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.
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.
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.
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.
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.
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!
In the May issue of Credentialing & Peer Review Legal Insider, we discuss with Linda Van Winkle, CPCS, CPMSM, manager of medical staff services at Christus St. Patrick in Lake Charles, LA, the chart review form and the peer review referral form that she submitted to the Credentialing Resource Center Symposium contest. These two forms have helped in Christus St. Patrick’s quest to reduce the number of peer review cases that are sent to the multi-disciplinary peer review committee unncessarily and have helped Van Winkle sail through the OPPE process. In the newsletter, Linda explains why she developed the forms and how to use them. Check them out and see if your facility can adapt them.
Thanks for sharing, Linda!
National Doctor’s Day is quickly approaching. Hint: It’s on March 30. There’s still time to organize events and activities to recognize your physicians. Here are some ideas to honor your physicians at your institution:
Food is always a crowd pleaser and lends itself to good conversation. Whether it’s breakfast, lunch, or dinner (depending on your budget), remember to include various options for special dietary needs (vegan, gluten-free, kosher, etc.). Who doesn’t enjoy a good meal?
- Theme parties
Remember to have fun with the day. Consider creating a decorative theme for each year’s Doctor’s Day, such as the Doctor Oscars, superheroes, or M*A*S*H. The medical staff office can take it a step further and even dress up in custom.
You may have noticed that the HCPro editors have been a little quiet on the blog lately. We’ve been busy wrapping up our projects for 2010 and brainstorming ideas for 2011! As an editor, I have the benefit of working on multiple projects, including two newsletters and multiple books. Managing these products means that I get to talk to new people and learn new things every day. I’ve had a chance to come up for air this week, so I wanted to share with you some of the things that I’ve learned in the past month.
1. Sexual addiction is just as serious as drug or alcohol addiction
Some people may consider sexual addiction a weakness, rather than a disease, but it’s not. Medical staffs should be just as vigilant finding treatment resources for physicians with sexual addiction as they are for physicians with drug or alcohol addiction. Professionals of all types are increasingly admitted to addiction treatment centers for compulsive behavior involving sexual issues, according to Dean White, DDS, MS, in A Practical Guide to Managing Disruptive and Impaired Physicians, Second Edition, which will be released in mid-December.
White writes: “I recently had a conversation with an emergency room physician who admitted that when it comes to addictions to cocaine and sex, ‘the high from the sexual addiction is far greater and much more difficult to overcome than the one to cocaine.’… The physician who continues to hit on nurses, tell dirty jokes, and touch people inappropriately affects patient safety because the nurses will avoid him at all costs, and that could limit physician-nurse communication. Physicians with a sexual addiction may view pornography on the internet during working hours or “sext” people (send inappropriate messages or photographs via text message). Addicts are at a real risk of acting out their fantasies with patients or employees.”
“Undercover Boss” and “Honey, I Shrunk the Kids” from the medical services professionals perspective
Motivational, strategic, or management presentations often tell us to “think like a CFO” or “approach challenges from the CEO’s perspective.” This is sound advice. However, there are times when it is beneficial to view processes from the worker’s perspective. Looking at a process from the staff’s perspective often reveals the need to review and revise established rules or practices.
“Undercover Boss” is a TV show wherein the owner or president of a company goes undercover to determine the affect company policies and practices have on day–to-day operations; it features top execs “hitting the front lines for an unfiltered look inside their own companies.” As the manager of the medical staff department or a medical staff leader, you cannot go undercover per se, but you can spend time reviewing processes with staff to better understand their perspective and hear their ideas about how to improve a specific process.
Looking to create name recognition, give your career a boost, or simply share your bright ideas? We’re now accepting applications to present at the 2011 Credentialing Resource Center Symposium at Caesars Palace in Las Vegas, May 12 – 13, 2011. We are looking for medical staff professionals and medical staff leaders to speak on the following topics: privileging, credentialing, practitioner competency, and medical staff organization and leadership.
If you are interested, download a copy of the application. Please submit your completed application to Associate Editor Emily Berry at firstname.lastname@example.org by Monday, August 16.
The medical staff services department supports the activities of the medical staff in many ways, from credentialing practitioners to taking meeting minutes. Ultimately, MSPs touch every department in the organization, including information systems, communications, finance, dietary, administration, quality, human resources, clinical services, nursing, medical records, payroll, education, and public relations, just to name a few.
As the medical staff services department reaches out and collaborates positively with so many other departments, it assumes public relations and internal customer service roles. I like to envision all of the departments within the hospital as an atom—a nucleus surrounded by electrons. When all the atoms come together, they create energy, and that energy can be used in a positive way or a negative way.