HCPro.com - Credentialing Resource Center Connection

Tip of the week: Don't give in to pressure from applicants

Fri, 10 Feb 2012 19:06:00 GMT

Regardless of whether an organization develops an expedited process for credentialing, MSPs will always face pressure from applicants, recruiters, and members of their organization to speed up a file. Dana Crowell, CPMSM, director of medical staff services at Longmont United Hospital and president-elect of the Colorado Association of Medical Staff Services, advises MSPs to be prepared for of a few phone calls they may receive regarding an application’s status. One comes from an applicant who has applied to more than one organization. The applicant will ask what the holdup is, and when the MSP identifies the piece of information causing the delay, the applicant will claim that the other organization completed the application without a problem.

Crowell recommends calling that other organization and asking its MSP whether he or she was able to complete the file. "Nine times out of 10, they are having the same problem we are," she says. "The applicant is trying to pit us against each other."

This week’s tip is from Credentialing Resource Center Journal, HCPro, Inc.’s monthly credentialing newsletter. For more information, click here.

News and briefs: Hospital claims it had no obligation to make allegations public

Fri, 10 Feb 2012 19:02:00 GMT

Children’s Hospital Boston is seeking dismissal of a lawsuit involving 11 patients from North Carolina and one of its former physicians. According to The Boston Globe, the 11 plaintiffs allege Melvin Levine, MD, abused them while he was employed at the University of North Carolina Medical School. Melvin previously worked at Children’s Hospital and the plaintiffs claim the abuse could have been avoided if Children’s Hospital reported accusations of abuse it received while Melvin worked there.

A lawyer for the hospital says the organization had no obligation under state law to report the allegations. The judge has not ruled on the case yet.

To read more, click here.

News and briefs: Learning curve for ACL surgery is 60

Fri, 10 Feb 2012 18:57:00 GMT

A new study from the American Academy of Orthopaedic Surgeons found that ACL reconstructions performed by novice physicians are four to five times more likely to need additional repair. According to the study, there was a significant difference in outcomes between physicians who performed the surgery at least 60 times than those who had not.

In an article in Outpatient Surgery Magazine Robert Marx, MD, says ACL repair is a “complex procedure with many technically challenging surgical steps.” He suggests medical programs reevaluate how they train physicians for the surgery.

For more, click here.

Featured blog post: Courtesy and Respect? Don't have to; I'm the physician!

Fri, 10 Feb 2012 18:52:00 GMT

William F. Mills, M.D., MMM, CPE, FAAFP, CMSL, senior vice president of quality and professional affairs for the Upper Allegheny Health System, will discuss how to use patient satisfaction scores to drive improvement at the 2012 Credentialing Resource Center Symposium. In anticipation of his talk, Mills created the Patient Satisfaction blog series to give readers a taste. This week, Mills provides tips for improving behavior that patients view as signs of courtesy. To read the tips, click here.

Ask the expert: Does the medical staff need to credential nurses or physicians who conduct clinical trial studies that only involve chart reviews?

Fri, 03 Feb 2012 19:47:00 GMT

The short answer is no; individuals collecting data for clinical trials that involve only chart review do not need to be credentialed by the medical staff services department, nor do they need privileges because they are not interacting with patients, explains Kathy Matzka, CPMSM, CPCS, a medical staff consultant in Lebanon, IL. The HR department typically processes the individuals collecting data, who are often referred to as clinical trial monitors.

Clinical trial studies are usually conducted in a teaching hospital or a hospital with an institutional review board. Studies may also occur when physicians are participating in a drug trial sponsored by a pharmaceutical company and need access to patient records as part of that study.
Because clinical trial monitors access patient information, it is critical for the hospital to verify the monitors' identity and purpose. Some hospitals' HR departments go so far as to conduct criminal background checks.

This week’s question and answer are from Credentialing and Peer Review Legal Insider, HCPro Inc.'s monthly newsletter. For more information, click here.

News and briefs: CIHQ applies for CMS deeming status

Fri, 03 Feb 2012 19:44:00 GMT

The Center for Improvement in Healthcare Quality (CIHQ) recently applied to CMS for deeming authority of its acute care hospital accreditation program. In an open letter on its website, CIHQ Executive Director and CEO Richard Curtis, RN, MS, HACP, says the organization believes it can offer a viable alternative from the other deemed-status agencies.

