Medical Staff

Not All Advances in Technology Bring Us Improvements

Medical Staff Affairs Monthly, August 25, 2006

The dog days of summer are upon us and I'm sure many of you are enjoying the remaining pleasures of the season before fall once again picks up the pace of our lives. For me, this is the time I get to enjoy the fruit of my labor in the garden--real tomatoes!  Decades ago, new technology brought us the advent of the "store tomato"--one that could be picked by machine, easily transported around the country, and delivered any time of year. The result was also a wan imitation of the real thing.

So it goes in medicine--not all advances in technology bring us improvements. And not everyone is qualified to deliver those advances when they do prove useful. Lately, I have been mediating an increasing number of turf battles among specialists in hospitals around the nation. Such battles are growing and will continue to be fueled by the introduction of new technologies and questions over their usefulness and the proper qualifications to utilize them. On August 1, the New York Times ran a front page article entitled The Growing Debate as Doctors Train on New Devices by Barry Meier. The article should be read by everyone engaged in credentialing for new procedures. The exposé focuses on 'fast track' training provided by the companies that make implantable defibrillators and discusses the controversy over what qualifies a practitioner to implement these devices.

One of the most current examples of 'turf battles' is generated by hospital purchase (or contemplated purchase) of 64 slice CT scanners. Cardiologists and radiologists around the country are squaring off over access to these impressive machines. Interest in these devices should be managed pursuant to clear policies and procedures at your institution. The first such policy should require the board to firmly establish whether the new technology is to be implemented at the facility. This is a JCAHO requirement and should have the board asking critical questions, such as:

  • Is this a proven technology which provides clear benefit to patients?
  • Is their a need for this technology in our community?
  • Is our hospital the best place to deploy this technology?
  • Do we have the staff to properly support the new technology?
  • Is purchase of this technology the right use for limited hospital resources?
  • Is this the right time to purchase this technology or are further advances just around the corner (e.g. 124 slice or higher CT scanners now in development)?

Once the board has answered these questions and decided to implement the new technology, privileging criteria should be developed in accordance with a clear policy (to purchase the book, Top 30 Medical Staff Policies & Procedures, click here). The policy should direct research into recommendations on the qualifications to use the technology. For example, with regard to the dispute over CT privileges, see the ACCF/AHA Clinical Competence Statement on Cardiac CT and MR: A Report of the American College of Cardiology Foundation/American Heart Association/American College of Physicians Task Force on Clinical Competence and Training published in the American Journal of Cardiology, Vol. 46 #2, 2005 and accessible at www.acc.org. Other valuable resource when doing credentialing research are the Credentialing Resource Center White Papers, published by HCPro, Inc., constantly updated to provide privileging information on evolving procedures. Once this research is completed,  the policy should clearly articulate how  privileging criteria for the new technology will be drafted and then approved by the credentials committee, medical staff executive committee and board. When everyone knows what the policy and procedure require (and it is strictly adhered to) the incidence of posturing and attempts at political maneuvering (i.e., "Turf Battles") are dramatically reduced. 

On a somewhat tangential note, for those of you who want to provide onsite education for your doctors on advances in medicine, the government is making itself less of a barrier these days. Many of you have contacted me concerned that free CME provided by the hospital may be illegal. However, the Centers for Medicare and Medicaid Services have given hospitals permission to pay for continuing medical education for doctors that is performed on site (e.g. grand rounds). This addresses concerns that such free CME could be interpreted as a kickback for patient referrals under the Stark self-referral laws and the federal anti-kickback statute. Dr. Mark McClellan announced the CMS position noting that "traditional, on-site hospital grand rounds and other similar in-house education programs provided by hospitals are important and convenient ways for physicians to earn CME credit and for hospitals to ensure high quality patient care. We do not believe such programs...necessarily constitute remuneration to the physicians who attend them."

On a final note, as the baseball season winds down and summer subsides, let's acknowledge real advances on the health care front line when they occur. According to press accounts, the eastern Illinois Gateway Grizzlies have a new feature at the concession stand--a bacon cheeseburger sandwiched between two halves of a Krispy Kreme donut. It has 1000 calories and 45 grams of fat but is advertised as baseball's best burger. As with the implementation of medical technology, sometimes we do something not because it promotes better health, but because we can. For me, I'm sticking to my homegrown tomatoes.

Bon appetite, and enjoy the remainder of your summer!

Best regards,
Todd Sagin, M.D., J.D
National Medical Director, The Greeley Company

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