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Joint Commission issues quality and safety report

Good news from The Joint Commission. According to its Annual Report on Quality and Safety, hospitals are providing safer, higher quality care than they did in 2002. In addition, hospitals have significantly improved the quality of care provided to heart attack, pneumonia, surgical care, and children’s asthma patients. However, improvement is still needed in two areas that were introduced in 2005; hospitals must do better providing fibrinolytic therapy within 30 minutes of arrival to heart attack patients and providing antibiotics to ICU pneumonia patients within 24 hours of arrival. 

Check out the full report.

Will we see you at the NAMSS conference?

HCPro will be attending the 34th annual National Association Medical Staff Services conference October 2-6 in Orlando.  Stop by the HCPro/The Greeley Company booth in the exhibit hall and say hi to associate editors Emily Berry and Julie McCoy and executive editor Erin Callahan. Emily, Julie, and Erin will be happy to explain our products and services and are eager to learn what your biggest medical staff challenges have been during the past year.  

To get customer input on some of HCPro’s new product ideas, we will also be hosting two focus groups during the conference: 

  • Focus group one: Monday, October 4, 4:15pm-5:30pm
  • Focus group two: Tuesday, October 5, 4:15pm-5:30pm

If you are interested in participating in either of these focus groups, please contact Emily at We hope that you join Emily, Julie, and Erin for one of the focus groups to share your ideas, meet fellow development partners, and enjoy light refreshments and hors d’oeuvres.

How much health did you make today?

Two articles in the August 12 issue of the New England Journal of Medicine highlight the difficulty in assessing the work product of physicians. The first article, “Quality Measures and the Individual Physician,” describes the difficulties encountered by a primary care physician, Danielle Ofri, MD, PhD, in achieving desirable scores on process measures, such as glycohemoglobin and blood pressure.

The second article, “Accountability Measures—Using Measurement to Promote Quality Improvement” (by Mark Chassin and others) outlines a method for ensuring the validity of measures used by regulatory agencies. Many of us find ourselves in a predicament similar to Dr. Ofri—measured against processes that she is seemingly unable to influence. Incentives are proliferating in hospital medicine and most are based on compliance with various aspects of evidence-based medicine. Does this actually make patients healthier? I do not know.


Doctor accused of unnecessary stents: What happened to the peer review process?

It’s every hospital’s, doctor’s, and patient’s worst nightmare—a doctor allegedly committing fraud, a stack of lawsuits, and claims of complications after surgery. Each member involved in the cardiac stent cases at St. Joseph Medical Center in Towson, MD, continues to be more entwined as the story unfolds.

The Maryland Board of Physicians investigated and this month met with Mark G. Midei, MD, for “gross overutilization of healthcare services” and “willfully making a false report or record in the practice of medicine,” among other violations of the Maryland Medical Practice Act, according to a June 11 Baltimore Sun article.


Sharpen the tools in your interactive recruitment marketing kit

In the physician recruitment cycle, we are at a critical stage when residents and fellows who completed training in 2010 have started practicing, and the members of the class of 2011 have started searching for their dream jobs in earnest. Our current Cejka Search focus group of 2011 residents and fellows revealed that more than half of residents and fellows have already started, or will begin, to interview before the year’s end, and more than one-third say they hope to sign a contract by that time.

The urgency for reaching out to these young recruits is high, and the channels with which to reach them are diversifying with every new technology that emerges. Manhattan Research stated that the “professional use of smartphones and online user-generated content are no longer early adopter activities of a tech-savvy few; these types of activities are the norm for the majority of physicians today.”


Medical staff advisor: Advocate for MSPs

One of the most valuable duties of the medical staff advisor is the working alliance with the medical staff professionals. As a group, MSPs are probably the most unappreciated employees of the hospital. They serve as the gatekeepers of safety in their credentialing and recredentialing roles and assist the medical staff as it performs its primary duty of governing itself. Many times, administrators and other hospital departments do not understand the depth and breadth of knowledge these dedicated professionals possess or their passion for keeping patients safe.

The medical staff advisor can serve as a senior advisor to MSPs, as well as provide a buffer between the medical staff officers and administration. They can help the MSPs as they seek to implement change by explaining, introducing, and adopting new Joint Commission standards, CMS directives, and other regulations.

This relationship is a two-way street, and the medical staff advisor is continuously educated by the professionals on current rules and regulations and what is needed to maintain good medical staff governance.

Over the past few weeks, I have described just some of the ways medical staffs and hospitals can leverage seasoned physicians for the common good of the hospital, the medical staff, and–most importantly–the patient. Given the opportunity, the medical staff advisor can leave the place a little better than he or she found it.

Avoid confusion when wearing multiple hats

Many times physicians wear different hats, meaning they hold different roles within the hospital and function under different scopes depending on which hat they are wearing. Physicians switch hats so often that it can sometimes be difficult for staff to identify which role a physician is functioning under. However, it can be an important clarification that the physician needs to make.

