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TJC releases more FAQs on MS.01.01.01

The Joint Commission on Thursday released new information of frequently asked questions (FAQ) regarding MS.01.01.01.

The Joint Commission introduced MS.01.01.01, the medical staff bylaws standard formerly known as MS.1.20, in May 2010 when the accrediting body revealed its FAQ, explaining the relationship between the medical executive committee and the medical staff. The standard may affect many institutions as they must amend their medical staff bylaws, rules and regulations, and policies.

The new FAQ further reveals:

  • Medical staff representatives(s) should participate in all governing body meetings.
  • There is no requirement in which the organized medical staff must formally meet when it adopts or approves medical staff bylaws and revisions of amendments.

MS.01.01.01 goes into effect on March 31.

The ‘S’ word

As value-based purchasing approaches, hospitalists are going to feel the heat from hospital administrators. I believe that this is largely a shell game played by the Centers for Medicare & Medicaid Services to give hospitals the idea that they can win at this game, when all but a few will lose. The reality is that Medicare needs to reduce payments to hospitals to avoid impossible deficits. There will be pressure in all areas to reduce costs, and I can’t help but believe that hospitalist subsidies will be a prime target.


Slideshow: The top blog posts of 2010

Did you miss some of the most popular blog posts this year? Don’t fret. We’ve compiled the top 10 news stories and tools of 2010 here:

10. Joint Commission updates blood transfusion requirements (September 28)

9. Free form: Example seven-day on/seven-day off hospitalist schedule (January 12)

8. ABMS and ACGME update core competencies: Don’t forget about procedural skills (October 11)

7. CMS issues first clarification on accountable care organizations (June 11)

6. Contest entry: MSP orientation plan (May 19)

5. Improving patient satisfaction scores one question at a time (May 3)

4. Free form: Clinical references policy and procedure (June 24)

3. MSPs offer tips for working collegially to accomplish goals quickly (July 6)

2. Contest winner: OPPE for low-volume providers (April 30)

1. Contest winner: Physician report card (May 26)

Related: Top blog posts of 2009 Yeah or nay?

A recent Archives of Surgery article, “Say It Ain’t So, Joe: Comment on ‘Hospital Process Compliance and Surgical Outcomes in Medicare Beneficiaries,’” questions the utility of the Centers for Medicare & Medicaid Services Web site The article states that patients did as well (surgically) in the lowest scoring hospitals as in the best scoring ones. So the question is, “Should hospitals spend time collecting and trying to improve their scores?” 

My bias is that publically reported data is a good thing. For far too long, hospitals and physicians have explained away quality issues and not been held accountable. It is certainly time that we all step up to the plate. That said, I question the methods. It is difficult for the public to understand what is beneath the ratings. Is there really “bad” quality, or did only one of the three cases that met the criteria for reporting fall out due to a legitimate medical or documentation issue? We need a better way to let the public know about the good work we are doing, the improvements we’ve made, and the fact that we are holding ourselves accountable. Maybe the government shouldn’t be the purveyor of information—shouldn’t it be our job as physicians?

Mandatory flu shots for healthcare workers

An article in the Tuesday, October 26, 2010 MedPage Today discussed making influenza immunizations mandatory for healthcare workers as potentially the only way to approach 100% compliance. The traditional methods of education, easy access to free vaccines, and peer support fall short of the mark. Last year, New York State mandated influenza immunization (including H1N1) of all healthcare workers, but pulled the law at the 11th hour in response to significant political pressure. My bias: it is unconscionable for healthcare workers to put the at-risk population we care for in jeopardy of acquiring a potentially life threatening illness due to our right to refuse immunization. That said – what about religious convictions? What about our right to decide what is best for us?  Who is responsible if a significant adverse reaction occurs to a healthcare worker who was forced to be immunized? I believe the benefits far outweigh the risks. What do you think?

AHRQ releases new common format for adverse event reporting on health IT

The US Department of Health and Human Services’ (HHS) Agency for Healthcare Research and Quality (AHRQ) has released a new common format designed to help healthcare providers collect information about adverse events related to health information technology and devices. 

This common format entitled, Device or Medical/Surgical Supply including HIT Device, is currently available as a beta version for public review and comment. The format will be revised based on feedback and released with AHRQ’s Common Formats, version 1.2 in August 2011.

To view AHRQ’s full set of common formats (Version 1.1) along with technical specifications, and accompanying user information, visit the AHRQ’s patient safety organization (PSO) Web site at

Common formats, which are authorized by the Patient Safety and Quality Improvement Act of 2005, establish a standard language, definitions, technical requirements, and reporting specifications that patient safety, quality, and risk managers; clinicians; and others can use to collect patient safety event information. PSOs use common formats to ensure consistency in reporting patient safety event information and allow aggregation and analysis of comparable, interoperable data at provider, PSO, and national levels. 

