MSSPNexus Blog

Simple Data Solutions - Simple For You, Not So Much For Me

Ever thought about starting your own business? Entrepreneur, according to Dictionary.com is "A person who organizes and manages any enterprise, esp. a business, usually with considerable initiative and risk." For the past several months I've been diligently working toward opening a small start-up, which should be ready for prime-time within the next couple of months.  It has been an exciting, scary, exhausting, major-learning-curve, process.  Did I mention exhausting?  My eyes are about to fall out of my head from so many late nights staring at a computer screen! The business is SimpleDataSolutions.com, and the first product strangely enough, has not a thing to do with credentialing, privileging, or medical staff administration.  It does have to do with heatlhcare, and complying with CMS Conditions of Participation however, so maybe it's not such a stretch after all. One of my "day job" co-workers just released a book and audio CD, "Complying With CMS Patient Grievance Regulations", which is designed to help hospitals and ambulatory surgery centers understand and meet CMS and Joint Commission regulations and standards regarding patient rights.  (Note: Final CMS Rules are pending for ASCs.) As she was working on the book, she kept telling me that understanding regulations is only part of the problem healthcare organizations face; developing a system for tracking patient concerns, and the hospital or ASC's response to those concerns, is the other part. I don't generally worry too much about big organizations with large budgets as they have a multitude of options.  Smaller hospitals, and many of the 4,000 or so Ambulatory Surgery Centers around the country, are another matter.  I'm finding that often they are developing paper-based logs, or using an Excel spreadsheet, to help them track patient concerns and complaints. So, being the long-standing purveyor of "I'll just whip up a little Microsoft Access database we can use to track that..." I got to work, thinking "How hard can it be?"  Okay, time for honesty, it has been much more challenging than I originally thought.  I've learned to dread the words, "This is great Rita, but what about...?"  Aarghghh!  The database is just about done.  Now I'm working on license agreements and user instructions.  Yuk!  However, there's another new experience just over the horizon... I'm about to star in my very own (thankfully non-music) video production!  Users will have another learning option besides slogging through a boring technical manual.  I'll let you know how that goes.  Rumor has it the videographer has high production standards, so we'll see how he does working with a novice. Nothing ventured, nothing gained... gulp!

Dogs, Ponys, and the Hospital Credentialing Process

EM Physician writes about the fun she's having filling out hospital credentialing/privileging applications in The Hospital Credentialing Process Dog and Pony Show.  To say the least, EM Physician is feeling a bit testy at the moment, and not entirely without reason.

So, I've been filling out multiple hospital applications lately. It's not uncommon for physicians to have hospital "privileges" at multiple hospitals, you know? And it's *crazy* what's involved in this process.

Okay, here's how it goes -

First you get this huge packet, maybe 70-100 pages of...who knows what. A piece of paper for everything...completely unnecessary and purely a hospital CYA. Read, sign, read, sign. They ask for accompanying documents, such as a CV, copies of your medical license, DEA, ACLS, PALS, board certification, diplomas, health clearance, etc.

Read the rest.

Electronic Medical Records - Limping Forward

On December 3rd U.S. Health and Human Services Secretary Mike Leavitt wrote a serious blog post about use of electronic medical records and e-prescribing.  He stated that the Bush Administration supports a requirement that doctors adopt e-prescribing and electronic medical records in order to get the full Sustainable Growth Rate update (HHS statement).

Nearly everyone agrees that adoption of computerized medical records is both inevitable and positive.  Anyone who has ever attempted to slog through a multi-volume, hand-written medical record looking for specific information could only agree.  So other than cost, which can be enormous, what holds U.S. healthcare back from enthusiastically adopting electronic record keeping?

I'm pleased to report that I have located the definitive answer to this question.  While blog-browsing the other day, I read this in-depth analysis of the matter from Aggravated Doc Surg.  If you happen to be a regular reader as I am of this cantankerous curmudgeon's blog, you know that he often captures the essence of thorny issues while granting us reason to smile.

In his recent post on the developmental wonders of the electronic health record, he reveals that he was a teenage techno-geek and started out with a computer system similar to the first one we brought home. Ah, a trip down memory lane.

