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

News and briefs: Palliative care specialty attracts young physicians

Thu, 09 Feb 2012 20:23:00 GMT

As the palliative care field continues to grow, so does the number of young physicians in the field. According to an article in the San Jose Mercury News, experts have mixed reactions about whether age matters.

The SUPPORT study, which is the largest study on end-of-life care, found that elderly patients were unlikely to disclose important medical information to young physicians. "We found that patients did not tell interviewers about certain things until the interviewers were older—that is, past 60," she said. "So, young doctors are going to have to make a special effort to get this sort of information."

Young physicians will have to learn how to overcome this challenge because as of January 2012, physicians that want to become board certified in hospice and palliative care by the American Board of Medical Specialties have to complete a one-year training program in palliative care; older physicians are no longer be grandfathered into the specialty.

To read more pros and cons of young physicians dominating the palliative care field, click here.

Running an effective peer review committee meeting

Thu, 09 Feb 2012 20:01:00 GMT

Physician leaders often perform tasks for which they have received no formal training. Some of these responsibilities are technical, such as evaluating privileges, and others involve general leadership principles. A physician leader’s inexperience in leadership skills can have a major impact the medical staff if not performed well. One of those critical responsibilities is running a committee meeting.

Recently, I was asked to speak at a medical staff retreat on how to run an effective committee meeting. The medical staff president specifically requested a presentation on this topic after observing that many of the organization’s committee meetings were not run well. As a good leader, he realized that most of the incoming leaders, either as department chairs or specific committee chairs, had not received any formal or informal guidance on how best use the time voluntary medical staff members spend in meetings.

My presentation focused on four key aspects to running a successful meeting:

Prepare for the meeting
Manage the agenda
Manage discussion and decision-making
Plan follow-up action

Although my presentation covered a number of techniques for using meeting time productively, one of the main points that most physician leaders don’t realize is that half of activities related to conducting a successful meeting occurs outside the meeting! Unless there is solid preparation and follow-up on actions identified in previous meetings, meetings will be unproductive.

Unfortunately, too many physician leaders walk into a meeting that they chair without any idea what is on the agenda, how long discussion items will take, or what decisions need to be made. Consider the following tips on how to prepare for a meeting:

Hold a regularly scheduled pre-meeting with support staff
Create a consent agenda of those items that don’t need discussion
Create a strategic agenda with timeframes and desired outputs, listing important items first
Prepare support materials needed for decision-making and problem solving

Effective follow-up on action items is necessary for a truly productive meeting and for committee members to consider their time well-spent. Committee members become frustrated when the issues they spend time considering and discussion do not come to fruition. In these cases, the committee chairman is not sufficiently following up on items, causing a lack of movement. Here are tips on how to provide effective follow-up:

Clarify action items and responsibilities during and at the end of the meeting
Have a set meeting with staff for follow-up activities
Find out the status of follow-up items well in advance of the next meeting
Hold members and staff accountable for persistent lack of follow-up

Remember, as a committee chair, you have been entrusted with the valuable time of your colleagues. A little extra time on your part spent in preparation and follow-up, will yield a tremendous return in savings of the total time spent by your committee.

Robert J. Marder, MD, CMSL, is vice president of The Greeley Company, a division of HCPro, Inc. in Danvers, MA.

Ask the expert: What should we include in our medical staff leader evaluations?

Thu, 09 Feb 2012 19:54:00 GMT

Medical staff leadership performance evaluations do not have to be lengthy or intimidating. The evaluator should assess whether the leader:

Understands the bylaws, policies, and procedures of the medical staff
Performs the duties of the office in a timely and efficient manner
Creates an environment of teamwork and develops strong working relationships within the medical staff and hospital
Uses caring, courteous verbal and nonverbal behaviors in all interactions
Maintains confidentiality and the integrity of the medical staff
Actively participates in the education, mentoring, and coaching of others
Continues to strive for improvement

This week’s question and answer are from Medical Staff Leadership Essentials: A guide to developing leadership skills and recruiting the next generation by R. Dean White, DDS, MS.

Featured blog post: Courtesy and Respect? Don?t have to; I?m the physician!

Thu, 09 Feb 2012 19:46:00 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.

Financial Statements for Physician Leaders, Part II: The Balance Sheet

Thu, 02 Feb 2012 15:10:00 GMT

Last month, we covered the statement of operations, or as it is more commonly known, the profit and loss (P and L) or income statement. This month, we will cover the balance sheet. This financial statement demonstrates an organization’s financial position at a specific point in time and presents a “snapshot” using the accounting equation:

                                      Assets = Liabilities + Equity

Assets are economic resources that an organization relies on to provide services to its customers, and liabilities are economic obligations or debts to creditors. In a for-profit organization, equity represents economic obligations to investors or stockholders, whereas in a nonprofit setting, equity is called net assets and represents the difference between total assets and total liabilities. Net assets represent a combination of retained earnings or funds left over after dividends are paid to stockholders and the amount of investment or donations/funds that are provided to a for-profit or nonprofit entity, respectively. In a nonprofit organization, funds are divided into unrestricted, semi-restricted, or restricted categories based upon whether donors or grantors want the organization to utilize funds for a specific reason or leave it up to senior management to decide.

