HCPro.com - Medical Staff - DO NOT USE Top Stories

ABIM announces focused practice in hospital medicine certification

Tue, 01 Dec 2009 20:21:00 GMT

If hospitalists felt like they were trapped by a glass ceiling in the past, they can consider it broken. The American Board of Internal Medicine has announced a five-year pilot program for focused practice in hospital medicine (FPHM). The ABIM is a member board of the American Board of Medical Specialties (ABMS).

MSPs think outside the box: Next-generation tips to save time, money, and resources

Tue, 01 Dec 2009 20:05:00 GMT

There is no time like an economic downturn to get people thinking about how to do more with less, and few know that better than MSPs.

MSP tip of the week: Stay on top of legal issues

Wed, 18 Nov 2009 18:31:00 GMT

Whether you’re responsible for coordinating the peer review committee or perform credentialing duties, at some point in your medical staff services career, you will more than likely need to know certain aspects of legal issue. At minimum, legal considerations include the following:

The Health Care Quality Improvement Act of 1986 (HCQIA): Congress passed this statute to protect those who participate in good faith peer review. This Act also led to the establishment of the National Practitioner Data Bank (NPDB) and the Healthcare Integrity and Protection Data Bank (HIPDB). To learn more about the NPDB and the HIPDB, visit www.npdb-hipdb.hrsa.gov./ Also read “How to navigate National Practitioner Data Bank reports effectively: Legal experts offer tips for medical staffs and practitioners” in the November issue of Credentialing and Peer Review Legal Insider (subscription required).
Sharing of information: Due to recent law suits, hospitals need to be cautious when providing verifications to other entities. To learn more, read “Don’t be scared into silence: Affiliation letter safeguards allow you to disclose more” in the June issue of Credentialing and Peer Review Legal Insider (subscription required).
Attestations, acknowledgements, and release forms: All three of these forms are essential elements of the credentialing process. For more information, please see The Credentialing Coordinator’s Handbook, published by HCPro, Inc.
Criminal background checks: MSPs should have knowledge of how to implement criminal background checks and when they are appropriate. To learn more, read “Why, when, and how to conduct criminal background checks on the medical staff” in the January issue of Briefings on Credentialing (subscription required).
Disruptive and impaired practitioners: MSPs should know how to avoid lawsuits related to behavior and impaired practitioner-related issues. To learn more, read “Tips for writing an effective code of conduct policy” in the January issue of Medical Staff Briefing (subscription required). Also read “Sounding the alarm on disruptive behavior to meet Joint Commission standards” in the October 2008 issue of Medical Staff Briefing (subscription required).

This week’s tip is adapted from The Credentialing Coordinator’s Handbook by Anne Roberts, CPMSM, CPCS—now available at a reduced price!

Ask the expert: At academic medical centers, who appoints the department chairs?

Wed, 18 Nov 2009 18:28:00 GMT

In some academic medical centers, the chair of the medical staff department also serves as the chair of the medical school department. This means the dean or a selection committee has primary or sole authority to appoint the department chair. In other academic medical centers, the academic department chair’s role is separate from the medical staff department chair’s. In such cases, the hospital CEO may have significant authority to appoint the department chair, and the medical school dean has varying degrees of influence on the decision, including co-appointment authority. Academic medical centers do not generally select department chairs through self-government (nominations or election by the members of the department).

This week’s question and answer are excerpted from The Greeley Guide to New Medical Staff Models: Solutions for Changing Physician-Hospital Relations by Richard A. Sheff, MD, CMSL and William K. Cors, MD, MMM, FACPE, CMSL.

Credentialing monthly: What is the role of the credentials committee in addressing unprofessional conduct?

Wed, 18 Nov 2009 18:20:00 GMT

If you believe everything you read, it may appear that we are in the midst of a disruptive physician behavior epidemic. As I travel to hospitals across the country, I am not convinced that the frequency or severity of unprofessional conduct (the term I prefer to use instead of “disruptive behavior”) has increased. Rather, I believe that we are changing our expectations of physician behavior.

In other words, medical staffs are no longer tolerating behavior that they tolerated in the past. The Joint Commission has weighed in on this issue with Sentinel Event Alert #40, which highlights the adverse affect unprofessional conduct has on patient safety. The Joint Commission also issued leadership standard LD.03.01.01, which requires hospitals to address unprofessional conduct throughout all levels of the hospital, including management, staff, and board members—not just physicians.