So, as he points out, he's not a total novice to the capabilities of computers.  (Actually, he uses a bit more colorful language, but you get the drift.) Regarding his review of current EHR programs the Aggravated One writes:

The systems that I have seen are so non-intuitive, so counter-productive, and so blinking difficult to navigate that they make other business world programs seem so advanced that they were given to us by time travelers who had spent time with Captain Kirk. Some of them have the feel of potpourri programs forced to work together but which were written in different programming languages in different decades, and they look as elegant as the interior of an AMC Pacer.

How about my 128 character sign-on password that must include capitals, small letters, at least a dozen numbers and the symbol for that guy who used to be called Prince...

Do take time to read the rest, it's quite an informative rant.

http://docsurg.blogspot.com/2007/12/ehrs-amc-pacers-of-computing-world.html

Grand Rounds 4.13

Grand Rounds comes to us this week from London.  Trick Cycling for Beginners, authored by a self-proclaimed "dissatisfied and stroppy junior psychiatrist working in the crumbling institution that is the NHS," hosts this week's collection of posts, cleverly dispensed in haiku.

Grand Rounds presents a weekly sampling of the best of the medical blogosphere.

Are You A Career Coach?

Unless your business cards include the title Career Coach, you probably don't think of yourself in those terms.  Maybe it's time you did.

Your daily responsibilities may involve patient care, medical staff administration, healthcare law, risk management, etc., but chances are you, at least occasionally, also fill the role of career coach.

Do people come to you for advice, or ask if they can bounce an idea off you?  Have you been asked for an opinion about a potential career move, or the best way to handle new responsibilities?  If so, congratulations, you're a coach.

I consider it one of the most meaningful and satisfying parts of my job when someone says, "I'd really like to get your thoughts about how I can best handle this situation." I feel honored by their trust.

So how can we bring out the best in other people?  Here are a few ideas. 

1. First, make sure that the other person wants, and is open to, coaching.  If they're not ready to listen it won't matter a bit how much wisdom and experience you have to share.

2. Give the person you're coaching your full attention, including eye contact; it shows respect and gives you the opportunity to better understand their needs.

3. Ask open-ended questions that require more than a single word response.  For example, "How do you feel about that?" or "What do you think you can do to improve the situation?"

4. By all means avoid saying "Well, if this were me, I'd try..." because it's not you, and it's not your responsibility to give someone else an absolute answer. It's your responsibility to help them sort out their thoughts and work on a plan of action.   

5. Help the individual weigh the pros and cons of their choices.  Give them a safe sounding board.

6. Help them evaluate and question their own assumptions.

7. Give sincere commendation and express confidence in their abilities.  Don't say what you don't mean, but be encouraging and focus on the positive.

8.  Express your continued interest, encourage the person to keep you informed about their progress.

9.  Be open to learning something from every person that asks you for guidance.  You may see a solution or an opportunity through their eyes that you might never have seen through your own.

10. Keep up the good work.  We need more people like you.

 

Patient Complaints - How Does Your ASC Handle Them?

I'm featuring a brief article here from guest writer Lisa Venn, J.D., M.A., of Advocate Alliance.  Lisa's topic is the Centers for Medicare and Medicaid Services (CMS) proposed new patient grievance regulations for Ambulatory Surgery Centers.

Ambulatory Surgery Centers’ Patient Grievance Process

In August 2007, the Centers for Medicare & Medicaid Services (CMS) responded to a 2002 Congressional report calling Ambulatory Surgical Centers (ASCs) a “System in Neglect.” CMS proposed new ASC patients’ rights which include a mandate that ASCs establish a patient grievance process.

With history as a guide, ASCs should expect the proposed standards to become reality. In recent years, CMS has mandated that, in order to participate in the Medicare program, a nursing home or hospital must establish a patient grievance process. In many respects, the proposed ASC patient grievance process mirrors the hospital patient grievance regulation.

Like hospitals, ASCs will be required to investigate, document and respond to all grievances made by a patient or the patient’s representative. Grievance is broadly defined as including, but not limited to, mistreatment, neglect, verbal, mental, sexual or physical abuse, and theft of personal property. ASCs will be required to specify time frames for review and response to grievances. As are hospitals, ASCs will be required to provide patients with written notice of the ASC’s decision, ASC contact person, the results of the grievance process and the date the grievance process was completed. Under both hospital and ASC regulations, Medicare patients are provided extra protection by accreditors and State agencies. Like hospitals, ASCs will be required to inform patients and educate staff about patients’ rights and the grievance process.

