Thursday, December 31, 2009

Physician Ethics and Industry Relationships

Earlier this month, Medscape interviewed Amy Brodkey, MD, an adjunct associate professor of psychiatry at the University of Pennsylvania. Dr. Brodkey discussed how physician interactions with industry representatives, such as the receipt of gifts, free drug samples, and funded CME programs, can lead to conflicts of interest.

As we enter the new year and consider good habits to adopt, we might want to take Dr. Brodkey's advice and encourage our physicians to be transparent in their interactions with industry representatives. This will help to maintain the integrity of their patient care and to eliminate the appearance that the treatment they provide is merely the result of a business relationship.

To read the full article, click here:

Thursday, December 17, 2009

MS.01.01.01 Out for Field Review

How does one articulate the basic tenets of an effective working relationship between hospital governance, medical staff leadership, and the medical staff itself? The Joint Commission, in attempting to do just that, has in the past produced new versions of the standard addressing the issue, formerly known as MS 1.20 and now called MS 01.01.01. But these versions, when made available for comment, drew criticism from physicians and hospitals that pointed to the potential for substantial unintended consequences.

A new version, which is attached for your review, has been crafted by a special Task Force assembled by The Joint Commission in January 2008. The Task Force includes hospital executives, physician leaders, physician and hospital counsel, representatives of those who staff the medical staff functions, and others. Throughout its work, the Task Force was guided by three fundamental principles:

A well-functioning relationship between the governing body, hospital leadership, and the medical staff is essential to the delivery of high quality, safe care.

Effective communication is the lubricant that keeps relationships functioning well; it therefore is important that structures and processes support it.

Well-functioning relationships also depend on all parties knowing what is expected of them, and being able to live up to those expectations.

The Task Force worked with The Joint Commission staff to incorporate its suggestions into the revised language of MS 01.01.01. The American Hospital Association, American Medical Association, American College of Surgeons, American College of Physicians, American Dental Association, NAMSS, and other interested organizations believe this revised version appropriately articulates the elements of a productive relationship between a hospital and its medical staff. It also allows as much flexibility as possible in how and where a hospital and its medical staff choose to articulate these responsibilities.

The Joint Commission Board has approved distributing this version for field review.

NAMSS will be posting our comment letters on the NAMSS Homepage in the coming days to provide you with background on the proposed revision. We encourage all members to participate in this field review.

NAMSS has suggested that The Joint Commission offer substantial implementation time for this standard once it is finalized. During that period, NAMSS will work to bring you educational programs and materials to help you properly implement this standard.

Tuesday, December 15, 2009

Sixteen Houston Hospital Workers Fired for HIPAA Violation

Sixteen employees of the Harris County Hospital District were terminated last month after accessing the medical records of a first-year medical resident who had become a patient.

The employees had accessed the records of Stephanie Wuest, a doctor who had been admitted after being shot in a supermarket parking lot on October 29. One terminated employee stated that the records were accessed out of concern for the colleague, and that they were just trying to locate Wuest.

HIPAA requires that a hospital issue "appropriate sanctions" when an employee violates the law. The Harris County situation is one example of employers setting a firm rule against access to medical records without the consent of the patient or patient's guardian.

Some have argued that incidents of mistake, or access to records out of concern for a colleague should not be considered severe enough to warrant termination. Others argue that the privacy risk to the patient is too great and that hospitals should punishing HIPAA violations with a firm hand, especially if employees are provided sufficient education in the law and in what constitutes a violation.

This incident serves as a reminder that when it comes to HIPAA, make sure your colleagues and members of the medical staff know the law and are aware of the consequences enforced at your facility.

Source: Houston Chronicle

Monday, December 14, 2009

Question of the Week: OPPE, FPPE, and Allied Health

As this year comes to a close, many of us are looking for ways to make things more efficient and less complicated in both our lives and our work.

One area that gets complicated for MSPs is how to track OPPE and FPPE for allied health professionals (AHPs). We are supposed to monitor the performance of AHPs, but this is difficult to do since all AHPs have a sponsoring physician and credit for procedures are usually recorded in the physician's name, not the AHP's name.

Some facilities have addressed this problem by developing activity logs that allow their AHPs to keep track of procedures they performed. If your facility has implemented a best practice, we'd love for you to share it in the comment field.

The question of the week is, do you currently track OPPE and FPPE for allied health professionals? Provide your answer in the poll on the NAMSS Blog homepage.

Friday, December 11, 2009

Improper Background Checks by Staffing Firms Are Connected to Hiring of Unfit Temporary Nurses

A report from ProPublica and The Los Angeles Times shows that hospitals may be using temporary RNs who are unqualified because of poor screening by staffing firms.

The report shows that many nurses with criminal histories, histories of poor performance, and improper credentials were able to acquire employment with a hospital because the staffing agency failed to perform a thorough background check or listen to warnings from other facilities. Some nurses were able to avoid being caught with unfit qualifications by moving to a new hospital before an investigation into their performance background could be performed.

Some attribute the rise in unqualified nurses to the nursing shortage. With hospitals needing to quickly hire nurses to meet their staffing needs, some facilities are relying solely on the background check performed by the staffing agency, without performing their own check.

While there are many quality temporary staffing agencies out there, this should also serve as a call to hospitals to do their due diligence when working with one. Your facility should always try to verify the credentials of temporary nursing staff. If this is not possible, then make sure that the staffing agency you work with has a proper credentialing system in place.

There may be a staffing shortage, but it is better to take the time to hire quality staff, than to meet staffing numbers with unqualified individuals.

To read the full article, click here:,0,1174984.story.

