MSSPNexus Blog

Hospital specialists assume national and state leadership roles

From The Indy Star - Submitted by Joe Steuteville

Two St. Francis Hospital & Health Centers staff members have been elected to lead a national and state chapter of medical service professional organizations.

Janet O'Hair recently was elected president of (the) National Association Medical Staff Services and Belinda Sherlock is the president of the Indiana Association of Medical Staff Services. Their elections mark the first time two professionals from the same health-care facility have simultaneously led the organizations.

Read the rest of the Indy Star article

The Role of Senior Leadership in Credentialing, Clinical Privileging, and Peer Review

Effective, thorough practitioner credentialing, clinical privileging, and professional peer review are vital components of safe patient care.  The importance of these complex functions is being reinforced this week at the Estes Park Healthcare Leadership conference. 

This conference attracts senior executive, board, and medical staff leaders from hospitals around the country.  Program topics include strategic planning, financing, legislation, technology, patient experience, medical staff relations, and yes, credentialing, privileging, and peer review. 

Sessions led by Charlotte Jefferies and Linda Haddad, Senior Partners in the law firm of Horty Springer, provided these items of note:

Credentialing/Privileging

• Make sure any privilege criteria developed is specialty specific, not department specific.  Department-specific criteria may lead to anti-trust allegations.
• Encourage recruiters to work closely with the medical staff office.  Recruiting a physician who does not meet the hospital's application criteria can create difficult and expensive problems for an organization.
• Associate any requests for temporary privileges with a well-documented patient care need.
• Share all pertinent information discovered during the credentialing/recredentialing process with the ultimate decision makers, i.e., the Governing Board. 

Peer Review

• Develop objective measures for actions and outcomes controlled by physicians.
• Share credible data routinely, not just when a problem arises.
• Remember that an organization cannot manage what it does not measure.
• Encourage early intervention by by medical staff leaders.
• Review concerns and findings with the affected physician, provide ongoing feedback.
• Establish the source of authority and responsibility in peer review matters by advising physician leaders to respond on hospital, not personal, letterhead.

And for both, developing and following well-formulated policies can save the day.

 

School For New Medical Credentialers Developed by Edge-U-Cate

Article provided by Edge-U-Cate, LLC of Colorado Springs, CO

Negligent credentialing cases are on the rise. Demands for qualified credentialers are greater than the supply. What do these two statements have in common?

Today, more than ever, healthcare organization’s credentialing practices are under scrutiny. Typically, when a malpractice case is filed against a hospital and the treating physician/s, one of the first requests by plaintiffs’ attorneys is for access to the credentials file (not very successful, but it has happened). Also requested are the medical staff bylaws, policies, etc. that define the credentialing process, the privileges held by the practitioner, what criteria is defined, and whether or not the practitioner met the criteria. From this information, the plaintiffs’ attorneys often add a suit against the healthcare organization for negligent credentialing if it is determined the hospital did not follow its procedures in allowing the practitioner to provide patient care.

While credentialing and privileging decisions are the ultimate responsibility of the Medical Staff and Governing Body, each group relies heavily on the trained Credentialing Specialist or Medical Staff Services Professional to conduct a thorough search of the practitioner’s background, training, experience and competence so an informed decision can be made about the applicant. Trained, experienced, certified Credentialing Specialists and Medical Staff Services Professionals know what to look for, where to obtain the information, how to analyze data for "red flags", and help the organization follow its processes to make good, sound decisions affecting the provision of patient care. These professionals are a significant asset to their organization and in high demand. Unfortunately, the demand for these qualified individuals far exceeds the supply. Due to this shortage, many hospitals have no alternative but to hire individuals with little or no previous training or experience. Frequently there is no one within the organization that is knowledgeable enough about the processes to provide the new hire with the necessary training.

