew out of the hospice movement that this should be something addressed by the oncologist or PCP, and not the ED physician?

New York State recently enacted a regulation requiring physicians to discuss and document their interactions with patients about palliative care and end of life issues.  What does that say about healthcare providers being pro-active and patient-centric? So palliative care in the ED—you bet!  But it should not stop there; it should be addressed in every healthcare setting.  To quote an anonymous 16th century writer, our job is to “Cure seldom, relieve often, and comfort always.”

My hospital’s palliative care committee is working hard to ensure that patients are getting what they need, when a “cure” is not possible. How about yours?

Connect the dots

I have been spending most of my time reviewing admission documentation for hospitals across the country, and it is surprising to me that rather few physicians will commit to a diagnosis for incoming patients.  I see “dyspnea” instead of “CHF” or “pneumonia,” “diarrhea” instead of “gastroenteritis” and “dysuria” instead of “urinary infection.”

Emergency physicians seem to be especially reticent to make a diagnosis, but hospitalists are not far behind. It creates a problem for the hospital because medical necessity for inpatient services is based on the presence of a condition that may incur significant morbidity or mortality, and the prescription of a treatment regimen appropriate for the condition. Determining necessity is more certain when a specific diagnosis is made. No one dies from shortness of breath, but one can certainly die from CHF or pneumonia, and there are well-established courses of treatment for those diseases.

I suspect that we started down this slippery slope because the definitive diagnosis of myocardial infarction can be difficult, even when the electrocardiogram and enzymes are abnormal.  This led to the term “R/O MI” as an admitting diagnosis. Ruling out a medical condition is really an observation service. Reticence to commit to a diagnosis can cost the hospital money. If you believe that the chest pain is related to heart disease, why not describe it as “acute coronary syndrome?” If the patient has fever, cough, and hypoxemia, it is appropriate to connect the dots and call it pneumonia, even if the x-ray is unclear. It is understood that admitting diagnoses may differ from the discharge diagnosis as more information becomes available. There is nothing to lose and much to gain from making your best estimate of the patent’s disease on admission.

Celebrate National Medical Staff Services Awareness Week with HCPro

Have you ever stopped to think about how your hospital would operate if the MSSD no longer existed? Who would prepare the hundreds of credentials files? Who would make sure the hospital’s privileging forms were up to date? Who would coordinate the next medical staff leadership retreat? And most importantly, who would remind you when it was time to submit your own credentialing and privileging reapplications?

You may not even be aware of all of the work that goes on in the MSSD. But this week is your chance to find out and to thank the members of your MSSD for their hard work. In 1992, President George Bush declared the first week of November as National Medical Staff Services Awareness Week.

In honor of this, HCPro is offering you and your colleagues a 15% discount on all of HCPro’s medical staff and credentialing products from Nov. 6-12. Visit the HCMarketplace and enter EO107658A during check out to receive your discount.  And don’t forget to thank your MSPs!

Nocturnist: A new concept?

One of my colleagues, Richard Rohr, MD, MMM, FACP, FHM, posts frequently about hospitalist issues. I thought I would poke a little too.

In a recent issue of the Tennessean, the concept of “nocturnists” was discussed. The article states what we all know: Hospitals are not safe places. Truth be told, we all knew this prior to the Institute for Medicine’s 1999 report, but it was one of healthcare’s dirty little secrets that we kept from the public. However this article cited several studies showing that hospitals are even less safe on nights and weekends. (Would that be another of our secrets?)

So is a nocturnist a new concept or is this a better dressed house doctor of yesterday? Should the goal of a hospital be to have physicians at night, or should the nocturnist really be a member of an integrated hospitalist system? I’ll agree that if there isn’t a physician in house at night (exclusive of the ED) that having one is a great first step. However having a nocturnist should not be the end game. Consistent coverage by a team of well-trained, experience hospitalists should be the goal. Thoughts?