For more information, please contact Ellen Crown, Health Communications Specialist in the Office of Communications and Knowledge Transfer at the Agency for Healthcare Research and Quality at (301) 427-1258 or

ABMS and ACGME update core competencies: Don’t forget about procedural skills

The American Board of Medical Specialties (ABMS) and the Accreditation Council for Graduate Medical Education (ACGME) announced an increased focus on procedural skills, according to a joint September 30 press release issued by the two organizations.

ACGME and ABMS is updating the six core competencies for physician performance measurement since they defined them in 1999. Procedural skills is categorized as a subset of the patient care core competency for which trainees and board-certified physicians must demonstrate proficiency. The competency previously known as “patient care” now will be referred to as “patient care and procedural skills.”


Where are all the doctors?

Although it might not come as a surprise, a new study says that all U.S. specialties are currently experiencing growing shortages, and it will get worse than previously thought because of healthcare reform.

According to the Association of American Medical Colleges (AAMC), physician shortage in all U.S. specialties will reach 90,000 in the next decade. The report predicts a shortage of 45,000 primary care physicians and 46,000 surgeons and medical specialists.


SHM goes to Washington – Part II: Bundled payments

In my last post, I wrote of visiting legislators on Capitol Hill along with my colleagues on the Society of Hospital Medicine (SHM) Public Policy Committee. The second day in DC was spent in a Public Policy Committee strategic planning session.

To begin the day, Karen Milgate, Director, Office of Policy, Centers for Medicare & Medicaid, treated us to a very informative briefing. Karen was very helpful in explaining the process of writing the rules and regulations required to enact the healthcare reform bill. I came away with a deeper understanding that, even though the bill is passed, reform is far from well-defined. We need to remain engaged as the regulatory agencies seek public comment on the endless rules and regulations required of this legislation.

Welcome to Lake Wobegon

The advent of Medicare’s Value-based Purchasing program next year is going to present significant challenges for hospitals and hospitalists. The Centers for Medicare and Medicaid (CMS) will be holding back 10% of hospital payments. The top 10% of hospitals achieving high scores on a composite measure combining core measures, HCAHPS, and readmission rates will get full payment. The next 40% of hospitals will get a portion of the holdback. The bottom half of hospitals will get nothing and will be losing 10% of Medicare revenue. Many of these hospitals would be forced to close, as they are barely surviving now.

I don’t think that Congress is really prepared to close half the hospitals in this country, and we may see something similar to the continuing debacle of the Sustainable Growth Rate system, which has been postponed every year since it was enacted. Hospital administrators have been extremely skilled at exploiting loopholes in Medicare reimbursement. As I write this, Garrison Keillor is on the radio telling a story about his mythologized hometown, Lake Wobegon, “where all the children are above average.” I suspect that hospitals will find ways to all be above average, with some complicity from CMS. I once lived in a college dormitory that was legally declared to be a ship in the US Navy, even though it was on dry land and had no capacity for flotation, so do not discount the ability of the government to torture a definition if it suits a purpose.

Regardless of any sleight of hand that may occur, we will need to bring the performance of our hospitals to a higher level. Patient satisfaction, readmission rates, and core measure compliance will be pocketbook issues for hospitalists. I think that there are significant opportunities for those of us who are able to form effective interdisciplinary teams in our hospitals and improve the efficiency of care.

SHM goes to Washington

On May 26 and 27, I was privileged, along with 25 other members of the Society of Hospital Medicine (SHM) Public Policy Committee, to visit the offices of senators and congressional members on Capitol Hill. Our mission was to educate and inform them on how hospital medicine is impacting the healthcare delivery system, as well as offer ourselves as resources for consultation on such topics in the future. I found this to be a fascinating experience on several fronts.

1. This was my first time to conduct such visits so I had no idea what to expect. There is a wide range in the level in understanding of what a hospitalist does and what hospital medicine really is. Some people I met with were very well informed about hospital medicine whereas others were only vaguely familiar with the term hospitalist. According to many of my colleagues on the committee, each year has revealed a little bit deeper understanding of our work. So I concluded that although we have come very far in educating legislators, there is still much work to do.


Joint Commission adds anti-discrimination language back in to medical staff chapter

The Joint Commission has added antidiscrimination language to MS.06.01.07 and MS.07.01.01 that prevents medical staffs from making medical staff appointment and credentialing decisions based on gender, race, creed, or national origin, according to the June issue of Perspectives. The Joint Commission had deleted similar language back in 2003 because it felt that antidiscrimination issues were addressed elsewhere in the Comprehensive Accreditation Manual for Hospitals, but The Joint Commission’s Standards and Survey Procedures Committee found that the language was not sufficient. The standards will go into effect July 1.