Source: The Los Angeles Times

Tuesday, December 8, 2009

New Hampshire Attorney General Investigating Alleged HIPAA Violation

The New Hampshire Attorney General's Consumer Protection and Antitrust Bureau announced that they are investigating an alleged breach of 1,500 patient records at Wentworth-Douglass Hospital in Dover, NH.

Two doctors at the facility reported the violation, saying that a former employee altered the records between 2006 and 2007. The doctors, Cheryl Moore and Glenn Littell, also claim that for reporting the violations, the hospital retaliated against them by ending their contract with their pathology practice.

The Attorney General's office is expected to spend a few weeks investigating the claim before determining if any additional action is required.

Tuesday, December 1, 2009

HFAP Announces New Standards for Ambulatory Care and Office-Based Surgery

The Healthcare Facilities Accreditation Program (HFAP) has announced new accreditation standards for Ambulatory Care and Office-Based Surgery. The new standards focus on "in-office requiring general anesthesia, deep sedation and moderate (conscious) sedation."

The standards require the physician administering or supervising the administration of general anesthesia to demonstrate knowledge of the risks involved and how to correct adverse consequences that may occur, including the rescue of a patient that becomes sedated beyond the intended level.

Accreditation for offices using local anesthesia, topical anesthesia, superficial nerve blocks, or minimal sedation is optional.

For more information, visit:

CMS Renews TJC's Hospital Deeming Authority

The Centers for Medicare and Medicaid Services (CMS) has renewed The Joint Commission's deeming authority its hospital accreditation program through July 15, 2014.

Organizations with "deemed" status have standards that meet or exceed those of the Medicare and Medicaid program.

To read TJC's full announcement, click here:

Monday, November 30, 2009

Question of the Week: Should Facilities Use Surveillance to Ensure Compliance?

An article in today's American Medical News highlights how Maryland is using $100,000 in federal stimulus funds to train volunteers who will secretly monitor hand washing in 45 of the state's 47 acute care hospitals.

Maryland isn't the only state turning to surveillance methods. Rhode Island Hospital requires surgeons to participate in at least two video-recorded surgeries a year after five wrong-site surgeries were reported in the past two years. In 2007, the Massachusetts Legislature considered mandating video recorded surgeries.

There are those who support the use of surveillance and those who don't. Dr. Mark Chassin, president of The Joint Commission says that if surveillance helps hospitals determine what is affecting performance, then it can be an aid. However, Chassin cautions against the improper use of surveillance data as ammunition against individuals in their personnel files.

Dr. Mark E. Rupp, professor of infectious diseases at the University of Nebraska Medical Center and president of the Society for Healthcare Epidemiology of America believes that some providers will not like the "Big Brother" feeling that this system may impose.

What do you think? Is surveillance an effective way to boost compliance and help facilities identify practices that need improvement? Or do you think that this oversight method will cause more provider stress and anxiety?

Let us know what you think by taking this week's poll and providing your comments below.


Tuesday, November 24, 2009

One in Ten Surgeons Believe They Made a "Major Error" Recently

A study published in the Annals of Surgery shows that one in ten surgeons believe that they made a major medical error in the past three months.

The survey showed that surgeons experiencing burnout as a result of exhaustion, depersonalization, and personal career dissatisfaction were more likely to report an error. 40 percent of respondents said that they were experiencing "burnout," and 30 percent reported experiencing symptoms of depression. The study did conclude whether the burnout was a result of the errors, or if the errors were a result of the burnout.

The results reflect the feedback of 7,905 surgeons who completed a survey by the American College of Surgeons.

If it turns out that burnout is a link to medical error, then it looks like hospitals will have to figure out ways to boost physician morale as a way to maintain patient safety.

Source: Wall Street Journal Health Blog

Thursday, November 19, 2009

Senate Democrats Propose $848 Billion Health Bill

Senate Majority Leader Harry Reid (D-NV) unveiled a healthcare proposal yesterday that would cover 94 percent of all Americans and cost $848 billion over 10 years. Estimates from the Congressional Budget Office predict that the bill will cut the federal deficit by $127 billion in its first year, and $650 billion over the next decade.

While the bill has wide Democratic support in the Senate, Republicans are hesitant to believe that the bill will be budget-neutral. The plan will be paid for by Medicare cuts and increased taxes, such as a tax on high-premium "Cadillac plans."

Some provisions of the bill include:
  • A public health care plan, with an option to the states to opt out of the system if they want to;
  • Employers under the House bill (except some small businesses) would be mandated to provide coverage to their employees; under the Senate bill, employers who do not offer coverage will only be fined $750 per employee;
  • Individuals (except illegal immigrants) who do not have access to affordable coverage through their employers would be able to purchase it from a multi-state exchange;
  • 5 percent excise tax on elective cosmetic surgery; and
  • A firewall segregating private insurance funds used to cover abortion from public funds; the HHS Secretary will be given discretion to determine whether or not public funding will be available for abortions.

The Senate is expected to hold a vote this Saturday to introduce the bill for debate.

Wednesday, November 18, 2009

$54.2 Billion Spent on Medicare Fee-for-Service Errors in 2009

Peter Orszag, Director of the Office of Management and Budget, reported that Medicare and Medicaid spent $54.2 billion in improper payments in 2009. Orszag also reported that the rate of Medicare fee-for-service errors doubled in the past year.

Orszag attributes the doubled rate to a new system of counting errors, which counts incidents such as an illegible signature or submitting a claim without sufficient documentation as errors.

To address this problem, President Obama will issue an executive order requiring greater agency oversight, the creation of a website that allows the public to track and report improper payments, and penalties for those who do not return payments received in error.

