Thursday, July 26, 2018

AMA Releases New Resource on Addressing Disruptive Physician Behavior

As MSPs, maintaining an organized, productive staff office is an essential part of the job. Disruptive behavior by physicians can pose a threat to the functioning of your hospital, and dealing with instances of such behavior is a struggle for anyone working around it. Dealing with disruption in the workplace can be confusing, and it is important to be prepared if you encounter it in your hospital.

The American Medical Association (AMA) has recently released a free learning course addressing this topic. This 30-minute module will show you how to define appropriate, inappropriate, and disruptive behavior and present guidelines for dealing with these behaviors. Additionally, you will receive your own downloadable copy of the AMA Model Medical Staff Code of Conduct that you can integrate into your own medical staff bylaws.

You can access the module here. The course is designed for physicians and hospital administrators as well as medical staff, so please feel free to share within your facility.

Thursday, June 21, 2018

How the Leadership Certificate Program Helped Meredith Land a New Job

The NAMSS Leadership Certificate Program can have a great impact on you and your career path. Read how Meredith Miller used the program to gain the confidence she needed to land the job she wanted. 

Did the Leadership Certificate Program help you gain any new skills, or help increase your confidence as a leader?
I absolutely gained new skills and confidence from the Leadership Certificate Program. I felt that the online modules were a great learning tool and the extra resources provided were a bonus. As a Credentialing Specialist, and not a manager, this program was extremely helpful in learning new skills, and I was able to gain a wealth of knowledge from both the online modules and the in-person course. I really feel as if I now have more effective communication skills, even in my personal life, which has greatly increased confidence in myself. 

How are you using what you learned from the Leadership Certificate Program in your current role?
Just prior to attending the in-person course, I resigned from a hospital that I had been working as a Credentialing Specialist for 14 years, with the past 12 having been offsite working from home. I decided at the beginning of January that I wanted to go back into the office setting and work closer to where I live. I applied for a Credentialing Coordinator position and was offered the job the day after the interview. During the hiring process, I was able to use the effective negotiating skills and communication techniques that I learned from the Leadership Certificate Program. I felt that my communication, calmness, and confidence during the interview process was very effective and I can say that the gained knowledge I attained from the program played a role in getting the job.

What aspect of the program did you enjoy most?
I immensely enjoyed the In-Person Course -- the instructors were fantastic and made everyone feel relaxed and at ease in being ourselves. It was fun working in teams and interact with other professionals that held different positions from mine. I ended up working with three managers in my group and it was very interesting to see their different management and leadership styles.

Would you recommend the Leadership Certificate Program to your peers?
I would absolutely recommend the Leadership Certificate Program to my peers and have already done so! In my opinion, the online modules are a wealth of useful information for both experienced and entry-level MSPs. The program helped me look at things from a different perspective in terms of communicating with others in a professional setting. I think the In-Person Course really allows you to apply what was learned during the online portion, and the live group scenarios was a confidence builder. Overall, I felt it was a very effective course and will continue to recommend it to others!


Visit the NAMSS website to learn more about the Leadership Certificate Program.



Wednesday, June 6, 2018

NAMSS Hosts 5th Annual Industry Roundtable in Washington, DC


As part of its ongoing efforts to work with industry leaders on meaningful reforms to the credentialing and licensure process, NAMSS held its fifth annual roundtable discussion with industry stakeholders on May 10, 2018 at the Dupont Circle Hotel in Washington, DC. This roundtable, entitled The Future of Digital Credentialing, is an important next step in achieving a more streamlined, more efficient, and more modern credentialing process while preserving our ultimate goal of patient safety.

The 2018 roundtable expanded the focus of our 2017 event on blockchain technology, examining an array of new and emerging technologies for the credentialing ecosystem. The wide-ranging discussion touched on a number of important ideas for preparing the industry for technological developments. This year’s roundtable marked the beginning of a new conversation around disruptive technology and its impact on credentialing. The discussion was thoughtful, engaging, and productive, but it is only the beginning. NAMSS will continue to work with the roundtable participants and others going forward to create and implement process guidelines, governance, and best practices that will be needed as technology continues to develop. Stay tuned for more exciting news to come!

The official 2018 roundtable report can be found on the NAMSS website, or by clicking this link.

The following organizations participated in this year’s roundtable: Accreditation Council for Graduate Medical Education (ACGME), Administrators in Medicine (AiM), American Association of Collegiate Registrars and Admissions Officers (AACRAO), American Board of Medical Specialties (ABMS), American Hospital Association (AHA), American Medical Association (AMA), Council for Affordable Quality Healthcare (CAQH), DNV GL Healthcare, Educational Commission for Foreign Medical Graduates (ECFMG), Federation of State Medical Boards (FSMB), Healthcare Facilities Accreditation Program (HFAP), The Joint Commission, Medical Group Management Association (MGMA), National Council for Quality Assurance (NCQA), and the National Practitioner Data Bank (NPBD).