As members of the self-governed medical staff, department chairs are accountable for the behavior of physicians within their department. Thus, they are responsible for intervening when a physician displays inappropriate or disruptive behavior.

In addition to department chairs, the credentials committee plays an important role in keeping problem behavior in check. I’d like to share with you a clear set of actions a credentials committee can take to fulfill its role in eliminating unprofessional conduct:

Take a close look at the criteria for medical staff membership, which are located in your bylaws or credentials manual, and make sure they address professional conduct. If you don’t have criteria in place that address professional conduct, consider this sample language: “Physician must produce a history of consistently acting in an appropriate and professional manner in previous clinical settings.” This would not preclude a physician who has had a rare outburst from joining your medical staff if he or she acts in an appropriate and professional manner the majority of the time. This would however, prevent chronic offenders from joining your medical staff.
Once the credentials committee has established criteria for membership that address professional conduct, it now has the grounds for gathering information on an applicant’s conduct in previous clinical settings. This is where references come in handy, especially those your medical staff services department sends to MSPs at those settings (not the handpicked references of the applicant’s choosing). The credentials committee owns the content of those reference queries and needs to ensure it has answered any questions about an applicant’s conduct.
One of the credentials committee’s most important roles is to prevent what I like to call an “information error.” An information error occurs when information existed that your hospital could have or should have discovered but didn’t, and that information would have caused the committee to make a different credentialing decision. In this case, the credentials committee needs to gather all the information it needs regarding the applicant’s behavior in previous clinical settings to make a well informed decision. If the committee has any concerns about the applicant’s conduct, the committee should drill down into those concerns to resolve them to the satisfaction of your medical staff’s professional conduct policy. The credentials committee is responsible for making sure this policy is well written and consistently implemented. The credentials committee should not make any decisions regarding an applicant when concerns regarding his or her conduct remain unresolved.
The credentials committee needs to guard against the second kind of credentialing mistake: a “decision error.” A decision error occurs when the medical staff and hospital are aware of potential issues regarding an applicant but lack the wisdom, clarity, or courage to make a wise decision. When the credentials committee receives a recommendation from the department chair regarding each applicant and re-applicant, it is responsible for ensuring that the department chair appropriately understood the physician’s past behavior and made a wise decision. Typical concerns that occur at this stage include:
- The physician admits a lot of patients to the hospital and may have been given too much latitude with his or her behavior in the past.
- The physician is well-liked, resulting in their friends on the credentials committee approving the reapplication based on camaraderie, not objective evidence.
- Members of the credentials committee or others are afraid to lose referrals from the applicant or reapplication and continue to approve his or her membership on the medical staff in spite of significant, chronic behavior problems.
- The physician threatens to sue the hospital if it tries to affect his or her membership or privileges based on behavior concerns, and the hospital backs down.
- Credentials committee members and other medical staff leaders lack a consensus concerning whether to take poor physician conduct seriously and what types of behavior are tolerable.
The credentials committee needs to remember that the goal of the medical staff professional conduct policy is not to “kick physicians off the staff” for bad behavior, but to help every physician act in an appropriate and professional manner as much as possible. Therefore, the credentials committee should recognize when to recommend to a department chair that further interventions are warranted to address a physician’s behavior. This may warrant initial or reappointment for a period of less than two years while the interventions regarding their behavior are carried out.

By fulfilling its role, your credentials committee can help make unprofessional conduct a thing of the past, and in so doing enhance patient safety and collegiality throughout your hospital.

Richard A. Sheff, MD, CMSL, is the chair and executive director of The Greeley Company, a division of HCPro, Inc. in Marblehead, MA.

Physician numbers down, recruitment up

Tue, 17 Nov 2009 19:25:00 GMT

The majority of hospital CEOs (95%) see the physician shortage worsening with the economic downturn, according to a study released this month, “Clinical Workforce Issues: 2009 Survey of Hospital Chief Executive Officers” by AMN Healthcare, Inc., a healthcare staffing agency. AMN Healthcare partnered with the research group, the Council on Physician and Nurse Supply, to complete the study.

Nearly half (46%) of the 284 hospital administrators surveyed said access to care was compromised because of a shortage of healthcare professionals. As a result, a quarter of CEOs said the downturn has caused them to boost physician recruitment efforts. Many indicated that they will are recruiting the same or greater number of clinical professionals in the next six months to fill numerous vacancies.