This is another example of how billions of dollars are being spent with no contribution to improving healthcare. As healthcare reform continues to develop, let's hope that the government figures cost-effective ways to improve the administrative side of healthcare delivery and increase accountability for errors. $52.4 billion could go a long way toward patient-centered improvements.

Click here for the full article:

Source: Modern Healthcare

DNV Releases First Annual Report

DNV has released its first annual report to the public on its hospital accreditation program.

The report includes comments from several hospitals that have switched to DNV accreditation. There are almost 100 hospitals accredited by DNV.

The report also includes new initiatives, including DNV's application for deeming authority to accredit critical access hospitals.

To view the report, click here:

Tuesday, November 17, 2009

Conn. Attorney General to Seek Legislation on Medical Mistake Disclosure

Connecticut Attorney General Richard Blumenthal has announced plans to seek legislation requiring hospitals to improve the disclosure of medical mistakes.

The legislation would also direct resources to the state Medical Examining Board and Department of Public Health to for the investigation of medical mistakes and complaints of errors.

Blumenthal believes that disclosure of medical mistakes will create transparency and increase hospital accountability for errors committed.

This is definitely a good strategy toward improving the delivery of health care services and preventing further medical mishaps. Better investigation of mistakes and complaints at all hospitals will be a huge undertaking for the state government, but may be an effective step toward preventing unnecessary patient harm. It will be interesting to see where the resources for this improved oversight will come from, whether or not this initiative is successful at improving care, and whether or not other states will seek similar legislation.

Source: BNA

Monday, November 16, 2009

Question of the Week: Online Doctor's Visits

A post on the blog, Hospital Impact, highlights a new subscription service called Hello Health, which allows patients to schedule an appointment and meet with a doctor online.

The service is aimed at providing both patients and doctors with a convenient forum where they meet in less time than a traditional office visit.

Currently the service is not covered by any insurance companies, so patients must pay out-of-pocket for all services, but may be able to receive a reimbursement depending on their health plan.

It will be interesting to see if Hello Health picks up steam and helps to improve patient-provider communication. It will also be interesting to see if Hello Health and any other similar services eventually seek to have the time spent on online patient visits covered by insurers. If so, this could raise interesting challenges on how to credential and privilege providers working in an "online practice."

The question of the week is, what do you think of the online doctor's visit? Is it a good strategy for improving the delivery of care, or will it have little impact?

Source: Hospital Impact

Thursday, November 12, 2009

Changing Landscape of the Medical School Curriculum

The following article from The Washington Post illustrates changes in the way medical schools are training doctors. Instead of focusing only on anatomy, students are learning more about patient communication and political advocacy.

Some schools have also adopted a different way of studying the human body, focusing on a multi-system approach, rather than focusing on the functions of individual organs.

These changes are intended to train doctors who can offer preventative care and greater patient interaction.

For the full article, click here:

Source: The Washington Post

Tuesday, November 10, 2009

Question of the Week: Health Reform

The House passed its bill over the weekend, and the Senate is expected to start debate on the issue on November 16.

There are several issues that are expected to cause controversy, including the inclusion of a public-run health plan, and whether those who receive federal subsidies to purchase health coverage should be allowed to select plans that cover selective abortion.

This week's question is, what do you think is the most difficult issue for our lawmakers to tackle as they debate our nation's healthcare system? Vote in the poll on the right of the NAMSS Blog page and let us know your thoughts in the comment field below.

Monday, November 9, 2009

House Passes Health Reform Bill

After a late Saturday session, the House passed H.R. 3962, the Affordable Health Care for America Act.

The bill includes a public-run health plan, which is expected to cause controversy in the Senate.

Below are a few highlights of the bill:
  • Estimated cost: $1.05 trillion
  • Includes a government-run health plan option that will compete with private insurers in a health care exchange
  • Prohibits insurance companies from denying coverage or increasing premiums based on pre-existing conditions
  • Provides subsidies to individuals and families receiving income at up to 400% of the poverty level
  • Provides tax credits to some small businesses that provide coverage to their employees
  • Prohibits lifetime caps on insurance coverage
  • Expands Medicaid eligibility
  • Prohibits the use of federal funds for abortions, except in the cases of rape, incest, or danger to the mother's life

Monday, November 2, 2009

Question of the Week: Registered Dietitians

This month's issue of HCPro's Briefings on Credentialing reports the movement toward Registered Dietitians (RDs) seeking clinical privileges so that they can write diet orders at their facilities. Currently, only licensed independent practitioners are required to write orders according to CMS regulations.

The American Dietetic Association supports the movement toward granting RDs clinical privileges. The ADA believes that allowing RDs to write diet orders on their own allows them to practice within the full scope for which they are trained. They acknowledge one issue, and that is that the physician in charge of a patient's care can still be liable in a malpractice suit, even if the patient's injury is a result of the dietitian's order.

The credentialing of RDs is a practice that facilities have handled in different ways. Some facilities delegate it to their human resources offices, while medical staff offices take care of it in other facilities. If the movement toward granting RDs clinical privileges picks up steam, it is likely that credentialing of RDs will become a function of the medical staff office.

The question of the week is, who currently performs the credentialing of Registered Dietitians in your facility? Take the poll on the right side of the NAMSS Blog page, and leave any comments or thoughts on this topic in the comment field below.

Happy Medical Staff Services Awareness Week!

In 1992, President George Bush signed Congressional House Joint Resolution #399 proclaiming the first week in November as National Medical Staff Services Awareness Week. Since then, NAMSS has partnered with hospitals, MCOs, doctor’s offices, university health systems, and government agencies to promote awareness of the medical services professionals (MSPs).

Don't forget to visit the NAMSS website to find a toolkit that you can use to teach your facility more about the importance of medical staff services. Invite colleagues to visit your office this week to learn more about what MSPs do on a daily basis. This is our week!

