Supporting Safer Healthcare

Courageous Credentialing and Privileging Support Patient Safety

"For a long part of the history of modern medicine, the mention of credentialing and privileging a physician conjured images of paper stacks, rubber stamps, and file cabinets.  Every couple of years, someone would make sure the new stack of papers were in order, stamp them, and add them to the file cabinet.  The process often was perfunctory - frequently political - but infrequently rigorous.  Those in a position to authorize (or reauthorize) a physician's appointment were reluctant to mount a challenge against a substandard candidate - a potential legal quagmire - and simply followed the path of least resistance.  Every so often, the newspapers would chronicle patient tragedies linked to a clinician who should never have been practicing medicine.  Hospital leaders would dismiss those as unavoidable circumstances: bad apples who cheated the system."

"Competition and the burgeoning patient safety movement now demand a different response from the entities that credential and privilege physicians."

So opens a document created by CRICO/RMF, the medical malpractice company owned by and serving the Harvard medical community, Credentialing, Privileging & Patient Safety.

The National Association Medical Staff Services, whose members are charged with verifying credentials and clinical competency for healthcare providers in hospitals, managed care panels, ambulatory surgery centers, nursing homes, etc.  has long stated that "Patient Safety Begins With Us." Verifiers and administrators provide the foundation for a thorough credentialing and privileging program, but more is required.  The system only works as intended if that foundation supports strong medical staff and business leadership; individuals who may at times need courage to navigate a difficult and treacherous course.

During the years that I worked in the field of medical staff administration in various organizations, more often than not I had reason to be proud of the leaders with whom I worked. They took their responsibilities seriously; they stood for the patient. On the few occasions when the path of least resistance was chosen over the safety of patients and the organization, I found it profoundly disappointing. 

If you are charged with the responsiblity of assuring that only safe, competent clinicians care for patients in your organization, please remember that at this most crucial time in healthcare we need courageous leaders.  Will you help guide us to safer waters? 

  

CPMSM CPCS Job Listing Added to Side Bar

I've added an interesting little widget to the side bar that posts random jobs around the nation using the search terms CPMSM, CPCS. 

Scroll down and look for this widget on the far right --->

Whether or not you're in the market for a career change, it's fascinating to keep your eye on current trends in medical staff service positions around the country.

Enjoy!

Back By Popular Demand - The Ugly Truth

The Ugly Truth About Credentialing and Privileging was recently featured in the May/June 2009 issue of Synergy, the journal of the National Association Medical Staff Services (NAMSS).  Since many people have asked about it, here it is again - enjoy!

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The Ugly Truth About Credentialing & Privileging - Part I

Dear Doctor:

If you've been a practicing physician for more than about an hour, chances are you already know the ugly truth. If you're in medical school or a residency program, odds are good that you don't have a clue. Not to worry, as a fourteen-year veteran of the credentialing wars, I'm about to enlighten you.

(I feel I must preface this ominous tale with a disclaimer that I am a firm believer in the need for effective, thorough credentialing and privileging - more about that later.)

At last, you’ve completed your training and can begin to practice in your chosen field. You look forward to curing illness, cutting away disease, and finally earning some money so you can start paying back those lovely student loans you’ve accumulated.

Whether you join a large multi-specialty group or bravely hang a solo-practice shingle, you will no doubt need to apply for privileges at one or more hospitals, and perhaps a few ambulatory surgery or urgent care centers as well. If you hope to make even a small dent in those outstanding loans, you’ll also need to join various managed care panels.

How bad can it be, right?

You’re about to find out just how many ways you can be asked to document every place you’ve been, every job, license, certification or board you’ve ever held, whether or not you have any disabilities for which you’ll need accommodation, whether any professional privilege has ever been denied, revoked, limited or suspended, and whether to the best of your knowledge anyone is even thinking about denying, revoking, limiting or suspending anything of yours.

You’ll also need to produce the names, addresses, phone, and fax numbers of various individuals who will serve as your references. Some you’ll get to select, others may be prescribed. If you apply to a number of organizations all at once the people you name will get the joy of responding to multiple requests. If they don’t answer in a timely fashion you’ll be given the opportunity to prod them along. You may want to practice groveling, as nothing delays privilege approval quite as effectively as references who fail to respond.

Getting the picture? Verification of credentials is a huge, time-consuming, pain in the neck. Establishing that you’re currently competent to request and perform a vast array of delineated privileges only adds to the discomfort.

Unlike fine wine, the process does not become more palatable with age. The longer you’ve been in practice the more years of experience there are to verify, and the more proof you’ll need to produce to show that you’re still proficient at the ‘otomy, ‘ectomy and ‘ostomy that you learned way back in training.

There’s more, but I don’t want to discourage you overmuch with too many dark, dire warnings of a future decorated in red tape and dominated by writer’s cramp. (And we haven’t even touched on medical records documentation!)

Take heart - I have some tips to share on ways to make the credentialing process a slightly less bitter pill to swallow, so continue reading "The Ugly Truth - Part II" to get your next dose of "Realdox."