The balance sheet is arranged with assets on the left hand side and liabilities and equity/net assets on the right as follows:

             --------------------------------------------------------------------------------------------------------------------------------
Current Assets:   Cash                                                               Current Liabilities: Accounts payable
                               Short-term investments                                                              Accrued expenses payable
                               Net accounts receivable                                                              Deferred revenues
                               Inventory
                               Pre-paid expenses
Total current assets:                                                                 Total current liabilities:

Long-term Assets:    Long-term investments                    Long-term liabilities:
                                     Plant and equipment
                                     Less accumulated depreciation
                                     Net plant and equipment                  TOTAL LIABILITIES:

                                                                                                    NET ASSETS (Unrestricted + temporarily
                                                                                                     Restricted + restricted funds) or EQUITY (total
                                                                                                      common stock – dividends payout = retained
                                                                                                     earnings)
TOTAL ASSETS = TOTAL LIABILITIES + NET ASSETS OR SHARE HOLDER’S EQUITY

You will notice that assets and liabilities are divided into current assets or liabilities (those that have a life under one year) and long-term assets/liabilities (those that last for more than one year). A “year” may be a calendar year or a fiscal year, which is 365 days from the beginning of one budgetary cycle to the next and often begins/ends at a time of year when revenues and expenses are stable enough to be predictable. Another pattern is that both assets and liabilities are placed in order of liquidity (the ability to convert an asset or liability into cash) with the most liquid asset/liability at the top and the least liquid at the bottom.

Definitions of typical line items are as follows:

Current assets:

Cash = cash
Temporary or short-term investments are securities or other investments that mature in under a year
Net accounts receivables are money owed for services minus allowances for contractual allowances (the difference between what you charge and what a third party payer has agreed to pay you), charity care (money you don’t expect to receive), bad debt (money you expect to receive but don’t)
Inventory includes the cost of food, drugs, equipment, and supplies purchased but not yet used
Pre-paid expenses are expenditures made for goods and services (e.g. insurance) not yet used

Long-term assets:

Long-term investments are corporate bonds or securities that the organization intends to hold for more than one year
Net plant and equipment is the purchase value of land, buildings, and equipment minus a calculated percentage of the value that is subtracted as an expense over time (depreciated) in either a consistent (line depreciation) or accelerated (accelerated depreciation) way

Current and long-term assets are added together to make total assets, which according to the accountant’s formula, must equal total liabilities plus net assets or equity.

Current liabilities:

Accounts payable are amounts the organization owes to creditors or suppliers for merchandise and services purchased.
Accrued expenses payable are obligations (accrued wages, etc.) that the organization owes its employees.
Deferred revenue is revenue received by the organization prior to providing a service and represents a pre-paid expense to the creditor. An example of this would be capitated revenues paid by a third-party payer, such as a managed care organization or patients prior to receiving services.

Long-term liabilities are economic obligations due in more than one year. Again, short-term and long-term liabilities are added to determine total liabilities.

As mentioned, in for-profit entities, stockholders’ equity equals the amount of outstanding stock held by investors minus dividend payout plus retained earnings, whereas in nonprofit entities, net assets (the difference between total assets and total liabilities) is the sum of non-restricted, semi-restricted, and restricted donations, and retained earnings.

What are the strengths and weaknesses of the balance sheet?

The strength lies in its clarity and ability to create a simplified view of the total financial condition of an organization summarizing the key assets, liabilities, and net assets or equity. It is simple to read and provides a good view of summary information at a given point in time.

The weakness is that it doesn’t show the financial condition of the organization over time, including cyclical fluctuations and variability in financial performance. Most importantly, it fails to show the organization’s cash position, which may be a critical determinant to the overall solvency of the organization and its ability to meet its debts. When healthcare services are provided, it may be weeks or months before cash is received (if ever) and this can have an enormous impact on the organization’s ability to reinvest in capital and equipment to continue to provide up-to-date services with up-to-date technology and equipment.

This critical determinant will be covered next month with the most important financial statement of all: the statement of cash flows.

Jon Burroughs is senior consultant and director of education services with The Greeley Company, a division of HCPro, Inc., located in Danvers, MA.