“The heart of a deemed-status accreditation process should be to assure that patients receive care in a safe environment by an organization that complies with the minimum standards set forth by the federal government. Your deemed-status provider should assure this; provide you with the tools and support you need, engage with you in a collegial and educational manner, and perform these services at a reasonable cost. If we are approved, this will be our commitment to you,” he says.

CMS will review the application and conduct a site visit; Curtis says a decision could be made by July.

News and briefs: Six years later, plastic surgeon disciplined

Fri, 03 Feb 2012 19:42:00 GMT

The Maryland Board of Physicians revoked Dr. Oscar Ramirez’s medical license this week, six years after he performed two “lengthy surgeries in an outpatient setting without adequate resources,” according to the Baltimore ABC affiliate, ABC2. Under state and industry guidelines, Ramirez was not supposed to perform procedures longer than six hours or keep patients overnight at the outpatient clinic. Both patients died following their surgeries, which occurred about six months apart.

Ramirez says the deaths were not related to the surgeries. In one case, patient Janet Hannan suffered cardiac arrhythmia three days after undergoing a tummy tuck and liposuction. The state did not prove Ramirez directly caused her death. The Hannan family sued Ramirez for medical malpractice in 2006 and agreed on a settlement. However, soon after, Ramirez filed for bankruptcy and moved to Florida, where he opened a clinic. Ramirez did not have malpractice insurance, according to state of Maryland records. He gave up his insurance in 2003, which led to him losing his hospital privileges. The Hannan family says that Ramirez did not have any hospital privileges when he performed the procedure on Hannan, something they did not learn until after her death.

Featured blog post: Holy Moly, He Wants to Come Back!

Fri, 03 Feb 2012 19:38:00 GMT

At some point during their tenure, physician leaders will be faced with the tough decision of whether to let an impaired or disruptive physician back on the medical staff. What can they do? Where should they start? R. Dean White, DDS, MS, featured Credentialing Resource Center Symposium speaker, discusses ways to create a physician re-entry process in this week’s blog post.

Ask the expert: How many times should we follow-up a practitioner that does not return a reappointment application?

Fri, 27 Jan 2012 15:24:00 GMT

MSPs should first document the following:

Date the application was sent
Address where the application was sent
Any follow up communication regarding the status of the reappointment application

Then, MSPs should perform two additional follow-ups (fax, e-mail, or phone call) every 10 days. Be sure to document your attempts either in your credentialing software, database, or spreadsheet. Set a reasonable limit for follow-up, as the MSP has several other activities to attend to, not to mention processing applications that were returned on time. On the third or final follow-up, it is a good practice to send a list of practitioners who have not returned their reappointment application to the appropriate physician leader.

This week’s question and answer are from The Medical Staff Professional’s Handbook by Anne Roberts, CPMSM, CPCS, and Maggie Palmer, MSA, CPMSM, CPCS.

Tip of the week: Gather information about ABMS boards

Fri, 27 Jan 2012 15:15:00 GMT

Physicians who choose to participate in Maintenance of Certification (MOC) show a dedication to lifelong learning, which is essential as best practices seem to change daily.

But board certification shouldn't be the only factor that influences a medical staff's decision to recommend a physician for membership and/or privileges. Rather, medical staffs must educate themselves on the MOC requirements for each of the American Board of Medical Specialties member boards and then decide what to do with that information.

"Every MSP should at least gather information from each of the boards as to what the MOC programs are and make sure that the credentials committee and the executive committee are fully aware of what that means," says Christina Giles, CPMSM, MS, president of Medical Staff Solutions in Nashua, NH.
Using that information, she suggests that medical staffs ask themselves the following questions:

Is board certification going to make a difference to us in terms of our criteria for privileging?
Are we going to require all physicians who have privileges to maintain their certification, or are we only going to require it when they initially come on staff?
How else will we measure a physician's competence?

This week’s tip is from Medical Staff Briefings, HCPro Inc.’s monthly medical staff newsletter.

News and briefs: Bariatric surgery patient awarded $178 million

Fri, 27 Jan 2012 15:12:00 GMT

Memorial Hospital Jacksonville (FL) will pay a former Florida deputy sheriff $178 million in medical negligence and fraud damages due to complications from a laparoscopic gastric bypass surgery.

During the trial, DePeri’s inexperience was brought to light; the hospital’s president testified that DePeri previously performed about 20 bariatric surgeries. The American Society for Metabolic and Bariatric Surgery (ASBMS) Bariatric Surgery Center of Excellence program, of which Memorial Hospital was a member, requires physicians to perform 50 surgeries. DePeri used the Center of Excellence accreditation seal on promotional material. The jury found that the hospital committed fraud by allowing DePeri to perform surgeries although he did not meet the ASMBS requirements.