How serious are the consequences of having inexperienced individuals in charge of and/or responsible for managing the medical staff credentialing process? The hospital counts on its medical staff professional/s to know what the rules are and to make the process work successfully. If not, the consequences can be devastating – to the patient, to the physicians, to the organization, to the community – and costly. Credentialing is serious business, and education is key to effective, quality credentialing.

As a credentialing specialist or medical staff services professional, you know the importance of having someone who is knowledgeable about the credentialing process. Be sure to build in education for all your staff (and yourself) so that your organization can be confident that the people they have hired to manage the credentialing and privileging process know what they’re doing, do a good job, and can defend the process in court should the negligent credentialing lawsuit end up in your organization.

For further information on the first ever Credentialing School for new credentialers and those who need to brush up on their basic, day to day skills go to www.edge-u-cate.com/school. This 5-day intensive class has been approved by NAMSS for 38 CEUs, and is being offered nationally every ninety days in various locations.

NAMSS Increases Education Requirements For Dual Certificants

The National Association Medical Staff Services has announced new Continuing Education requirements for dual certificants. 

Beginning with the 2010 recertification cycle, individuals holding both the Certified Provider Credentialing Specialist (CPCS) and Certified Professional Medical Services Management (CPMSM) certification will be required to obtain 45 CE credits for recertification, of which 25 must be NAMSS approved.

http://www.namss.org/certification/index.cfm

Education Conference in Medical Staff Administration/Credentiailng/Privileging - On the Beach!

I'll be speaking in mid-May at the Alabama & Georgia Association Medical Staff Services combined Spring conference being held in Destin, Florida.

The conference program looks interesting, and Destin beautiful, so if you're looking for education, networking, and CE's in medical staff administration, consider attending. Paul Verardi, an Attorney from Horty Springer speaks on Friday, and I'm certain he'll be a tough act for me to follow on Saturday!

I spoke to this group a couple of years ago, and found them to be both professional and lively, I'm looking forward to being with them again.

Education, friendly folks, and a white sand beach... what could be better?

Hope you can join us in Destin!

Registration Brochure:
http://www.aamss.com/content/2008%20AAMSS%20GAMSS%20Spring%20Conference%20.pdf

Suffering Loss

This patient's catastrophic death struck me and everyone else involved in his care as a complete and utter surprise. I had been trying to help this boy, and he suddenly and unexpectedly died. Never, until the moment the process server showed up in my new office, did it occur to me that what I had and had not done could be construed as malpractice. When I opened the envelope and read these things about my being "negligent, careless, and without skill", I picked up the phone and called my personal lawyer. I thought I was being accused of manslaughter. I had suffered the loss of a patient and now I was being accused of having killed him, or so I thought.

My lawyer calmly explained that I was being sued for malpractice, not manslaughter and advised me to call my malpractice carrier. I put the envelope in my top drawer and went in to see my first patient of the day. My new practice had been open for two months.

Dr. Robert Lindeman, a pediatrician from the Boston area, blogged anonymously as Flea.  The combination of that blog and the trial noted above changed his life when he unexpectedly landed on the front page of the Boston Globe last May.

The medical blogosphere was rocked by the impact of the case, but of particular interest to those of us who work with physicians are Dr. Lindeman's words about how it felt to be named in a medical malpractice suit.  He speaks to that during an insightful interview with Eric Turkewitz, author of the New York Personal Injury Law Blog.

Physician Peer Review - How Good/Bad Is Your Faith?

Roland F. Chalifoux, Jr., DO, a West Virginia Neurosurgeon and long time critic of current standards in professional peer review, has started a new blog - Fighting For Hospital Privileges. 

The author is certainly no fan of the Health Care Quality Improvement Act (HCQIA) of 1986, about which he wrote, "HCQIA has become antiquated and used unfairly by some hospitals to effectively ruin as well as run a competent doctor out of town."

"The public and doctors alike believe in “good faith peer review”; however, until the playing field is balanced and the burden placed on hospitals to “prove” that a doctor was not practicing good, safe medicine as opposed to only being required to “state the problem,” doctors need to be wary of the fact that they have little to no rights when practicing medicine."