[via ACP Hospitalist]

Q: We are considering launching a hospitalist program to reduce the burden of ED call. Are there any drawbacks?

Tue, 17 Nov 2009 19:22:00 GMT

A: Although hospitalist programs can be helpful in reducing on-call burden, they are not a panacea.

First, the money spent on hospitalist programs prompts some specialists to accuse the hospital of unfairness. These specialists may view these large payments as relief of burden for PCPs but no relief for specialists from call.

Second, aggressive hospitalist programs sometimes disrupt traditional referral patterns, leading to a small number of “preferred” specialists who get the lion’s share of the referrals. Sometimes, it also leads to a net reduction in referrals and loss of revenue to specialists.

Finally, the shortage of hospitalists nationwide leads to overburdened hospitalist programs that cannot adequately meet all the demands placed on them. Hospitalist job satisfaction may be poor when they are perceived as glorified house staff, ultimately undermining hospitalist recruitment and retention in a tight job market. If hospitalists take on excessive volume, they aren’t able to see new admissions in a timely manner. This leaves the specialists to be the first to see the patient, often causing the specialty to provide more time-consuming and comprehensive care than initially intended. And, if specialists assume the hospitalists are taking care of the general medical care, but the hospitalists aren’t seeing patients soon enough, delays in care can contribute to less-than-optimal outcomes and greater liability for everyone.

The above excerpt is adapted from Emergency Department On-call Strategies: Solutions for Physician-hospital alignment, 2nd edition, by Jonathan H. Burroughs, MD, MBA, FAPE, CMSL; Martin B. Buser, MPH, FACHE; Roger A. Heroux, MHA, PhD, FACHE; Richard A. Sheff, MD, CMSL; published by HCPro, Inc., Marblehead, MA.

Wondering about The Greeley Medical Staff Institute Symposium?

Wed, 11 Nov 2009 18:03:00 GMT

If you didn’t get a chance to attend The Greeley Medical Staff Institute Symposium in Naples, FL on November 8-9, don’t worry. Associate editor and freelance photographer Karen Cheung has been covering the event extensively on the HospitalistLeadership.com blog. Check it out!

Ask the expert: How can I ensure that the MEC is living up to the medical staff’s and hospital’s expectations?

Wed, 11 Nov 2009 17:57:00 GMT

One of the best ways to ensure that the MEC is living up to the medical staff’s and hospital’s expectations is for the group to answer self-assessment questions. The Medical Executive Committee Handbook, Third Edition, published by HCPro, offers more than 80 self-evaluation questions, but start with these five to get the committee talking:

Does the MEC consist of a workable number of members—neither too few nor too many—to function effectively and efficiently?
Are individuals other than physicians (e.g., the CEO or VPMA) present during MEC meetings, either as voting members or non-voting members?
Are prospective MEC members identified by a nominating committee or through another formally organized process?
Does the mechanism used to select MEC members use pre-established criteria pertaining to:
1. Prior service with the medical staff?
2. Commitment to the institution and medical staff?
3. Demonstrated leadership ability?
4. Professional respect?
5. Interest in serving?
6. Commitment to participate?
7. Absence of significant conflict of interest?
Are potential MEC members selected carefully to ensure a balance of both leadership and management talents and a sufficient representation of the various sectors within the medical staff?

Tip of the week: Do away with arbitrary time limits on committee appointments

Wed, 11 Nov 2009 17:52:00 GMT

Because so much work goes into training new committee members, keep existing members as long as they are doing a good job and are willing to serve. This may mean changing bylaws to do away with arbitrary time limits that do not allow for reappointment. For example, many medical staff bylaws contain language such as “Committee members will serve for a period of two years.”

To allow for greater continuity and return on the investment of training committee members, the medical staff should consider modifying this language to read, “Committee members will serve until replaced by the medical staff president,” or “Committee members will serve for a period of two years and may be reappointed.”

If the medical staff wishes to have timed appointments, it should consider staggering appointments so that there are always trained, experienced members serving on the committee. If you use staggered appointments, be sure to keep track of when committee appointments are due to expire.

This week’s tip is an excerpt from The Medical Staff Meeting Companion: Tools and Techniques for Effective Presentations by Kathy Matzka, CPMSM, CPCS.

