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HHS Secretary Alex Azar has reauthorized the declaration of a public health emergency (PHE), meaning the PHE and its special rules for providers remain in effect at least through the end of the year.
At the federal government's PHE website, Azar declared on Oct. 2: "As a result of the continued consequences of the Coronavirus Disease 2019 (COVID-19) pandemic, on this date and after consultation with public health officials as necessary, I, Alex M. Azar II, Secretary of Health and Human Services, pursuant to the authority vested in me under section 319 of the Public Health Service Act, do hereby renew, effective October 23, 2020, my January 31, 2020, determination, that I previously renewed on April 21, 2020 and July 23, 2020, that a public health emergency exists and has existed since January 27, 2020, nationwide."
As this is a 90-day authorization, physician practices can count on the flexibilities instituted by CMS under the authority of the PHE—such as the right to provide and bill Medicare for expanded telehealth and even telephone services regardless of site of service and expanded scope of practice for many non-physician practitioners—to continue through the end of the year.
The renewed 90-day period will cover Oct. 23 to Jan. 21, 2021.
But this is no guarantee that Azar will reauthorize again in January.
It also remains to be seen whether CMS will retain the flexibilities in 2021—the recent proposed rule for the physician fee schedule suggests the agency is eager to drop at least some of them.
President Donald Trump’s recent executive order (EO) placing limits on the diversity training that federal employers and contractors can offer is raising concerns of a chilling effect on employers’ diversity, equity, and inclusion efforts.
The order, released on September 22, was referenced during the September 29 presidential debate between Trump and former Vice President Joe Biden.
Even before that rancorous exchange, the EO had many concerned it could handcuff employers wanting to train their workforces on such topics as unconscious bias and inclusive workplaces.
Nita Beecher, an attorney with Fortney & Scott, LLC in Washington, D.C., says she’s seen employers worried about what the order may mean for the commitments they have made in light of the Black Lives Matter and #MeToo movements.
Also, the Office of Federal Contract Compliance Programs (OFCCP), the division of the U.S. Department of Labor responsible for ensuring that employers doing business with the federal government comply with nondiscrimination laws, on September 28 announced a hotline for employees to complain about training.
“So, federal contractors are very concerned that their employees will complain to OFCCP about the training, which could lead to a complaint investigation,” Beecher says. In a worst-case scenario, she says, companies that are subject to complaints could be debarred from federal government contracts.
Title VII and legal challenges
In addition to federal agencies and federal contractors, the executive order may affect private-sector employers that aren’t federal contractors.
An alert on the Fortney & Scott website says the order instructs the attorney general to assess how an employer’s workplace training teaches what the order calls “divisive concepts” and whether that teaching contributes to a hostile work environment in violation of Title VII of the Civil Rights Act of 1964.
The order also says the attorney general and the Equal Employment Opportunity Commission (EEOC) can issue guidance on compliance with the order and “such guidance could address the potential tensions between Title VII compliance and trainings with the new EO restrictions,” the Fortney & Scott alert says.
The EO may trigger legal challenges on either procedural or constitutional grounds. Beecher says she hasn’t heard of any so far, but such challenges may depend on the outcome of the presidential election, since a Biden victory likely would mean the order would be rescinded.
Russell says she’s not seeing employers without federal contracts limit their training.
“The reality is that given the current climate in the country, I think this executive order is out of step with the desires and the practices of the vast majority of employers who are large enough to have developed training programs and are focusing on diversity,” Russell says.
She points out that her state—Delaware—mandates certain sexual harassment training. She says for nonfederal contractors, “our guidance has not changed at all.”
Diversity and antiharassment trainings are important for legal defense, Russell says, but they “are extremely important in terms of morale.” She says employers she works with are interested in more than legal compliance. They are more focused on making sure employees feel valued in the workplace.
Mark I. Schickman of Schickman Law in Berkeley, California, says employers should not abandon diversity training in light of the executive order. He says eliminating training would likely create more trouble than it would solve.
Schickman says employers should gear their training toward conduct and not to personalities. For example, sexual harassment training doesn’t need to change someone who thinks saying “honey” or “sweetie” is good or bad. Training would just say not to say that in the workplace.
Implicit bias training isn’t meant to train people to say they are racist or sexist. Instead. it shows people how they can unconsciously let biases lead them to make racist or sexist decisions, Schickman says.
Contents of the EO
The Fortney & Scott alert says the EO “states that workplace training is teaching ‘that men and members of certain races are inherently sexist and racist.’”
The order instructs employers to no longer use training that includes what the order refers to as “divisive concepts,” among them that one race or sex is inherently superior; the United States is fundamentally racist or sexist; and individuals, by virtue of their race or sex, are inherently racist, sexist, or oppressive.
Schickman says some of the language in the order casts doubt on implicit bias training because of how it defines race or sex “scapegoating.”
Implicit bias training attempts to identify an unconscious inclination to treat others discriminatorily, and training aims to point out how anyone can have biases that they should be aware of. But Schickman says that’s the kind of training the order calls race or sex scapegoating.
Tammy Binford writes and edits news alerts and newsletter articles on labor and employment law topics for BLR web and print publications.
The less strict definition of zero tolerance states that disruptive behavior is never justified.
A version of this article was first published September 30, 2020, by HCPro's Credentialing Resource Center, a sibling publication to HealthLeaders.
When addressing disruptive physician behavior, organizations must understand an often confusing phrase: zero tolerance.
Many medical staffs are adopting a zero-tolerance policy with regard to disruptive behavior, but some hospitals are confused about what exactly zero tolerance entails.
This confusion is understandable because this phrase has been defined in two ways: strict and less strict.
The strict definition of zero tolerance implies that a single incident of disruptive behavior will lead to corrective action and the physician will automatically lose membership and privileges.
The less strict definition of zero tolerance states that disruptive behavior is never justified, and the organization’s first step is to provide feedback to that physician and remind him or her of the expectations set forth in the behavior policy.
If your organization adopts a zero-tolerance policy regarding disruptive physician behavior, be sure to clarify how the term should be applied.
This clarification is not only fair to your physicians, but it will likely improve compliance with the policy.
MSPs are optimistic that their working conditions will go back to normal once the pandemic is over.
A version of this article was first published September 23, 2020, by HCPro's Credentialing Resource Center, a sibling publication to HealthLeaders.
Almost 70% of MSPs said they will return to working onsite when the COVID-19 pandemic is over. This is according to the 2020 MSP Salary Survey, which is conducted annually by Credentialing Resource Center. Twenty-three percent said they will do a hybrid of working both from home and the office. The remaining 7% said they would not return to working onsite. Interestingly, many MSPs left comments in the survey that they were deemed essential employees and were not given the option to work remotely because of the pandemic.
The survey also reveals that prior to the COVID-19 pandemic, only 30% of MSPs were able to work from home (either part- or full-time). Many respondents commented that their department is not paperless, so working from home would not be feasible.
The MSP salary survey remains open for a few more weeks, and we encourage everyone to participate! The more answers we have, the more thorough a report we will be able to release to help MSPs further advance the profession. To take the survey, click here.
The Health Insurance Portability and Accountability Act (HIPAA) requires healthcare employees to use or share only the "minimum necessary" information they "need to know" to do their jobs.
A version of this article was first published September 21, 2020, by HCPro's Credentialing Resource Center, a sibling publication to HealthLeaders.
Physicians, nurses, therapists, dietitians, and others use confidential information about patients to determine how to treat them, but they are not the only ones who access such data.
Coders and billing department employees use confidential information to bill patients, their insurance companies, Medicare, or Medicaid for services.
Staff performing quality assurance or performance improvement activities review confidential information to make sure patients are receiving high-quality care.
Transcriptionists must access information to transcribe it, and scanners will unavoidably access information in the course of doing their jobs.
Confidential information includes all identifying information patients provide and information about their treatment, in any format (written or verbal), including the following:
Observations of health status
Photographs that include faces
Social Security number
The Health Insurance Portability and Accountability Act (HIPAA) requires healthcare employees to use or share only the “minimum necessary” information they “need to know” to do their jobs.
For example, a coder needs to look at the entire record of a patient’s hospital stay to apply all the correct codes. However, perusing the correspondence section of the record is unnecessary and inappropriate.
Remind staff to ask themselves before handling any patient information:
Do I need to know this to do my job?
Do I need to share this information with my colleague to get the job done?
What is the least amount of information I need to access or share to do my job?
Use this sample form to help set a minimum necessary policy for your organization:
While many medical staffs remain organized by clinical departments, there is no requirement to do so.
A version of this article was first published September 14, 2020, by HCPro's Credentialing Resource Center, a sibling publication to HealthLeaders.
Does your organized medical staff structure help or hinder the strategic development and mutual success of physicians and the hospital?
A comprehensive medical staff development plan is incomplete without an analysis of the effectiveness of your medical staff structure and processes. The following best practices will help you conduct such an analysis:
Clear bylaws: Most medical staff bylaws resemble archaeological documents that are occasionally dusted off and modified to accommodate a new accreditation requirement or to address a current controversy. Well-written bylaws clearly define the purpose of the medical staff, promote good citizenship by clearly outlining the rights and responsibilities of members, foster excellent credentialing/privileging and peer review/performance improvement processes, and set unequivocal expectations for appropriate behavior.
Clinical services: While many medical staffs remain organized by clinical departments, there is no requirement to do so. Many medical staffs have moved to a clinical section or clinical service line model to achieve greater flexibility and higher quality patient care.
Committees: The only committee required by The Joint Commission is the medical executive committee. Effective medical staffs often have a credentials committee and a centralized, multi-specialty medical staff quality committee. Other committees are determined by strategic direction (e.g., a cancer committee for ACS certification or a trauma committee, if required). Other areas can be addressed as functions without the bureaucracy of ongoing committees, such as pharmacy and therapeutics, medical records, and infection control.