"In this day and age, when we all want a patient's bill of health, let's not forget that in order for patients to receive such benefits, doctors need not fear reprisal from their economic competitors or hospital administrators for practicing medicine in the patient's best interest. Currently, this system does not exist."

Having sat for years primarily on the "hospital" side of the table, I see some of the benefits of HCQIA.  In my experience it is very difficult for physicians to openly criticize the care provided by a colleague.  During those often emotional discussions I've heard the expression "There but for the grace of God go I."  There is also understandable concern over being sued for having expressed a negative opinion, and HCQIA, as well as State law, offer some protection to the reviewers. 

Dr. Chalifoux references the Poliner case in which a Dallas cardiologist was awarded a very large settlement for bad faith peer review.  However, there is another side to the issue as demonstrated by the Kadlec Hospital case, where the courts determined that "hospitals have a duty to disclose information about their medical staff members to other health care providers in order to protect future patients when the doctor moves on."

Dr. Chalifoux brings up some points worthy of further discussion; no the system is not always fair.  However, his stand on the issue appears to be completely one sided. 

At some point we are all patients.  When the system works well, and I believe it often does, it protects us all.

Thoughts?

Veterans Administration Undertakes Major Credentials Review

The Chicago Tribune is reporting that the Department of Veterans Affairs has limited the surgical privileges of three doctors at the troubled Marion VA Medical Center in southern Illinois, and it is reviewing the credentials of 17,000 other health-care providers for veterans across the country.

Testifying before the Senate Veterans Affairs Committee, VA officials called their response to the Marion deaths "swift" and their credentialing process for doctors "the envy of the health-care industry." But the top official present, Dr. Gerald Cross, also expressed "some concerns" about the agency's ability to keep tabs on doctors once they've been granted privileges to treat VA patients.

The hearings followed questions about the VA's physician credentialing procedures first raised in a Tribune story in September about deaths at the Marion VA hospital. The story revealed that Dr. Jose Veizaga-Mendez, a surgeon with a troubling professional history, was operating on veterans at the hospital for more than a year after surrendering his license in Massachusetts during a disciplinary proceeding.

Read the Full Text: Marion woes spur VA to widen probe

Collecting, analyzing and tracking the credentials of thousands of health care providers stationed all over the country is no small task. The VA uses an internally developed software program called VetPro to track the professional credentials of its healthcare providers.  Although I have not personally seen the program, I've heard good things about it. 

I have no information other than the public reports about what may have happened at Marion VA Medical Center, and Dr. Jose Veizaga-Mendez, but it's good to see that the VA is taking the matter seriously. 

Credentials verification is an onerous, sometimes tedious job.  It requires exceptional attention to detail as well as the ability to understand the needs of the organization and interact well with its leaders.  Every healthcare organization must take a solid look at its credentialing and privileging process periodically, including development of education for top leaders to make sure they understand the importance of their role.  The process is literally the foundation for patient safety in the organization.

   

Medical Staff Services Awareness Week, Nov 4-10, 2007

In 1992, the United States Congress, by House Joint Resolution 399, and George Bush, President of the United States, issued a proclamation designating the first week of November as “National Medical Staff Services Awareness Week.”

MSSPs - A Vital Part of Your Healthcare Team

Revised Joint Commission Medical Staff Standards - Another Take On MS.1.20

Michel Cassidy of Med Law Blog offers up a post about Medical Staff Standards changes forthcoming from the Joint Commission in Revised Joint Commission Standards for Medical Staff Operations Roil Industry. 

The article focuses on the controversy surrounding the change to MS.1.20 and its impact on the Medical Staff Bylaws.  Charlotte Jeffries of the health law firm of Horty Springer is quoted as saying "This is one big roller coaster ride, and it is not over yet."

Full text:
http://www.medlawblog.com/Revised%20Joint%20Commission%20Standards.pdf