Use the comment field to share stories and ideas on how your facility is celebrating National Medical Staff Services Week.

Click here to access the National Medical Staff Services Awareness Week toolkit:

Wednesday, October 28, 2009

Census Estimates Predict Doctor Shortage and Younger Workforce

According to an article in Medscape Medical News, US Census Bureau estimates are predicting a younger physican workforce as new doctors replace the large number of current doctors that are expected to reach retirement age over the next 10 years. The Census is also estimating a workforce shortage that is larger than predictions based on data from the American Medical Association's Physician Masterfile.

Census estimates predict an increase of young physicians in the 25 - 34 year old age range, based on the number of current first-year residents. However, Census data also shows that the US may face a shortage of up to 200,000 active physicians by 2020, while the AMA Masterfile predicts only 100,000 fewer physicians.

Although the Census and AMA data do not provide a conclusive outlook on the possible physician shortage, we should start preparing just in case. Health reform is expected to increase patient intake as more people will have access to coverage and care. Also, incidents like the H1N1 pandemic have shown the need for a solid workforce as hospitals face higher admission rates.

Another interesting aspect of this article is the younger workforce that is expected over the next decade. As MSPs, we will still be charged with identifying competent and qualified providers, but it is our role in medical staff management that may see some changes. With many of the current physicians expected to retire in the coming years, it will be interesting to see how the new generation of doctors will step into the roles of medical staff leadership and governance.

Source: Medscape Medical News

Monday, October 26, 2009

Question of the Week: Telemedicine

Today we're launching a "Question of the Week" on the NAMSS Blog. Each week, we will feature a new poll on an issue facing MSPs. This will allow you to get a pulse on what your colleagues think, and on practices that are implemented in other facilities.

This week's topic is telemedicine. The following article from Scripps Howard News Service includes comments from several health experts who believe that although telemedicine is addressed in health reform proposals, the government is not making enough of an investment in this technology. (Link to article:

We all know that telemedicine can expand access to care, especially in rural areas. However, we also know that there is still debate over how credentialing of telemedicine providers should be handled. Recently, The Joint Commission amended its credentialing by proxy standards in order to comply with the CMS Conditions of Participation, which currently do not recognize this practice.

So this week's question is, how does your facility currently perform credentialing for telemedicine providers? Vote in the poll to the right, and feel free to discuss your views on the issue in the comment field below.

We are also looking for other "Questions of the Week." If there is a topic or question you would like to see on the NAMSS Blog, e-mail your idea to

Friday, October 23, 2009

Doctor Responsible for Treating Octuplets' Mom Ejected from the Society of Reproductive Medicine

It wasn't so many months ago when hospitals and Ethics Committees across the country were discussing the issue of in vitro fertilization. Today a decision was made by the American Society of Reproductive Medicine in the case of Dr. Michael Kamrava. Dr. Kamrava was responsible for treating Nadya Suleman, who had octuplets in 2009.

Dr. Kamrava's case focuses on the question of how many embryos should be implanted into a woman during in vitro fertilization. Dr. Kamrava had a history of implanting six or more embryos in women other than Suleman.

While Dr. Kamrava is not barred from practice, stripping him of his Society membership is a signal of what the Society will consider ethical regarding embryo limitations.

The full article can be found here:,0,4363432.story.

Source: Los Angeles Times

Wednesday, October 21, 2009

House Votes to Exempt Small Groups from FTC "Red Flag" Rules

On Tuesday, the House voted to exempt small businesses from the Federal Trade Commission's "red flag" rules by a unanimous vote of 400 to 0.

The bill, H.R. 3763, exempts healthcare, legal, and accounting practices with 20 employees or less from "creditor" status under the rules. The "red flag" rules require creditors to implement programs and policies to monitor and combat identity theft by November 1.

The "red flag" rules faced opposition from several professional groups including the American Bar Association and American Medical Association. They felt that the FTC's broad definition of "creditor" included entities that were outside of the Congressional intent of the rules. Under this interpretation, healthcare providers are considered creditors since they defer payment of services until they are reimbursed through a patient's insurer.

Source: BNA

Thursday, October 15, 2009

NPDB Reporting Guidance Available

The Medical Staff, Credentialing, and Peer Review Discussion List of the American Health Lawyers Association recently discussed whether or not the termination of a physician making misstatements and failing to make required disclosures about an insurance gap requires NPDB reporting.

Daryl Gray, Director of the Division of Practitioner Databanks, provided the NPDB's interpretation of the issue. The Data Bank's official guidance can be found here:

Source: Katten Muchin Rosenman LLP

Visit the New NAMSS Website!

The new NAMSS website has officially launched today!

The new website features an updated look and easier navigation. You will also be able to view the latest NAMSS Blog headlines on the homepage.

On the new website, you will be able to access resources such as the Grassroots Advocacy Toolkit and Guide to Grassroots Advocacy to help state associations develop a system for tracking local legislative and regulatory developments.

Visit our new site and let us know what you think:

Wednesday, October 14, 2009

American Board of Pediatrics Announces Pediatrics-Anesthesiology Program

The American Board of Pediatrics (ABP) has approved a new combined Pediatrics-Anesthesiology training program. The following description is taken from ABP's website:

Combined training consists of a coherent educational experience in two or more closely related specialty or subspecialty programs. The educational plan for combined training is approved by the specialty board of each of the specialties to assure that resident physicians completing combined training are eligible for board certification in each of the component specialties. Each specialty or subspecialty program is separately accredited by ACGME through its respective specialty review committee. The curriculum components that comprise the combined training must be taken from those experiences that have been approved by the Residency Review Committees in each of the specialties. The duration of combined training is longer than any one of its component specialty programs standing alone, and shorter than all of its component specialty programs together.

A special agreement exists with the American Board of Anesthesiology (ABA) whereby an applicant may fulfill the training requirements for certification in pediatrics and anesthesiology by completing five years of combined training. An applicant may not take the certifying examination of the ABP until all training requirements in both programs has been successfully completed.

Program requirements and other information can be found here:

Source: American Board of Pediatrics

Study Compares Board Certification Requirements Among Physician Multi-Specialty Organizations

An independent study performed by The Associated Industries of Florida Service Corporation (AIFSC) has compared multi-specialty board requirements for both certification and re-certification. The study shows that the requirements of the three national certification organizations are generally equivalent.

The groups included in the comparison are: the American Board of Medical Specialties (ABMS), the American Board of Physician Specialties (ABPS), and the American Osteopathic Association's Bureau of Osteopathic Specialists (AOABOS).

The comparison brochure can be found here:

Source: American Association of Physician Specialists, Inc.

Tuesday, October 13, 2009

Senate Finance Committee Passes Health Reform Bill

This afternoon, the Senate Finance Committee voted 14-9 in support of the Committee's health reform overhaul bill.

Sen. Olympia Snowe (R-ME) was the lone Republican to support the bill. She stated that she did not completely support the bill, but felt that urgent action needed to be taken to improve healthcare.

"When history calls, history calls, and I happen to think that the consequences of inaction dictate the urgency of Congress to take every opportunity to demonstrate its capacity to solve the monumental issue of our time," said Snowe in a quote to CQ.

The Senate Finance Committee's bill expands Medicare and creates healthcare insurance marketplaces to provide Americans with greater options for coverage. It does not include the creation of a public plan. The Congressional Budget Office estimates that the plan will cost $829 billion over the next ten years.

The Senate Finance Committee's bill must now be reconciled with the Senate Health, Education, Labor, and Pensions (HELP) Committee's bill before it a proposal is sent to the full Senate for a vote. The Senate Finance bill is considered the more moderate of the two plans.

Source: CQ

Are Hospitals Ready for Expanded Coverage?

The answer is "yes," according to Dr. William Jessee, President and CEO of the Medical Group Management Association (MGMA). In an article in Modern Physician, Dr. Jessee supports the initiative to expand healthcare coverage but wonders whether or not the current payment structure and medical workforce is ready to take on the greater patient load.

Dr. Jessee recognizes that work needs to be done in order to provide high-quality, safe care for what will become an increased patient population. However, he believes that facilities will be able to figure out ways to eliminate administrative waste and increase efficiencies in their own settings.

Dr. Jessee's message is a call to all of us to act now and be a part of healthcare reform. Prepare your facility now by exploring more efficient ways to perform the work that you are currently doing. Determine if your facility has a plan to ensure that it has the workforce to handle greater patient intake.

Source: Modern Physician
(Free subscription required to view article)

Thursday, October 1, 2009

TJC Releases Telemedicine Revisions to Hospital Standards

The Joint Commission (TJC) has released revisions to the Leadership and Medical Staff chapters of the Hospital Standards in order to comply with CMS requirements for deeming authority.

Currently, TJC accepts credentialing and privileging by proxy. CMS currently requires that telemedicine providers be credentialed by both the originating and distant sites. TJC would have allowed the originating site (where the patient is located) to accept the credentials and privileges granted by the distant site (where the provider is located) if the distant site is TJC accredited and complies with the appropriate Medical Staff standards.

TJC has revised its telemedicine standards to comply with the CMS rule, but continues to work with CMS and Congress to accept credentialing by proxy by the distant site.

The revised standard is effective July 15, 2010 and can be found here:

Source: The Joint Commission

TJC Accreditation Requirements Available for Pre-Publication Review

The Joint Commission has released the 2010 standards revisions for pre-publication review. Revisions for all accreditation programs will be available online until December 1, 2009.

Questions from accredited organizations can be submitted to the Standards Interpretation Group at (630) 792-5900 or via the online form.

To review the 2010 revisions, click here:

Source: The Joint Commission

Wednesday, September 30, 2009

ABMS Plans to Launch Hospital Medicine Board Certification

Modern Healthcare reports that the American Board of Medical Specialties (ABMS) plans to launch a five-year pilot program offering physicians board certification in hospital medicine.

After obtaining certification as internists, physicians would seek hospital medicine certification before their 10-year internal medicine certification expires.

The new certification would focus on knowledge and skills obtained through practice in the hospital setting.

Source: Modern Healthcare

Public Plan Cut from Senate Finance Bill; House Vote Expected in November

On Tuesday, the Senate Finance Committee voted to eliminate the public health plan from the health reform bill. Committee Chairman Max Baucus (D-MT) and 4 Democrats joined the Committee's 10 Republicans in striking the plan from the bill.

Chairman Baucus acknowledged that a public option would pressure private insurance companies into offering high-quality, affordable coverage. However, he recognized that a bill with a government plan may not garner enough final votes to pass in the Senate. Instead of a public option, the Senate Finance Committee bill includes the creation of non-profit co-operatives which would compete with private insurers.

The Senate Health, Education, Labor, and Pensions (HELP) Committee's bill still includes the public option. Both Committees' proposals must be reconciled into a single bill before a full Senate vote.

Meanwhile in the House, Majority Leader Steny Hoyer (D-MD) said that he expects a bill to be completed for review in October. However, both he and Speaker Nancy Pelosi (D-CA) have agreed not to rush the bill to the floor for a vote, implying that a full House vote may not take place until November.

Sources: CQ, CongressDaily

Friday, September 25, 2009

CMS Approves Continued Recognition of AOA Deeming Authority for Ambulatory Surgical Centers

The Centers for Medicare and Medicaid Services (CMS) has approved continued recognition of the American Osteopathic Association (AOA) as a national accreditation program for ambulatory surgical centers seeking participation in Medicare or Medicaid.

Organizations with deeming authority have accreditation standards that meet or exceed Medicare requirements.

The AOA's renewed deeming authority runs from October 23, 2009 to October 23, 2013.

CMS' announcement can be found in the September 25 issue of the Federal Register:

Tuesday, September 22, 2009

Doctor Sues Georgetown University for Defamation and Breach of Contract

Dr. Carlos F. Gomez, medical director of the D.C. Pediatric Palliative Care Collaboration is suing Georgetown University for $1.25 million after he was denied staff privileges.

Gomez claims that Georgetown sought him to become a member of the medical staff despite the known fact that he had a past history of substance abuse. Gomez's complaint states that Georgetown rejected his credentialing application in August 2008 "imput[ing] that Dr. Gomez's history of substance abuse had caused harm to his patients." Gomez denies the claim and said that he had been sober for five years and had no malpractice or disciplinary actions against him when he applied to Georgetown.

The two parties settled in January, with Georgetown agreeing to keep his file confidential and to report that privileges were denied based on questions of Dr. Gomez's clinical competency due to his time away from practice.

Gomez claims that Georgetown violated this agreement by reporting to the NPDB that his privileges were denied due to a "diversion of controlled substances."

From an MSP perspective, it will be interesting to see how this case is ruled. We deal with denied applications all the time, but it is surprising to see the alleged settlement reached between the parties and the subsequent NPDB report that stems from this case.

Source: Washington Business Journal

Wednesday, September 16, 2009

Senate Finance Committee Chairman Introduces Health Reform Bill

Senate Finance Committee Chairman Max Baucus (D-MT) has introduced the America's Healthy Future Act of 2009. It is scheduled for a full Committee markup on September 22, where Democrats hope to obtain more Republican support.

The bill offers initiatives that will help all Americans meet the requirement of having health coverage, such as the expansion of Medicaid and the creation of state co-operatives to provide consumers with options outside of private insurers. Employers would not be required to provide coverage to workers; however, employers who have 50 or more workers and do not offer coverage by 2013 will have to reimburse the government for every full-time worker receiving tax benefits through the government's health care exchange system.

The $856 billion to fund coverage will be obtained through initiatives such as reductions in Medicare and Medicaid spending; taxes on insurers offering high-cost, high-premium health plans; and fees on providers such as device manufacturers.

The bill overs various changes to the Medicare and Medicaid systems that are intended to increase efficiency, lower costs, and maintain a level of quality and care.

Health Care Quality Improvements

The bill directs the Secretary of Health and Human Services (HHS) to create a national strategic plan for improving the quality of care. The strategy will focus on goals such as reducing medical errors, maintaining hospital infection-control, addressing preventable hospital admissions, and an overall look at increasing efficiency and quality in the healthcare system.

In order to prioritize these strategies, the Secretary of HHS will seek the input of various stakeholders in the healthcare system including representatives of hospitals, physicians, credentialing and accrediting bodies, allied health professions, health plans, and other industries.

A copy of the Chairman's mark-up can be found here:

Source: BNA

Introducing New Changes to the NAMSS Blog!

New Subject-Matter Expert

NAMSS would like to introduce Carole La Pine, MSA, CPMSM, CPCS as the new subject-matter expert of the NAMSS Blog. As subject-matter expert, Carole will be working with the NAMSS Executive Office to identify issues of interest to MSPs that will be featured on the NAMSS Blog. Carole will also be available to respond to questions posted in the comment fields, another new feature of the NAMSS Blog.

Carole is the Manager of Physician Services at Trinity Health. She was previously the Director of the Credentialing Department for Saint Joseph Mercy Health System, a 4-hospital system in Ann Arbor, Michigan. Carole has been in the medical services profession for greater than 30 years. She has experience in a university hospital setting, single hospital environment, Independent Physician Association, Physician-Hospital Organization and in a multi-facility health system.

Carole has served in a number of leadership positions in the Michigan Association Medical Staff Services, including President. She has served as a member and Chair of the Certification Commission of NAMSS and as President of NAMSS in 2007.

New Comment Field

You are now able to post comments to any blog item. We hope that you use the comment field as a way to discuss the latest policy issues with NAMSS and with your colleagues nationwide. A link to add comments will appear under each post.We encourage you to post comments, questions, or your personal perspective on issues addressed in the blog.

Please note that all incoming comments will be moderated, so comments that may be disrespectful to others, irrelevant to the issue at hand, or may be misinterpreted as a NAMSS position will not appear on the blog.

New Look

We have also changed the look of the NAMSS Blog to make it easier to read. As always, we welcome any comments, questions, or news tips at

Thursday, September 3, 2009

Last Call for MS.1.20 Comments; New FAQ on Standard

All comments on The Joint Commission's task force revision of Standard MS.1.20 (now MS.01.01.01) should be submitted by September 30, 2009. Because of NAMSS' involvement on the task force, our membership has been given the opportunity to comment on the standard before it is released for a full field review.

Copies of the 2007 standard and the task force's proposed revision can be found here (Members Only, requires log-in):

Comments can be submitted using the following survey link, or by e-mail to

FAQ on MS.1.20:

Friday, August 28, 2009

Nonprofit Hospital Executive Shares Health Reform Worries

Charles J. Barnett, chief executive of the Seton Family of Hospitals, a nonprofit hospital group in Texas, shared his concerns about challenges hospitals may face after the health care overhaul takes place.