For example, if a physician is in a training program and moonlights in another area of the hospital, it’s important to ensure that the staff understand the difference in the scope of the practice that the physician may function under while wearing his “fellow-in-training” hat versus his “general attending” hat when he is moonlighting. If he or she is a sub-specialty fellow for example, he or she may require direct supervision when performing certain services as a part of the training program; however, when moonlighting as a generalist in another service, he or she would be granted privileges specific to that area. Because the Accreditation Council for Graduate Medical Education does not allow a resident or fellow to moonlight in the same area in which he or she is training, this helps to eliminate some of the confusion. However, the organization and training program director need to ensure that this potential liability is clearly addressed in policies.

Another example is when a physician holds a medical staff leadership position, or many leadership positions, and continues his or her clinical practice. Often times, medical staff leaders will need to make administrative decisions that require them to determine which is the most appropriate hat that the decision should be guided by. For example, a chief medical officer who also serves as a committee chair may make decisions not in his or her role as the CMO, but in his or her role as the committee chair. When addressing communication while wearing the hat of committee chair, he or she should be sure to address that the communication accordingly.

Hospitals introducing palliative care in the emergency department

About 200,000 patients per year enter the ED but never leave. Another 500,000 die during their hospital stay after emergency treatment. But these patients and their families may not be getting the attention they need in the emergency room. That’s why several hospitals have started incorporating palliative care into their EDs, according to an article on, a daily general interest Web magazine owned by The Washington Post. Emory University, Northwestern Memorial Hospital, and Montefiore Medical Center, among others, are experimenting with palliative care in the ED. For example, at Northwestern, emergency physicians have learned to call the palliative care team for complex emergency cases, and at Montefiore, a palliative care nurse is stationed in the ED.

Aging practitioner policy survey

The medical staff advisor as mediator

Peer review activities and credentialing committee deliberations and recommendations are arguably the main reason the organized medical staff exists. Traditionally medical staff members sought these committee appointments. However, for whatever reason, the number of physicians that are willing to perform these duties is diminishing. Medical staff advisors can serve on these committees. Particularly if he or she is retired, the partner or competitor conflict goes away and the medical staff advisor can become a statesman and not a “turf warrior.”

The medical staff advisor can also provide the cultural history of how the medical staff has approached similar problems or questions in the past, such as interviews, longer provisional periods, proctoring arrangements, and referrals to the physician health committee to name just a few. Many times, practicing physicians are hesitant to evaluate a fellow physician’s clinical competence, but the medical staff advisor can be the catalyst to aim the discussion in the right direction. Instead of looking for reasons not to investigate or discipline a physician, the medical staff advisor many times is in the unique position to describe  how similar behavior in the past has resulted in less-than-desirable outcomes.


Monopoly or the New World Order?

An August 16 article in The Washington Post raises a concern that the formation of accountable care organizations may create monopolies and increase the cost of healthcare. An eight-hospital system that employs 550 physicians in Virginia has caused some to wonder if this is “a new model for health care or a blatant attempt to corner the market.”  

With healthcare reform looming on the horizon, many organizations are scrambling to find ways to survive in the new paradigm, whatever it may be. Physician alignment strategies, vertical and horizontal integration strategies, and service line growth strategies are just a few of the options the industry is evaluating.  Everyone knows that life will not be the same in healthcare, but no one knows exactly what the new world order will look like. Will the lofty attempt to improve healthcare degenerate into a monopoly system that will stifle competition and increase costs?  Or will the system become one that provides care that is safe, effective, efficient, personalized, timely, and equitable?

As Abraham Lincoln said, “The best way to predict your future is to create it.” Physician leaders must take an active role in defining and preparing for the future of healthcare.  Are accountable care organizations the way to go? Is the medical home model feasible for the majority of patients?  Is there a better paradigm?  Whatever your thoughts, physicians must no longer be passive and content to “just practice medicine.” Now is the time to create our future and the future of those we have taken an oath to care for. I am certainly interested in your thoughts on this.

9 tips for conducting peer review in the face of discoverability

They call Missouri the “Show Me State,” but perhaps that name is better suited for Florida. In the September issue of Credentialing & Peer Review Legal Insider, I spoke with George Indest, an attorney with The Health Law Firm in Almonte Springs, FL about the consequences of Amendment 7. Amendment 7—otherwise known as the Patient Right to Know about Adverse Medical Incidents Act—makes  what would normally be considered protected peer review information discoverable to the public. Originally meant to help patients do research on their healthcare providers, the amendment has stifled peer review efforts across the state since it was implemented in 2004. As case law continues to define the amendment, many medical staffs are choosing to minimally document peer review activities to protect physicians from the career damaging effects of discoverability.

However, choosing to keep only sketchy documentation of peer review activities can have a negative effect on peer review as a whole. According to Indest, inadequate documentation can result in  the inability to obtain meaningful feedback from the healthcare providers involved in specific incidents of adverse care due to their inability to identify the specific incident or patient about whom feedback is being sought, inability to comply with certifying or accrediting organizations’ guidelines and requirements, failure to be able to show compliance with state requirements for peer review activities.

To avoid these undesirable consequences, Indest recommends the following: