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Fundamentally, there should be no difference between how employed practitioners and independent practitioners are credentialed.
Verifying the information and evaluating current clinical competence should be the same regardless of whether the applicant internist is an employed hospitalist or an independent internist opening his or her own office.
In the real world, however, hospitals and health systems are under great pressure to expedite credentialing for the employed physicians coming on board in order to maximize productivity (and thereby generate income for the organization).
Even in the face of this pressure, the credentialing process should take no shortcuts—although having an expedited workflow for clean applicants is still possible.
Likewise, the credentials committee should not wield the credentialing process as a political weapon to slow employed physicians’ entry to the medical staff.
Unfortunately, such an approach can occur in areas where independent physicians feel threatened by the employed group or are upset with hospital administration for pursuing these practitioners.
Your organization’s credentialing policies should stress that the processes are the same for all applicants seeking privileges on the medical staff.
Last Thursday, the Florida Supreme Court overturned a 2003 state law that restricted pain and suffering–related payouts in medical malpractice claims.
“We hold that the caps on personal injury non-economic damages … violate the Equal Protection Clause of the Florida Constitution,” the 4-3 majority stated in their opinion, emphasizing the adverse impact of these “arbitrary” reductions on “plaintiffs who suffer the most drastic injuries.”
The 2003 bill instating these caps, signed into law by then-Governor Jeb Bush, was a hotly contested response to what physicians called a crisis of high insurance premiums.
The majority in last Thursday’s ruling found “no evidence of a continuing medical malpractice insurance crisis justifying the arbitrary and invidious discrimination between medical malpractice victims.”
For their part, dissenting justices argued that the majority’s ruling was an overreach.
“Under our constitutional system, it is the Legislature, not this Court, that is entitled to make laws as a matter of policy based upon the facts it finds,” the minority opinion stated. “For a majority of this Court to decide that a crisis no longer exists, if it ever existed, so it can essentially change a statute and policy it dislikes, improperly interjects the judiciary into a legislative function.”
Last week’s ruling effectively broadens a 2014 Florida Supreme Court decision that found caps unconstitutional in wrongful-death malpractice cases.
Reporting to the National Practitioner Data Bank (NPDB) has nothing to do with a failure to meet some standard in an employment agreement, provided that there has been no similar action by a “peer review body” (generally understood to be the organized medical staff peer review process) or actions taken under the medical staff bylaws for investigation/suspension and so forth. Most of the time, this is the end of the subject; however, if you are part of a large health system/group practice, there are some new trends afoot that make life a bit more complicated.
A new rub is that some large health system–employed medical groups (and many larger independent group practices as well) are now establishing their own separate “peer review body” within the medical group itself. There are several reasons why this might be done:
competency for practitioners strictly in the ambulatory setting who have only medical staff membership and no privileges. Such physicians are not subject to the organized medical staff’s peer review process.
The desire to ensure physician competency strictly in the ambulatory setting for physicians who hold “ambulatory privileges” under the medical staff peer review process. Here the health system may decide to create a peer review function that truly understands the ambulatory world as opposed to devoting more resources to an inpatient-based medical staff peer review support function that has no knowledge of this setting.
The desire to have a group practice–based entity to receive protected peer review information from the formal medical staff process through a peer review information sharing agreement.
A poorly thought-through decision of the health system that they need to do something to ensure quality care in the ambulatory setting, so they create a new peer review body without fully thinking through the unintended consequences.
The creation of a “peer review body,” as defined by the Health Care Quality Improvement Act of 1986, that is separate from or independent of the hospital-based medical staff peer review body now subjects the employer potentially to the same NPDB reporting requirements. The health system would be wise to seek expert counsel in this arena and consciously and thoroughly think through what is being done and why. The good news for medical staff leaders is that you are responsible for the medical staff process only. What the health system does beyond the medical staff is its choice, for better or worse.
The Midwest may be the best place for physicians to practice, according to data measuring physician income and burnout.
Based on data collected in May 2016 by the U.S. Department of Labor Bureau of Labor Statistics, physicians in New Hampshire had the highest annual average wage at $272,820, followed by Wyoming ($259,940), and Minnesota ($253,440). The states where physicians earned the least were New York ($177,330), Kentucky ($176,330), and Nebraska ($163,730). Overall, the average annual wage for physicians was $205,560.
Medscape ranked the best cities for physicians to avoid burnout and stress and the top four are located in the Midwest: Minneapolis, Minnesota; Madison, Wisconsin; Sioux Falls, South Dakota; and Des Moines, Iowa. The ranking was based on several factors believed to contribute to burnout, including the rates of medical board actions and malpractice lawsuits, physician density, income, insurance coverage, divorce rates, and cost of living. Rounding out the top 10 cities are Burlington, Vermont; Manchester, Hampshire; Boston; Fargo, North Dakota; Portland, Maine; and Overland Park, Kansas. The worst cities were New Orleans, Phoenix, Las Vegas, Albuquerque, and Tulsa.
Are you considering a change in your credentialing software or a move to an automated system? Modern medical staff services departments are increasingly turning to technologies that allow MSPs and other credentialing stakeholders across the organization to go paperless; house large volumes of quality data in a centralized, searchable, and secure location; facilitate virtual committee meetings; purchase managed care modules; trend initial and reappointment turnaround times; and more.
Given these myriad capabilities, finding a viable solution is easy. What’s harder is sifting through the range of vendors to identify the best partner and, once you do, gaining approval to move forward.
Over the course of my career, I’ve participated in numerous software transitions and learned a lot about effectively addressing these goals. Here are my top tips for pinpointing specific organizational needs, choosing the right vendor, and earning buy-in from organization leadership.
Assess organizational needs
Before purchasing new credentialing software—or making a wholesale move from a manual to a database-driven process—MSPs must assess their organizational needs and expectations, which will aid in identifying the desired software and developing criteria for evaluating vendors. Use the following questions to focus your preliminary assessment:
Why are we doing this, and why now? Motivators may include going paperless; establishing a single “source of truth” for providers’ demographics; standardizing the credentialing process across multiple facilities within a healthcare system; easing the transition from manual credentialing to an automated process; and integrating web crawlers that obtain practitioner data through state licensure, the U.S. Drug Enforcement Administration, the Office of Inspector General, and other authorities.
What are the pros and cons of implementing new software? Pros may include improved efficiency, better reporting capabilities, the option to add more modules for online applications, and the ability to hold virtual committee meetings. Cons may include high costs, limited IT availability, and difficulty gaining support to make the transition to a new software.
What’s the anticipated return on investment?
What are the anticipated costs? Consider direct and indirect expenditures, including annual fees and staffing hours devoted to research, training, and getting up to speed on the new software.
Will we need a single or multi-entity software?
What’s a realistic implementation time frame?
What level of support and commitment can we expect from key stakeholders? How much time can IT personnel, MSPs, medical staff leaders, and others realistically dedicate to the project?
Who (if anyone) will serve as executive sponsor and project manager? Typically, the executive sponsor will be the senior leader who oversees the medical staff services department. If available, a specific project manager may be assigned, or the director/manager may assume the position.
Through answering these questions, the medical staff services department should determine which type of software would be the best fit and prepare a formal recommendation for senior leadership.
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