Barnett believes that providing coverage to the uninsured is only the first step to reform; however, he worries about access being compromised if the physician shortage continues and if the new policies create reduced revenue for hospitals.

Barnett isn't the only one worrying. Hospital executives nationwide have been wary of reform proposals offered by the Obama administration and Congress, fearing that unintended effects of the change will actually hinder, rather than help hospitals provide care to their communities.

For the full article, click here:

Source: The Washington Post

CMS Continues Recognition of AOA Deeming Authority for Hospitals

The Centers for Medicare & Medicaid Services (CMS) has published an announcement in the August 28, 2009 Federal Register approving continued recognition of the American Osteopathic Association's (AOA) deeming authority for hospitals. The renewed deeming authority runs from September 25, 2009 to September 25, 2013.

CMS has determined that the AOA's standards and survey process "meet or exceed" the Medicare Conditions of Participation for hospitals. The announcement includes several changes that the AOA made to its requirements in order to become more aligned with the CoPs.

To read the full announcement, click here:

Source: Federal Register

Thursday, August 27, 2009

TJC Releases Sentinel Event Alert on Leadership

The Joint Commission (TJC) has released a Sentinel Event Alert describing the importance of leadership in ensuring the quality and safety of care. TJC reports that "inadequate leadership was a contributing factor in 50 percent of the sentinel events reported to The Joint Commission in 2006."

While TJC realizes that the healthcare industry has not yet developed the "zero-defect" approach adopted by other industries, they provide several suggestions for how adverse events should be treated and actions senior leadership, the governing body, and medical and clinical staff leaders should take in order to avoid adverse events due to poor leadership direction. This guidance should be shared with your facility's administration and medical staff leaders.

TJC's Sentinel Event Alert on leadership can be found here:

Tuesday, August 25, 2009

Arkansas Doctor and Hospital Employees Plead Guilty to HIPAA Violations

A doctor and two hospital employees at St. Vincent Infirmary Medical Center in Arkansas face a maximum penalty of one year in prison and/or a fine of up to $50,000 because of their curiosity. All three parties have pled guilty to unrelated misdemeanor violations of HIPAA laws.

Dr. Jay Holland admitted to accessing a patient's record after seeing a news report. Dr. Holland accessed the record in order to determine if the news report was true. His privileges were suspended for two weeks and was required to complete on-line HIPAA training.

Sarah Elizabeth Miller, a former account representative at St. Vincent, admitted to accessing a patient's records 12 times. Miller, who had received HIPAA training, was fired after admitting that curiosity was the reason why she had accessed the records.

Canada Griffin, an emergency room unit coordinator, was asked to set up an alias for a patient. After the patient was moved the the ICU, Griffin was curious about the patient and looked up the patient's medical charts. Griffin was also fired from St. Vincent.

All three situations show how simple curiosity can turn into a serious HIPAA violation that can compromise your employment. Make sure that the members of your medical staff and staff in your medical services office are well-trained in HIPAA to prevent violations in your facility.

Source: Federal Bureau of Investigation, Little Rock

TJC Names Two New Commissioners to Board

The Joint Commission has named two new members to its Board of Commissioners. The members were appointed by the American Hospital Association for three-year terms, starting in January 2010.

"Nancy Howell Agee is the chief operating officer and executive vice president for Carilion Clinic in Roanoke, Virginia. Her primary responsibility is serving as the chief executive officer of Carilion Medical Center, an 825-bed tertiary care teaching hospital, which serves as one of five Level I Trauma Centers in Virginia, and co-leading the development of an organized medical group. In addition to her work at Carilion, Agee was appointed by the governor of Virginia to the Radford University Board of Visitors, and she currently chairs the Board of the Virginia Hospital and Healthcare Association and the Foundation of Roanoke Valley. Agee earned an undergraduate degree at the University of Virginia, received a master’s degree from Emory University and participated in postgraduate studies at the Kellogg School of Business, Northwestern University.

R. Timothy Rice, F.A.C.H.E., has served as president and chief executive officer of the Moses Cone Health System in Greensboro, North Carolina since 2004. He earned a bachelor of science in pharmacy from Washington State University and a master’s in health administration from Duke University. He is a Fellow in the American College of Healthcare Executives and chair-elect of the board of directors of the North Carolina Hospital Association. Rice is active in the community serving as a board chair for the Greensboro Partnership, the Central Atlantic VHA Board, and the United Way of Greensboro Campaign. "

The 29-member Board of Commissioners is TJC's governing body. The Board is composed of representatives from the American Hospital Association, American Medical Association, American College of Physicians, American College of Surgeons, American Dental Association, six public members, one representative of the nursing profession, and president Mark Chassin, M.D., M.P.P., M.P.H.

Thursday, August 20, 2009

Peer Review Privilege Can Be Undermined by State Freedom of Information Law, According to Connecticut Court

The Connecticut Supreme Court has ruled that peer review records may be subject to disclosure for use in a civil lawsuit under the provisions of the state's Freedom of Information Act (FOIA).

In its decision (Director of Health Affairs, University of Connecticut Health Center v. Freedom of Information Commission), the court noted that this ruling will not substantially affect the privacy of peer review records since most hospitals are private and therefore, are not subject to FOIA rules. The court also noted that while a party may be able to access this information during the discovery process to prepare for trial, peer review records are still privileged information that cannot be entered as evidence in a civil action.

Source: BNA

Monday, August 10, 2009

South Carolina RAC Releases List of Audit Areas

Connolly Consulting, the Medicare Recovery Audit Contractor (RAC) of Region C, has released the first set of issues eligible for audit. While these areas only apply to South Carolina at the moment, it is believed that other states will eventually adopt these areas as well.