According to the patient’s attorney, Tom Edwards, the patient suffered respiratory failure and fluids leaked from his bowels to his abdomen after his surgery, The Florida Times-Union reports. An expert witness for the hospital testified that Dr. John DePeri should not have waited eight days to take the patient back into surgery to fix the leak. The patient suffered a “low-flow stroke” and was in a coma for two weeks. His lawyer also stated that while in the coma, Chandler did not receive eye drops to keep his retinas lubricated. The patient is now confined to a wheelchair, blind, and brain damaged.

To read more of this story, click here.

Featured blog post: Pat Sat/HCAHPS/P4P - Huh?

Fri, 27 Jan 2012 14:12:00 GMT

William F. Mills, M.D., MMM, CPE, FAAFP, CMSL, senior vice president of quality and professional affairs for the Upper Allegheny Health System, will speak about using patient satisfaction scores to drive improvement at the 2012 Credentialing Resource Center Symposium. In anticipation of his talk, Mills created the Patient Satisfaction blog series to give readers a taste. This week, Mills covers the basics, such as just what the heck is HCAHPS? To find out, click here.

Featured webcast: Assessing the competence of low- and no-volume practitioners

Fri, 20 Jan 2012 19:10:00 GMT

Create strategic solutions to privileging low- and no-volume practitioners with advice from two leading medical staff and credentialing experts. In this online program, Yisrael M. Safeek, MD, MBA, CPE, FACPE, an experienced physician leader and former Joint Commission surveyor, and Sally Pelletier CPMSM, CPS, a national credentialing and privileging expert, walk medical staff leaders and medical services professionals through steps to develop a working strategy to establish competency for low- and no-volume practitioners.

Take a peek at the agenda:

Contributing factors to the increase of low- and no-volume practitioners
- Governance documents that hamper the hospital's ability to effectively manage low- and no-volume practitioners (i.e. link membership and privileges)
How does low volume affect competence
Matching privileges with competence
Building a strategic approach to low- and no-volume practitioners (e.g. intended practice plan, medical staff development plan)
Working strategies to address low- and no-volume
- A medical staff culture that feels an obligation to the low- and no-volume practitioners
Types of data sources
How to compile and present the data in a meaningful way

This webcast will be presented on Tuesday, February 21 at 1 p.m. To learn more or to register, click here.

Ask the expert: When does it make sense to use perception data instead of clinical data?

Fri, 20 Jan 2012 19:02:00 GMT

Perception data differ from clinical data in that they are based on how others view a practitioner’s performance in relatively subjective areas. Perception data help practitioners understand how others perceive their actions, regardless of their intentions. Although a practitioner might think he or she is communicating clearly to a patient, it is the patient’s perception of the clarity of the message that counts.

Hospitals can best use perception data to evaluate performance-related expectations for the following:

Interpersonal relationship skills
Communication
Professionalism
Social interactions or team cooperation
Oral and written communication skills
Responsiveness
Sensitivity to diversity

Although perception data are typically used to evaluate behaviors, if there is a well-defined behavior that the hospital can measure more objectively, such as hand-washing techniques, perception data are not necessary.

This week’s question and answer are from The Complete Guide to OPPE: Strategies for Medical Staff Professionals, Physician Leaders, and Quality Directors by Evalynn Buczkowski, RN, BSN, MS; Valerie Handunge, MA; and Wendy R Crimp, BSN, MBA, CPHQ.

News and briefs: Supreme Court rules in favor of physicians regarding lack of informed consent

Fri, 20 Jan 2012 18:59:00 GMT

In Ohio, expert medical testimony will be required for a patient to allege lack of informed consent by a physician.

According to American Medical News, the Supreme Court of Ohio recently overturned a decision by an appeals court in which a patient sued his physician for not disclosing the risks of undergoing a second discectomy. The appeals court ruled that lack of informed consent is a common law claim based on battery—not a medical claim—and therefore expert medical testimony is not necessary. The appeals court ruled in favor of the patient.

However, the Supreme Court ruled it is a medical claim and the patient “bears the burden to present expert medical testimony identifying the material risks and dangers of the medical procedure and showing that one or more of those undisclosed risks and dangers materialized and proximately caused injury.”
The Supreme Court also wrote in its decision that a medical expert is required to help the jury understand the elements of the tort by using his or her knowledge and experience with the subject.