News and briefs: ABFM enhances Maintenance of Certification process

Thu, 02 Feb 2012 15:06:00 GMT

The American Board of Family Medicine (ABFM) recently made changes to its Maintenance of Certification for Family Physicians (MC-FP) program, including a new entry/re-entry process. According to the American Academy of Family Physicians, physicians who do not pass the MC-FP exam within three years of graduation from a residency program, or physicians who have never started the process, will have to follow the guidelines of the entry process to be eligible to take the test. The entry process includes continuing education credits and maintaining a full and unrestricted license for three years, among other things.

The ABFM also updated its definition of “board eligibility” as the first seven years after loss of certification or the completion of an ACGME accredited residency training program. The organization previously did not have a set definition for the term. After the seven-year period, a physician will lose the ability to refer to himself or herself as board eligible and will need to re-enter training and complete at least one year of additional training in an ACGME accredited family medicine residency before he or she will be allowed to take the ABFM certification exam.

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

Thu, 02 Feb 2012 15:03:00 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: Should medical staff bylaws address employment contracts and exclusive contracts?

Thu, 02 Feb 2012 14:56:00 GMT

Medical staffs should include a provision in the bylaws stating that if there is a contractual arrangement between the hospital and any member of the medical staff, the terms of the contract take precedence over the bylaws, says Michael Callahan, an attorney at Katten Muchen Rosenman, LLP, in Chicago.

“You don’t want to see a provision giving the bylaws precedence over the contract—the governing board would never approve that because it would limit their right to contract [with physicians and physician groups], he says.

This week’s question and answer are from Medical Staff Briefings, HCPro’s monthly newsletter. For more information, click here.

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

Thu, 02 Feb 2012 14:21:00 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: 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.

Tip of the week: Track and trend behavior issues

Thu, 26 Jan 2012 16:32:00 GMT

Medical staff and hospital leaders often find it difficult to track and trend behavior problems because medical staff members are reluctant to report improper conduct for fear of retribution. To encourage reporting, reporting systems must respect and protect staff members who disclose other physicians’ improper conduct while holding them accountable for reporting incidents in “good faith.” Reporting behavior in good faith means putting the best interests of patients first and discouraging reporting for the sake of retaliating against a provider for alleged wrong doing.

Unfortunately, many hospitals and medical practices have not created an institutional culture that supports the reporting of conduct concerns. Instead, these organizations too often overlook or tolerate disruptive physician behavior. Although some hospitals are officially moving toward zero-tolerance approaches to improper conduct, cultural change commonly lags behind policy change.

Leaders are challenged by the subjective nature of reporting methods that are based on individuals’ perception of a particular behavior. Because medical staff leaders are accustomed to dealing with hard facts when they evaluate data to reach conclusions, they often feel uncomfortable acting on subjective reports.

Behavioral assessments of any kind are considered perception data because they are dependent on what others perceive our behavior to be. Physicians may feel uncomfortable allowing non-physicians to evaluate any part of their performance and become offended when placed in that situation. Unfortunately, there are dimensions of performance, such as interpersonal skills, that are difficult, if not impossible, to assess solely through interaction with peers. Often, a nurse manager or other member of the healthcare team is in a far better position to view day-to-day interactions that may go unnoticed by leadership. This is also a challenging situation due to the inherent hierarchy between physicians, nurses, and other healthcare providers; nurses and other healthcare providers may feel uneasy attempting to communicate with physicians about their behavior issues and vice versa. This tension should be openly discussed with all parties so that every member of the healthcare team feels comfortable interacting with each other when they are asked to assess performance.

If your medical staff implements a behavioral event review committee (BERC) model, each incident report or occurrence of disruptive behavior that involves a physician is reported to the BERC, and a member of the BERC seeks the physician’s side of the story. The physician’s side of the story is factored into the equation before the BERC engages in discussion about or categorizes the incident. The BERC enters its final determination into a database that tracks all information regarding the incident.

This week’s book excerpt is from A Practical Guide to Managing Disruptive and Impaired Physicians, Second Edition by R. Dean White, DDS, MS, and Jonathan H. Burroughs, MD, MBA, FACPE, CMSL.

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

Thu, 26 Jan 2012 16:26:00 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 be speaking 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, like just what the heck is HCAHPS? To find out, click here.

News and briefs: Patients want easier access to medical records

Thu, 26 Jan 2012 16:21:00 GMT

Improved understanding and more involvement in care; these are two reasons patients would like “open visit notes” with their primary care physicians (PCPs). According to a study conducted by the Annals of Internal Medicine, 92% to 97% of patients surveyed thought open visit notes—in which patients can access their medical records through an electronic portal—was a good idea.