Friday, April 6, 2018

MedPage Today Investigation Highlights Gaps in Credentialing Process


Instances of incompetent or malicious practitioners have always made headlines, but rarely are the wider systemic issues discussed that allow such events. A recent investigation by MedPage Today and the Milwaukee Journal-Sentinel catalogued at least 500 physicians from 2011-2016 who exploited gaps in the medical licensing system to avoid sanctions or red flags.

In these instances, doctors who had actions taken against them by one state medical board were able to “slip through the bureaucratic net” and operate under clean licenses in other states. Physicians who had formal complaints, suspended licenses, or even permanent revocations maintained their licenses with other state boards, many of whom were not even aware of the action in the first place.

MedPage Today found that the majority of state boards only report their own disciplinary actions against physicians. Their investigation, titled “States of Disgrace: A Flawed System Fails to Inform the Public,” outlines seven categories of information on physician history, including state medical board disciplines, discipline by other states, malpractice claims/payouts, loss of privileges, criminal convictions, Medicare and Medicaid exclusions, and DEA/FDA actions.  Only five states (Florida, Kansas, Massachusetts, Maryland, and North Carolina) regularly reported six of the seven – no state routinely checked and reported all of the above.

The National Practitioner Data Bank, which was created to serve as a central identifying tool for all adverse actions, has not fulfilled its promise of transparency, according to MedPage. A survey conducted by the former NPDB research director found that few state boards made regular queries of NPDB – most states performed only 10 to 20 searches a year, and some didn’t submit any at all. High costs may make NPDB searches prohibitive for some states, but this can result in severe lapses in the information they hold about physicians who are licensed in their states, leading to gaps that can affect patient safety. Out of 64 state medical boards, only 13 subscribed to the “Continuous Query” service which provides alerts for new updates to physician records.

“States of Disgrace” emphasizes the issues that stem from the patchwork system of state licensing boards, but also flags the problem of physicians omitting relevant information in their own applications – whether for licensing or privileging directly at a hospital. NPDB’s survey found that almost 10% of the time, organizations querying the Database found new information about the physician, which shouldn’t occur if the physician was fully forthcoming in their application. “They should never find anything new in an NPDB report,” says Dr. Robert Oshel, formerly of NPDB. This problem is faced in credentialing offices across the nation as well. While it can’t fill in every gap, NAMSS PASS provides a unique ability to understand a practitioner’s full affiliation history, and can protect patient safety by guarding against reticent applicants. Find out more about NAMSS PASS here.

Wednesday, January 24, 2018

Recent Incidents Underscore Importance of Patient Safety

MSPs know that among all their responsibilities, the #1 priority is patient safety. Performing the oftentimes challenging work of credentialing is an essential part of protecting patients and allowing the delivery of high quality health care. Doctors are trusted to care for patients, and it is the job of MSPs to confirm their ability to provide care and that hospitals are aware of any negative incidents that could affect the doctor-patient relationship. Two recent stories underscore just how critical the work of MSPs is.

In Cleveland, USA Today found that a surgeon was accused multiple times of sexually assaulting patients, yet confidential settlements precluded formal charges against him. The Cleveland Clinic, where he was employed, placed him on leave, but did not prevent him from continuing to see patients after a settlement was reached. In fact, when the surgeon later moved to the Ohio State University Medical Center, the facility was unaware of any past allegations regarding the physician. While OSU maintains that the proper credentialing procedure was followed, having official notations of the investigation would have allowed an MSP to determine whether credentials should have been issued in light of the allegations.

Even if the Cleveland Clinic had progressed with formal actions, there was no criminal charge filed. The physician’s record might not have even reflected the settlement, especially if facility itself took on liability, as they often do. If the physician had not disclosed his affiliation with Cleveland Clinic when applying at OSU, or replaced it with another facility where he had privileges, the OSU credentialing department would have had no way of knowing whether he was ever employed at the Clinic, much less whether there had been misconduct.

In an even more recent example, a Maryland-based OB/GYN was found to have falsified his identity, including his Social Security number, to obtain licensure in the state. In fact, over the course of his career, the physician used four different Social Security numbers, three names, and forged dates of birth and education histories to obtain multiple credentials, licenses, and privileges at multiple facilities.

He failed the Foreign Medical Graduate Certification multiple times under different identities before finally passing, and went on to be removed from a residency program in New Jersey for falsifying information and rejected from Medicare for using different Social Security numbers. However, the Maryland facility, Prince George’s Hospital Center, completed the credentialing process for the physician and allowed him to practice medicine for years after the rejection. The intricacies of the fraud demonstrate just how important a thorough and exhaustive credentialing process is.