 

The Ugly Truth About Credentialing & Privileging - Part II

Negligent Credentialing Case Settled in Weirton West Virginia

(See 5/15/09 update below.)

In a case that appears to reveal multiple credentialing and risk issues, Weirton West Virgina Medical Center settled a negligent credentialing and supervision case in open court just after jury selection. 

The family of Genevieve Haught alleged that urologist Hardev Parihar was wrongfully permitted to operate on Mrs. Haught in 2005 without supervision, despite having only performed the operation once before, ultimately causing her death.

"During the procedure, Dr. Parihar's assistant perforated Mrs. Haught's stomach... The procedure, intended to remove a kidney mass, proved to be unnecessary as she was cancer-free."

"Regan, one of the attorneys, stated that Weirton Medical Center knew that Dr. Parihar had a questionable record of operating without proper informed consent and other incidents of ignoring safety procedures. The family was never even informed there would be two surgeons before the procedure began."

"The case also involved a claim for outrageous conduct by the hospital in mistreating the family during Mrs. Haught's care."


Source:  The State Journal
http://www.statejournal.com/story.cfm?func=viewstory&storyid=58832

Update 5/15/09

There are always two sides to a story, and it is important to note that Dr. Parihar strongly disputes the article I quoted this week from The State Journal.  I received this email from Dr. Parihar's attorney this morning.

Dear Sir or Madam: 

I represent Hardev Parihar, M.D. was specifically named in the news story on your webpage in about a settlement by Weirton Medical Center.  Please be advised that the story os misleading as to my client and I demand a clarification and/or retraction.  A correction has already been posted on the webpage of the State Journal which is where you got the story.  I demand that you run the correction as the information about my client is defamatory.  The so-called news story was simply a self promoting press release from a law firm.  The correction can be found at http://www.wtrf.com/story.cfm?func=viewstory&storyid=58981.

Patrick S. Case
BURNS, WHITE & HICKTON, LLC
32 20th Street
Maxwell Centre, Suite 200
Wheeling, WV 26003
Email:  pscasey@bwhllc.com
Webpage:  www.bwhllc.com

 

 

Picking Off the Low-Hanging Fruit in Healthcare Regulatory Reform

They're tired, frustrated, and verging dangerously close to hopeless.  They're also bright, dedicated, and desperately needed.  

Who are they?  Physicians.  In particular primary care physicians, although their more specialized brethren aren't lagging far behind.

It's no longer news that many doctors want to leave the practice of medicine.  The ever-increasing complexity and volume of mandatory regulations, requirements, and expectations takes an enormous toll on body, mind, and spirit.  Healthcare reform is a much-discussed initiative, but will it bring relief to this sorely-distressed core group? 

Not long ago I read an article admonishing physicians that if they would just spend a little more time with each of their patients they would no doubt see a corresponding improvement in the all-important patient satisfaction score cards.  Seemed like a good plan - improving patient satisfaction is a worthwhile goal. I couldn't help but notice, however, that the article never mentioned the enormous pressure this same group faces from administrators eager to increase volumes and reimbursement.  It's got to be hard to make all those things happen at once, and as is so often the case in the world of metric-driven healthcare, no one is willing to establish a priority.  In order to be considered a team player every goal must be fervently sought and simultaneously attained.  No wonder doctors are tired.   

There's something seriously wrong with this picture.

Dr. Scott Haig thinks so too, and addresses the issue in Time's Health & Science section; How to Fix Healthcare: Four Weeds to Remove.Here are the "weeds" Dr. Haig would go after first:

Healthcare Regulation, including Credentialing  "Of course we need to know that doctors are healthy and competent. But the system is redundant and takes up way too much of our time...  A unified federal credentialing agency could pull those weeds right out and leave the country with 5% to 10% more doctoring at almost no cost." (Many credentialers are surprised this process hasn't yet been nationally centralized.)

Malpractice  "There is little or no correlation between doing bad stuff and getting sued." 

Medical Billing  "The ultra-complex set of rules and regulations is a health-care expense that produces no health care."

Computerization  "Aside from their costs to us, electronic records are time-consuming — a constant distraction from patient care."  (I don't entirely agree with Dr. Haig's negativity about electronic medical records, and I've worked with both paper and computerized EMRs, but there is no denying that performing data entry while talking with a patient is distracting.)

In these difficult economic times it's worthwhile to look seriously at the cost of healthcare regulation and policy; not all of it provides an acceptable return on investment.

 

Reminder - CE Requirement Increases in 2010 for NAMSS Dual Certificants

I was reviewing my professional Continuing Education list the other day when it occurred to me that next year when it's time for me to recertify my CPCS (Certified Provider Credentialing Specialist) and CPMSM (Certified Professional Medical Services Management) credentials through NAMSS, I will need to submit 45 credits.

So as we consider our education opportunities for the coming year, here's a reminder for all of us who hold dual certification; if you will be recertifying dual credentials in 2010, you will need to submit 45 credits (at least 25 of which must be NAMSS approved) obtained between November 1, 2007 and October 31, 2010.