FREE white paper: Foster a higher standard of professional conduct

Wed, 11 Nov 2009 17:47:00 GMT

One of the most difficult challenges facing medical staff leaders is overseeing professional conduct and confronting disruptive physicians. Authored by Jonathan H. Burroughs, MD, MBA, FACPE, CMSL, senior consultant with The Greeley Company, this free white paper provides a roadmap for approaching disruptive behavior that may negatively affect patients, staff, and physicians if it is not properly addressed.

Poll results

Wed, 11 Nov 2009 17:44:00 GMT

Last week, we asked readers whether their organizations had a disruptive/impaired physician policy, and the results are in. Out of 57 respondents, 54 indicated that their organizations do have a policy in place, and three indicated that they do not.

Sally Pelletier, CPMSM, CPCS, president of Best Practices Consulting Group in Intervale, NH, pointed out that organizations should have separate policies addressing disruptive physicians and impaired physicians. A physician who is impaired due to age, for example, should not be automatically considered disruptive. Therefore, it is best practice to ensure that your policy delineates between the two.

Bylaws and governance monthly: Balance the value of time and money when determining medical staff leadership pay

Wed, 11 Nov 2009 17:37:00 GMT

If the burden of medical staff leadership was shared equally by all medical staff members, each member would spend a reasonable amount of time on their leadership duties. As a result, medical staff members would be less likely to consider these duties an additional burden worthy of monetary compensation. But the reality is that a handful of the members do the bulk of the work while the remaining wouldn’t touch leadership responsibilities with a 10-foot pole.

In the past, medical staff members gave their time more freely and without the expectation of being paid. However, in today’s economic environment, physicians are watching their salaries dwindle, and they resist giving their time and expertise away for free.

This trend begs several questions:

Should we pay medical staff leaders? More often than not, medical staffs are offering leaders some form of compensation. Some medical staffs are unable to get leaders on board unless they offer compensation in the form of a yearly salary, stipend, or hourly rate. So, if you’re not offering compensation but want to keep experienced leaders on board, consider it seriously.

Which medical staff leaders should we pay? The answer to this question varies widely from hospital to hospital. Some pay only the president of the medical staff, some pay the president and department chairs, and some pay everyone on the medical executive committee. I suggest that you analyze the amount of time these individuals spend on their leadership duties to determine which positions warrant compensation.

How much should medical staff leaders be paid? The answer to this question also varies from hospital to hospital, and we see huge differences based on the size of the institution. Unfortunately, we can offer no magic numbers. It depends on the need to pay leaders, how much time leaders spend performing their duties, and how much the organization can afford. Most medical staff leaders know that the compensation they receive will not reimburse them fully for the time they spend on their leadership responsibilities, so for most institutions, payment is best approached as a token of appreciation.

Who should pay medical staff leaders? Historically, the hospital has been responsible for paying medical staff leaders because they perform the duties designated to them by the board. But some medical staffs feel that if the full payment comes from the hospital, the hospital will have the leaders in its pocket. As a result, more medical staffs are sharing the cost of paying leaders with the hospital, usually dipping into the monies generated from medical staff dues. Some medical staffs across the country are so opposed to the hospital reimbursing medical staff leadership (and a potential conflict of interest) that they fully fund the cost themselves.

In these economic times, we understand that it is difficult to find the monetary sources to fund these positions. Start thinking creatively – is there something else that the medical staff leader would value that could be used instead of a monetary award? How about reducing or eliminating unassigned call for certain medical staff? Medical staff leaders want to feel appreciated for the hard work that they do, so another reward might include public recognition of a leader’s efforts. Money is nice, but other forms of recognition may work as well, and in some cases, better.

Mary Hoppa, MD, MBA, CMSL, is a senior consultant with The Greeley Company, a division of HCPro, Inc. in Marblehead, MA.

Resident duty hour restriction cuts inpatient teaching

Tue, 10 Nov 2009 18:27:00 GMT

The current 80-hour resident duty restriction, set by the Accreditation Council for Graduate Medical Education (ACGME), reduces the amount of time residents spend teaching, according to a new study, “Impact of duty-hour restriction on resident inpatient teaching,” published in the October issue of the Journal of Hospital Medicine.

Researchers at the University of California, San Francisco, surveyed 125 internal medicine residents and found that the ACGME’s duty hour restrictions limit them; 24% of the residents spent less time teaching.