PCPs who responded to the survey were not as enthusiastic; 69% to 81% said they were in favor of open notes. Some of the reasons given for lower approval ratings by PCPs included an increase in patient worry, more questions from patients between visits, and an increased risk for lawsuits. To read more about the survey, click here.

You Won't Believe who's Asking for What Privileges Now

Thu, 19 Jan 2012 18:14:00 GMT

Dear Colleague,

Traveling around the country and working with many hospitals provides a wealth of opportunities to see what’s happening on the frontlines. It also makes for some amazing stories. This one comes from a hospital at which an ophthalmologist requested privileges for breast reduction and augmentation after attending a two-week course.

Although perhaps comical, this story is all too real. Similar stories are playing out over and over as physicians, under pressure to find new sources of revenue, cross previously sacrosanct specialty boundaries in search of patients and procedures. In particular, physicians seek to provide elective, high margin, daytime, billable services, and all too often push the envelope of reason and patient safety. That’s exactly what made breast surgery attractive to this particular ophthalmologist.

Minimally invasive surgery and other technological advances lower the bar for the time and intensity of training needed to achieve competence in some of these attractive (read that lucrative) procedures. This trend blurs some of the bright lines of the past regarding training and competence. The question is: How will your medical staff respond to these challenges?

The first step is to adopt the “5 P’s” with which many of you are familiar: “Our Policy is to follow our Policy. In the absence of a Policy, our Policy is to adopt a Policy.”

Establishing eligibility criteria for requesting privileges is the policy in question. Should an ophthalmologist be eligible to request breast surgery privileges in your institution? If he or she is not eligible, the medical staff will not process the request. The medical staff will also not have to issue a denial or offer a fair hearing. If he or she is eligible, the medical staff must assess the ophthalmologist’s competence. If found to be inadequately competent for the requested privileges, the medical staff must issue a denial and offer a fair hearing, two steps it would rather avoid.

To determine whether the ophthalmologist will be eligible to request breast surgery privileges, the medical staff must wrestle with a key challenge that underlies many credentialing decisions. Where does your medical staff and hospital want to be on the spectrum between “managing loose” and “managing tight”? I refer to these two management styles as “goods” because there is a value to each, which are two poles on either end of a spectrum. Manage loose allows for flexibility, creativity, customizing care to individual patients, and, in this case, physician entrepreneurialism. Manage tight is how we achieve reliability, high levels of patient satisfaction, cost effectiveness, and patient safety.

Applying this framework to our ophthalmologist’s request for breast surgery privileges, we can recognize the value of supporting physician entrepreneurialism and weigh it against the priority of patient safety and good clinical outcomes. The example of an ophthalmologist requesting breast surgery privileges appears to be outside the bounds of safe and appropriate care, which makes the judgment call of coming down on the manage tight side of this issue quite reasonable. However, numerous current and yet to be imagined requests for privileges outside the usual bounds of a particular specialty lie ahead for your medical staff, especially requests driven by the pursuit of lucrative procedures and evolving technology. Many of these cases will be less black and white and more about managing shades of gray. Applying the 5 P’s and wrestling with where your medical staff and hospital want to be on the spectrum between manage loose and manage tight will be the keys to thoughtfully, safely, and fairly navigating these challenges ahead.

All the best,

Rick Sheff, MD
Principal and CMO
The Greeley Company

News and briefs: Trust plays important role in acquisitions

Thu, 19 Jan 2012 18:10:00 GMT

Integrating physicians, compensation, and trust are the three most challenging areas for healthcare leaders when it comes to merging physician practices with hospitals and health systems, according to a recent HealthLeaders Media Intelligence Report. The report was created from an online survey sent to HealthLeaders Media Council and select members of its audience; half of respondents are senior leaders in their organization.

Although only 19% of respondents said trust is the biggest challenge, Tom Gallagher, president and CEO of Seton Ventures and Alliances for Seton Healthcare says developing trust between the organization and physicians should not be taken lightly.

“There are lots of partnerships in terms of workshops at the hospital for physicians, but the physicians don’t generally have a financial tie to the hospital. Trust is a more difficult commodity with that kind of a relationship,” Gallagher tells HealthLeaders Media. To read more of the report, click here.

News and briefs: Work of older and younger PAs compared

Thu, 19 Jan 2012 17:59:00 GMT

Older physician’s assistants (PA) are more likely to work in primary care in a non-urban setting, according to a study published in the Journal of the American Academy of Physician Assistants. The study compared characteristics of PAs under the age of 60 to those 60 and older to offer insight into the career trajectory of PAs.

The older age group reported working only slightly less than the younger group: those 60 and older worked a mean of 39 hours per week; for those under 60, it was 41 hours per week. The study also found that older PAs spend more hours on call.
To read more of the results, click here.