As all MSPs know, credentialing is an intricate and often winding process. Even the most conscientious MSPs can run into issues of information gaps, whether it is a missing document, an undisclosed affiliation, or any number of other problems that can arise. NAMSS PASS is a free, secure, online database that provides quick and easy access to the affiliation history of practitioners applying for credentials. Through NAMSS PASS, you can automatically review past affiliations for practitioners, disclosed by the hospital, not the physician. This allows you to quickly analyze for any gaps in history, or to identify undisclosed affiliations (a major red flag). In a health care system where patient safety continues to be at risk and must always be a priority, NAMSS PASS can help your facility ensure the highest standard of credentialing is completed. To learn more about NAMSS PASS, please visit http://www.namss.org/NAMSSPASS.aspx

Friday, October 27, 2017

AHA Releases Regulatory Overload Report

The American Hospital Association (AHA) recently released a report entitled Regulatory Overload: Assessing the Regulatory Burden on Health Systems, Hospitals and Post-Acute Care Providers. The report details the extent of regulations promulgated on healthcare providers, spanning four federal agencies.

AHA and Manatt Health found that the four agencies – the Centers for Medicare & Medicaid Services (CMS), the Office of Inspector General (OIG), the Office for Civil Rights (OCR), and the Office of the National Coordinator for Health Information Technology (ONC) – produced 629 separate regulatory requirements across nine domains, in addition to health regulations from agencies outside the four studied. The scope of these regulations and the compliance actions required are significant – health systems, hospitals and PAC providers spend nearly $39 billion combined on compliance per year, and an average-sized hospital dedicates 59 full-time equivalents to compliance.

The AHA report also provided specific recommendations for regulatory relief, including canceling Stage 3 of Meaningful Use, suspending electronic clinical quality measure requirements, and expanding Medicare coverage of telehealth services. MSPs can find the full report here

Wednesday, September 20, 2017

UPDATE: New Guidelines Released as Telemedicine Services Expand

Update: The Joint Commission has retracted the draft standards for telemedicine outlined below, announcing that "At this time, we have closed the field review and decided not to move forward with the proposed telehealth standards." The proposed changes had garnered pushback from some in the industry who were concerned that the standards would be more restrictive than current requirements from the Centers for Medicare & Medicaid Services and state regulators. A spokesperson from TJC told FierceHealthcare that internal review had determined TJC's existing requirements for accreditation adequately applied to telehealth services and that further requirements would be unnecessary. In the future, TJC plans to address enhancements for survey guidance examining telehealth practices and quality and safety issues with telehealth provision.

Telemedicine continues to expand into the healthcare delivery system, and the recent natural disasters across the country have demonstrated just how useful telemedicine can be in a crisis and beyond. As federal and state governments, accrediting organizations, and other healthcare stakeholders recognize the growth and potential of these services, new rules, regulations, and guidelines are beginning to be released. Two major telemedicine efforts were released this month by The Joint Commission and the National Quality Forum.

First, The Joint Commission released proposed revisions to their hospital accreditation standards for hospitals providing “direct-to-patient telehealth services.” TJC, one of the largest and most widely accepted accreditation organizations for hospitals in the United States, introduced changes to two existing standards (Provision of Care Standard 01.01.01 and Rights & Responsibilities of the Individual Standard 01.03.01) and introduced a new standard, Ri.01.08.01. The proposed changes, which are examined in detail here, include requirements for informed consent for patients about the nature of the telehealth services and the provider. The National Law Review article linked above examines how the proposed standards go beyond statutory requirements in some cases, and how they may affect hospitals and other telehealth providers.

The National Quality Forum, an organization contracted by the federal government to develop healthcare performance measures, recently released a report developing a framework for a telehealth quality measurement program. NQF’s Telehealth Committee recommended various methods to measure telemedicine as a care delivery system along four basic categories: access to care, financial impact to patients and providers, patient and clinician experience, and clinical and operations effectiveness. The report, analyzed here by mHealthIntelligence, also highlights specific existing measures that can be applied to telehealth, as well as examining how telehealth activities can fit into the Merit-based Incentive Payment System (MIPS) introduced in the Medicare Access and CHIP Reauthorization Act (MACRA).


NAMSS will continue to monitor developments in telemedicine and their impacts on MSPs. Specifically, NAMSS recently formed a working group in partnership with the American Telemedicine Association to examine the issue of credentialing by proxy for hospitals attempting to credential telemedicine providers at other locations. The group will be developing a packet of educational and instructional materials to introduce MSPs who may not be as familiar with telemedicine to the topic and provide guidelines for developing credentialing by proxy programs at their own facilities.