The duty-hour restrictions, however, lead to less emotional exhaustion and more satisfaction in the quality of care they delivered.

“Academic hospitalists should consider these impacts of duty hour restrictions and make adjustments such as educational and work-life innovations to account for these shifts,” states the study.

Hospitalist program demographics released

Tue, 10 Nov 2009 18:21:00 GMT

Where are hospitalist programs cropping up? A researcher at the University of North Florida, department of public health, found that organizations that use the hospitalist model are located in communities with certain characteristics. “The hospitalist model: Does it improve the quality of care?” published in the spring issue of the Journal of Health Care Finance, states that those communities have:

Higher-per-capita income communities
Fewer uninsured patients
More Medicare managed care

The hospitals that use the hospitalist model have the following characteristics:

Shorter length of stay
Better quality of care
Higher occupancy rates
Wider range of clinical services

“From a managerial perspective, this study demonstrates a correlation between the hospitalist model and reduced length of stay and enhanced quality,” states the study.

Reader survey: Who gets to keep the medical records?

Wed, 04 Nov 2009 16:01:00 GMT

As editor of Medical Staff Briefing and Medical Staff Leader Connection, I write frequently about the need for collegiality between hospitals and their medical staffs. It’s an ever present issue, and I want to hear from you about your organization’s practice.

The recent war over who gets to keep 3,000 to 4,000 patient records that has erupted between a group of family practice physicians and Boston's Caritas Christi Healthcare is a perfect example of how hospitals can permanently damage relationships with community physicians.

For me, it also raises an important question: Who gets to keep patient records when physicians decide to move to another facility? How does your facility handle similar situations without burning their bridges? Are there laws in your state that clarify this issue? I’d love to hear your thoughts.

Please share your thoughts by emailing me at ejones@hcpro.com. Your responses may appear on the Credentialing Resource Center blog.

Best,
Liz Jones
Associate Editor
HCPro, Inc.

Do you have a disruptive/impaired physician policy?

Wed, 04 Nov 2009 15:58:00 GMT

HCPro wants to hear from you! Every month, we post a new interactive poll question on our Web site. To answer this month's question regarding whether your facility has a disruptive/impaired physician policy, click here.

Tip of the week: Train physician reviewers to do effective case reviews

Wed, 04 Nov 2009 15:54:00 GMT

Physicians have reviewed case charts from their first days of medical school, but they are rarely taught to do so formally. What should they be looking for when they are handed a folder filled with a patient’s medical records? To help physicians answer this question, it is best practice for a medical staff to create a training program to improve the inter-rater reliability of new committee members and keep current members on track.

There are three components to reviewer training. First, reviewers must have a common understanding of the procedures and tools. This is best achieved through an orientation session. During this session, the trainer needs to explain the case review process and define the expectations of reviewers in terms of review time frames and scoring form completion.

Second, the reviewers should have some practical guidance during the review. Provide a well designed review form and some questions for the reviewer to keep in mind.

Third, the reviewers need a method to calibrate their performance to the group norm. This can be accomplished by having reviewers score the same case independently and discuss the results. Medical staffs can do this when a new committee is started, when new members join the committee, and annually with the entire committee.

This week’s tip is excerpted from Peer Review Best Practices: Case Studies and Lessons Learned by Robert J. Marder, MD, CMSL and Jonathan H. Burroughs, MD, FACPE, CPE, FACEP, CMSL.

Ask the expert: Who should set physician performance targets?

Wed, 04 Nov 2009 15:50:00 GMT

When determining what data to collect to evaluate physician competence, it is critical that the medical staff sets targets for excellent and acceptable performance. This is generally done by the medical staff quality committee, which asks each department for recommendations for specialty-specific indicators. The medical staff quality committee then determines as a whole the non-specialty related measures (i.e., appropriateness of blood usage or inpatient complaints). Then, these recommendations are sent to the medical executive committee (MEC) for approval. This way, when physicians fall outside the targets and begin to challenge them, medical staff leaders will be able to explain that these are medical staff targets, not those of the quality office or administration.

This week’s question and answer are adapted from Effective Peer Review: A Practical Guide to Contemporary Design, Second Edition, by Robert J. Marder, MD, CMSL; Mark A. Smith, MD, MBA, CMSL; and Richard A. Sheff, MD, CMSL.