Policies and procedures: The effective medical staff develops clearly understood policies addressing key issues, such as code of conduct, medical record documentation, national patient safety goal compliance, conflicts of interest, and other areas of importance.
Credentialing and privileging: Credentialing and privileging processes need to be vigorous and rigorous without being onerous or unfair. Best practices include determining criteria-based privileges, developing new-technology privileges, creating a cross-specialty privilege dispute policy, and developing experienced medical staff credentials committee members. The seamless incorporation of focused professional practice evaluation for new privileges and ongoing performance practice evaluation for renewal of privileges are hallmarks of effective medical staffs.
Peer review and performance improvement: Peer review is the assessment and management of individual physician performance. The effective medical staff improves individual physician performance by setting and communicating clear expectations of performance, measuring performance, providing physicians with performance feedback on an ongoing basis, and designing processes to increase compliance and manage non-compliance. Performance improvement involves continuous changes to systems and processes to achieve ever-improving outcomes. An effective medical staff addresses the performance of individual physicians and actively participates in the hospital’s system and process improvement efforts.
Using instant messaging may be the answer for team members.
A version of this article was first published September 1, 2020, by HCPro's Credentialing Resource Center, a sibling publication to HealthLeaders.
As the COVID-19 pandemic persists, many MSPs across the country have transitioned to working remotely and will continue to do so for the foreseeable future.
Managing these virtual teams presents some different challenges and new twists on traditional team building and conflict resolution.
Here are five tips for managing virtual teams:
Use technology appropriately. Although email is good for relaying information and can be used for conversations, it has its limits. If you can’t convey your message in one to two email responses, then you need to pick up the phone.
Listen carefully in telephone conferences. Tune in to team members’ tone of voice, inflection, and pitch to understand what colleagues are saying. Think carefully about how to respond.
Repeat important messages. Follow up meetings with an email that includes topics of discussion, decisions, and due dates to ensure everyone is on the same page. The information should also be posted on the organization’s intranet site or other shared space.
Identify personal preferences. Some people are constantly in email. Others only look at email occasionally, so a phone call might work better. Using instant messaging may be the answer for other team members.
Consider cultural differences. This doesn't just mean colleagues outside the U.S. Different regions of this country have different customs, holidays, and special occasions.
Conducting an intervention with a practitioner who is impaired, disruptive, or performing poorly can be emotionally draining for even the most experienced physician leader. The process is made a bit easier if the leader is prepared. Therefore, plan, practice, and then carry out the intervention.
The question of who should conduct the intervention really has two parts:
How many people will conduct the intervention?
Who will conduct the intervention?
The first intervention is collegial, and only one person should carry it out.
However, if the physician displaying disruptive behavior is particularly combative or litigious or if the medical staff leader anticipates significant resistance, it may be wise to have two people present.
Subsequent interventions are less collegial, so it is wise to have a second person present, whether it is for a show of strength or merely to have a witness.
Any more than two people carrying out the intervention at this stage can create a hostile environment and detract from the success of the intervention.
Only at a final warning, with a potential appearance at the medical executive committee (MEC) or to invoke some other action, would it be appropriate to have more than two people present.
The person who will most successfully conduct the intervention is the one who should do it.
Generally, the department chair should conduct the first and second interventions unless there is a potential conflict of interest or unless he or she is not a strong leader.
When the disruptive physician is recalcitrant, is a high admitter, or has significant influence within the medical staff, it may be more appropriate for the chief of staff to perform the intervention, usually in conjunction with the chief medical officer (CMO)/vice president of medical affairs (VPMA) or the CEO of the hospital.
The board chair may also participate in the delivery of a final warning when the disruptive physician is especially difficult.
Recruiting has become big business for hospitals and group practices. Having said that, the most damaging communication breakdowns often occur between recruitment and credentialing staff, costing the hospital and the candidate time, money, and dignity.
It is important that the recruiter and the medical staff services department work together to create a positive experience for everyone involved—especially when issues arise during the vetting process.
Organizations with active recruiting programs should study the following three strategies for fostering successful collaboration between credentialers and recruiters.
1. Illustrate the value in coordinating credentialing and recruiting efforts
Clearly define both roles in relation to one another to promote mutual understanding and cooperation. If an external company is responsible for recruitment, collaborate with your administration and the recruitment team to establish ground rules up front. Doing so can save a lot of aggravation later.
2. Get recruiters up to speed on medical staff requirements
Be sure that recruiters understand the medical staff’s key requirements, including those surrounding the following:
Board certification: Must practitioners have board certification at the time of application or achieve it within a certain time frame following practice authorization? If so, from which boards must practitioners obtain this certification?
Sanctions: Are there any current/previous licensure/Office of Inspector General/Drug Enforcement Administration (DEA) sanctions?
A lot of time can be saved if recruiters know this information before entering into any negotiations.
3. Provide ongoing status updates
Discussion between the recruiter and MSP must occur frequently so that each person knows the status of the other’s onboarding work. If a problem is identified, both parties must meet with administration to share information on progress and/or stumbling blocks.