Featured blog post: Code of conduct policy

Fri, 13 Jan 2012 15:49:00 GMT

In the February issue of Credentialing Resource Center Journal, this sample code of conduct policy is referenced. With The Joint Commission’s announcement it is replacing the term “disruptive behavior” with “behavior that undermines a culture of safety” in its standards, now is an excellent time for organization’s to review their code of conduct policies. Although organization’s will not be required to eliminate the term from their own policies, they do need to make sure they have well-written standards that do not allow for any loopholes or misinterpretation.

Tip of the week: Help practitioners through the paper trail

Fri, 13 Jan 2012 15:44:00 GMT

Jon Mayer, MSN, MBA, department administrator in the Department of Surgery at Medical College of Wisconsin, manages the credentialing for all PAs and APNs in his department. His strategy when it comes to credentialing is to take a hands-on approach.

“My assistant and I personally manage the paperwork and follow up with institutions to see where the paperwork is that we need. I try to minimize the amount of paperwork applicants have to fill out. It is less painful that way and they are more likely to do it,” explains Mayer.

He tracks the status of outstanding forms and paperwork by:
Providing a FedEx envelope to the institution sending the form. If a form is sent in this envelope, Mayer can monitor it once it is shipped.
Asking to be copied on any e-mail correspondences between the applicant and the institution.

By closely monitoring the status of application materials, Mayer says it is easier to figure out why any delays are occurring, such as a missing signature from a PA, APN, or notary (which is required for some forms). “APNs and PAs are busy people, and oftentimes they are not watching for e-mails daily. So I do it for them and then tell them when to send a harder push or prompt to the institution sending the form,” he says.

This week’s tip is from Credentialing Resource Center Journal, HCPro Inc.’s monthly credentialing newsletter. To read similar stories, click here.

News and briefs: Is physician selling fake cure?

Fri, 13 Jan 2012 15:36:00 GMT

A recent “60 Minutes” report accuses a physician of selling fake cures. According to CBS News, Dan Ecklund, MD, told patients he could treat dozens of diseases, including cerebral palsy, using stem cells. Ecklund is the founder and director of Stem Tech Labs. Ecklund earned his medical degree from the University of Wisconsin in 1987; his medical license was revoked in 2005.

"With cord blood cells, the types of diseases and applications that (Ecklund) was discussing on '60 Minutes' is not possible," says David Gamm, MD, an ophthalmologist and stem cell researcher at the University of Wisconsin in an interview with Channel3000.com. "I spend a good deal of my time trying to educate those patients and steering them away from those fraudulent purveyors."

In the interview with “60 Minutes,” Ecklund says that the stem cells give off chemicals that cause other cells to repair themselves. He adds that he has witnessed their effect in treating cerebral palsy.

Letter from the editor: Win a free seat to CRC Symposium

Fri, 13 Jan 2012 15:19:00 GMT

Greetings CRC readers,

Want a free Kindle and the opportunity to learn from experts in the medical staff field? It’s pretty simple: Don’t wait to register for the Credentialing Resource Center Symposium!

Now in its 15th year, the symposium promises two days of best practices and winning strategies delivered by credentialing, medical staff, and quality experts who have been in your shoes!
MSPs and physician leaders will offer their perspectives on the most challenging issues facing the field today in a highly interactive format, allowing you to share ideas and network.

Some of the topics to be discussed include:

FPPE for APPs and physicians
Integrating competency data into reappointment
The relationship between MSPs and CMOs

In addition to learning from some of the most prominent experts in the field, the CRC Symposium offers a great chance to network with peers from around the country. For more information about this premier event, click here.

Hope to see you all in sunny Florida!

Karen Kondilis, credentialing editor

Ask the expert: Our privileging forms contain the word "other" with a blank line for

Fri, 06 Jan 2012 13:52:00 GMT

Including blank lines on privilege request forms invites applicants to add additional privileges that are not currently delineated on the forms, have not been recommended by the MEC, and have not been approved by the governing board. One problem is that a practitioner may request a privilege that is outside of the organization’s scope of services. Therefore, it is recommended that healthcare organizations delete any blank lines for additional privileges and the word “other” on the delineation of privilege form.

The medical staff, however, should adopt a process for addressing privileges that are requested but are outside both the core and specifically identified privileges for a particular discipline.

This week’s question and answer are from Core Privileges for AHPs: Develop and Implement Criteria-Based Privileging for Nonphysician Practitioners by Sally Pelletier, CPMSM, CPCS.