My how time flies! 

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

An Interview with Vicki Searcy, CPMSM

It's been quite a while since I've posted an interview with an interesting person in healthcare, but I recently had an opportunity to chat with my long-time friend Vicki Searcy, and wanted to share some of her fascinating professional experience with you. 

Vicki is a Certified Professional in Medical Services Management and a past-president of the National Association Medical Staff Services (NAMSS).  She currently serves on the NAMSS Past-President's Council, and works as a consultant in the field of medical staff services.

Now I don't want to say that Vicki is my "old" friend, but both she and I started working in the field of medical staff administration at a time when desktop computers were not yet common in hospitals.  She however, holds an accolade that I do not; Vicki had the FIRST personal computer in her hospital, and was sent to IBM programing school to learn how to write basic programs for its use. An original "propeller head!"

Vicki recently joined forces with the Morrisey Company; heading up their new medical staff consulting service, as well as providing content guidance for enhancements to the popular Morrisey credentialing and privileging software package used by hospitals around the country.  Vicki explained that she is developing criteria for both clustered and stand-alone privileges, as well as working with the programmers to incorporate tracking methodologies for both OPPE and FPPE.  (Ongoing professional performance evaluation and focused professional performance evaluation for those who do not "speak credential.")

Vicki and I talked about the profession of medical staff services/administration; its history, where it stands today, and where we believe it's heading.  Forty years ago hospitals hired medical staff secretaries, who often functioned far beyond the normal scope of a secretarial role, and who in general learned to be "the woman behind the doctor."  It's been a learning process over the years to change that perception, both internally and externally. 

Individuals attracted to this field are often highly organized, utilize excellent project management skills, are politically savvy, and exhibit a high degree of emotional intelligence. Those traits provide a solid foundation for the work of today's Medical/Professional Staff Department, which often functions as a central communication hub for the organization. Credentialing professionals work with senior leadership to ensure that only competent, safe practitioners are permitted to provide patient care.  And that determination is ongoing; there is no such thing as "once privileged always privileged" in healthcare.

Because the rules and standards that apply to the work of medical staff service professionals are in a continual state of flux, ongoing education is a necessity. To that end Vicki shared with me yet another of her many concurrent projects.  (I began to wonder when she finds time to sleep!)  She is partnering with Hugh Greeley and HG Health Consultants to provide an upcoming education program called The Credentials Experience, which will be held in Chicago on April 2-3, 2009.  I asked why MSSP's should choose this particular conference, and was told that attendees can expect content that is on point and realistic.  Presentations are being planned with the goal of offering limited theory and considerable practical application.  Vicki and HG Health Consultants hope that teams of physicians and medical staff service professionals will attend together, as they have found that team attendance facilitates both learning and change.  An additional benefit is a six-month period of follow-up via eResources, eConsultation and eNewsletter. 

If you don't get the opportunity to attend The Credentials Experience, Vicki will also be speaking at this year's annual NAMSS Conference being held in Reno, NV in October.  Her topics include Criteria Based Privileging and Using Best Practices to Set up a CVO.

If you'd like to contact Vicki, she can be reached at vsearcy@morriseyonline.com.

The First Credentials Experience Conference

The first Credentials Experience Conference will be held April 2-3, 2009 at the Chicago Marriott. The day and a half conference consists of 11 hours of intensive training, discussion and practical application on issues related to the toughest credentialing, privileging and competency problems.

Expert faculty include Hugh Greeley and Todd Sagin of HG Health Consultants, and Vicky Searcy of Morrisey Consulting

More Information
   

A Headline a Hospital Never Wants to See

Patient dies after surgery by doctor without credentials.  So reads a headline from ABC News in Queensland Australia. 

The article, complete with a photo of the hospital, goes on to to state that the Ethical Standards Unit, the Crime and Misconduct Commission and the Medical Board are investigating.

The investigation has revealed that Queensland Health has been provided misleading reports about credentialling. Rockhampton Hospital's executive director of medical service was stood down (fired) in April 2008. 

Another reminder that the role of the medical staff services professional and the hospital Credentials Committee are vital to both patient safety and hospital reputation.

The Cost of One Missing License

A recent news report revealed that a U.S. hospital has received conditional accreditation from the  Joint Commission after a survey found 10 or more requirements for improvement. The hospital has 45 days to submit an action plan to solve the issues, and will have a follow-up survey in about six months.

The Joint Commission survey apparently revealed deficiencies in several areas, and I am highlighting just one here: 

■ Medical staff, which requires all licensed independent practitioners to be properly credentialed.

The article went on to state that this requirement for improvement came about as a result of  finding one credentials file without updated license information.

This finding emphasizes the importance of maintaining current licensure records for all credentialed staff.  It also emphasizes the importance of the often under-valued role of medical staff services.  A considerable number of both medical staff and leadership accreditation standards fall under the auspices of the hospital's medical staff office.  Therefore, it is a wise investment of organization resources to ensure that medical staff services personnel are well-trained and well-supported.