When planning for the future, ASCs need only look to their nursing home and hospital counterparts. CMS has consistently required providers to establish a patient grievance process as part of quality improvement and patient safety. ASCs should plan, sooner rather than later, to establish a patient grievance process.

All of the proposed new rules for ASCs can be found at: http://www.cms.hhs.gov/center/asc.asp

Working Through Change - Part II

If you're leading a group through change (and leadership happens at all levels of the organization) you can expect people to respond in some fairly predicable ways.  Be aware that the roles they take on may shift during the process.

1.  Victim

Acknowledges and accepts no personal control. Feels pushed along by outside forces. "Why is this happening to me?"

2. Critic

Criticizes and challenges every plan and initiative.  "Who thought this was good idea?  It will never work." 

3. Spectator

Waits for others to take the lead; is unwilling to commit to any position. "Once the dust settles I'll see where I fit into all of this." 

4. Navigator

May or may not be the boss.  Looks for ways to be supportive and minimize anxiety about the change.  Seeks to understand and promote the benefits of the change.  "This is an opportunity to make our systems better."

Change happens; it's rarely comfortable.  How you respond is up to you.

 

Working Through Change - Part I

I have the pleasure of working with a diverse group of people, most of whom are quite generous about sharing their knowledge with someone who asks, "Could I pick your brain?"

The other day I asked just that question of a co-worker who has completely changed direction twice during her career.  Most recently she left a technical role in industry in order to apply her scientific knowledge and experience in a healthcare setting.  In her words, "This is a whole new world."

I figured someone who could make that kind of jump would know a little something about helping people work through change, so that was the subject of my query.

She offered these worthwhile insights.

1.  Acknowledge and address your own emotional response to the anticipated change.  It's not just "other people" who have trouble accepting change, most of us experience some level of anxiety when our routines are disrupted.

2. Assess the impact of the change.  Often we'll find that it's not as significant as it may at first seem.

3.  Encourage others to express their reactions; just talking it out can help.

4,  Take positive steps individually and as a group, usually just a few small ones at first, to help make the transition a smooth one.

Part II 

Patient Complaints - How Does Your Hospital Handle Them?

If your hospital is like most, the process for handling patient complaints is not well defined.  Whoever hears the complaint or receives the letter generally does their best to track down answers and get back to the complainant.

However, hospitals that participate in Medicare and Medicaid must meet more specific patient rights requirements in order to comply with the Conditions of Participation by which they're bound.

According to the newly released book "Complying With CMS Patient Grievance Regulations" by Lisa Venn, J.D., M.A., (Disclaimer: I work with the author and am developing a related product.) patient grievances must be handled by a centralized body (not a single individual) which has been authorized by the Governing Board to receive, investigate and resolve patient grievances on the Board's behalf. 

The CoP requires that hospitals inform the patient and/or the patient's representative of the hospital's grievance process, including the right to file a grievance with the State agency.  Hospitals are also required to keep records on all complaints and grievances and incorporate the information into the organization's quality improvement process.

The Society for Healthcare Consumer Advocacy posted the August 2005 CMS letter regarding new rules for patient grievance, along with their commentary (in red) on the SHCA web site.  Stephen Frew, J.D., of Medlaw.com also commented on the CoP revisions regarding grievance.  Joint Commission is incorporating patient grievance requirements into its Patient Rights standards, so these requirements are here to stay. 

As healthcare providers we may find the requirements a challenge to manage, but as patients, (And aren't we and our loved ones all patients are some point?) we can take comfort in knowing that hospitals must have a formal process in place to deal with serious issues that we bring to their attention.

Oh and by the way, similar requirements also apply to Ambulatory Surgery Centers.  More on that in a future post.

Patient Advocacy - That's Just So Seventies

Patient advocacy has been in the news quite a bit lately, and with good reason.  Healthcare is a complex place for patient and caregiver alike.  I often advise friends and family that being a patient sometimes means speaking up, loudly if necessary, or having someone on your side who can. 

The wonderful story, A Baby's Life is Saved, from Dr. Val and the Voice of Reason reminds us however, that patient advocacy isn't new.