The RAC program was developed to help identify areas of overpayment and underpayment in the Medicare system. The RAC reviews claims histories to determine improper payment situations, offsetting overpayments with underpayments when possible.

The areas of audit include announced for Region C include:
  • Blood transfusions;
  • Untimed codes;
  • IV Hydration therapy;
  • Bronchoscopy services;
  • Once in a lifetime procedures;
  • Pediatric codes exceeding age limits;
  • And Pegfilgrastim injections.

Source: Modern Healthcare

Friday, August 7, 2009

HASC Estimates $500 Billion Savings by Reducing Administrative Costs

In its latest report, the Healthcare Administrative Simplification Coalition (HASC) estimates that the US can save up to $500 billion over ten years by reducing administrative costs by just 10 percent.

The report, titled "Bringing Better Value: Recommendations to Address the Costs and Causes of Administrative Complexity in the Nation's Healthcare System," offers four suggested areas of improvement:

  • Implementation of a universal credentialing form for payers, hospitals, and other institutions;
  • Using electronic patient data to help speed up determinations on insurance coverage eligibility;
  • Standardization of patient ID cards;
  • And standardization of the prior authorization process for radiology and pharmacy services.

The report makes many references to cost savings for clerical work; however, MSPs know that the major focus of our work is at a higher level. Clerical work is one of those necessary-but-not-valued responsibilities.

As the experts of the credentialing process, there is a great opportunity for us to share our best practices and be a part of healthcare reform.

To read the full report, click here:

Source: HASC

Friday, July 31, 2009

Update: FTC Delays Implementation of Red Flag Rule Until November 1, 2009

The Federal Trade Commission (FTC) has delayed implementation of the "red flag" rule until November 1, 2009. The FTC's announcement does not mention whether or not the rule will be amended to exclude hospitals and other medical facilities from the list of "creditors" who are subject to the rule.

The FTC's announcement and guidance on the red flag rule can be found here:

Source: Federal Trade Commission

Thursday, July 30, 2009

Closed Residency Programs Records Are Available

A service from the Federation of State Medical Boards (FSMB) offers to permanently store the records of residency programs that have closed. The FSMB also offers to house medical staff files from closed hospitals. Upon request, the FSMB will verify a physician’s training or medical staff affiliation from one of these programs.

According to the Joint Commission (TJC), National Committee for Quality Assurance (NCQA), and URAC, verification of a physician’s credentials from one of these closed programs by the FSMB meets the primary source verification requirements of each of those organizations. To date, nearly 50 closed programs have sent their records to the FSMB.

The FSMB provides a centralized, uniform process for health care entities to obtain a verified, primary source record of physicians and physician assistants’ core medical credentials. For more information, please go to or contact Nicole Lloyd at or (817) 868-5084.

Wednesday, July 29, 2009

FTC Red Flag Rules May Be Delayed Again

The implementation of "red flag" rules requiring creditors and financial institutions to implement security programs and policies to deter identity theft may be delayed once more. Entities are currently required to be in compliance by August 1.

The American Medical Association, American Bar Association, and the National Retail Federation have filed complaints to the Federal Trade Commission (FTC), claiming that the red flag rules are meant for financial institutions such as banks and credit companies. The groups argue that the broad language of the rule has unintentionally placed other institutions under the policy. For example, hospitals would be considered creditors under the rule since they provide services and then defer payment until a patient pays a bill out of pocket, or insurance reimbursement is received.

The organizations have contacted the FTC and Congress to try and get a deadline extension, which would provide time to amend the policy to apply to only the intended institutions. If an extension is not granted, the American Bar Association intends to file a lawsuit against the FTC.

Source: BNA

Friday, July 24, 2009

Senate Delays Health Reform Vote Until September

The Senate has decided to hold off voting on a health reform package until September. President Obama's original desire was for both the House and the Senate to pass their reform bills prior to adjourning for the August recess.

Instead, Senate Majority Leader Harry Reid (D-NV) said that the Finance Committee will markup the Health, Education, Labor, and Pension (HELP) Committee's proposed plan prior to the recess, with a floor vote expected in September.

President Obama, Senate Republicans, and Senate Democrats are all in agreement over the delay, saying that it will allow senators more time to read the reform package and discuss it with their constituents during the August recess.

Source: CQ

Thursday, July 23, 2009

AMA Considers White Coat Ban

On June 16, the American Medical Association (AMA) voted to have a committee further consider a recommendation banning the use of white coats by doctors in hospitals.

The proposed recommendation comes after the British National Health System imposed a "bare below the elbow" system banning certain clothing items, including white coats. The movement toward eliminating the coats and items such as neckties has risen in response to the growing number of hospital-acquired infections. Although there has been no study directly linking white coats and business dress to the rise in hospital-acquired infections, it is believed that these items may be more likely to carry the germs that cause infections than short-sleeve scrubs.

The white coat has long been a symbol of physician responsibility and care. Now it seems that it may become a thing of the past in the pursuit to improve patient safety.

Source: The Chicago Tribune,0,1802810.story

President Obama Pitches His Health Plan to the Nation

As Congress is starting to face the fact that passage of a health reform bill is unlikely before the scheduled August recess, President Obama held a news conference last night to address concerns that have voiced by Americans.

Obama stated that changes in the delivery of care must be made in order to save money, which will in turn, be used to fund health coverage for the uninsured. His proposals included better communication between hospitals and doctors so patients aren't receiving repetitive tests, use of less expensive drugs, and higher Medicare reimbursement rates for healthcare providers who spend more time with their patients. The bottom line of the President's plan is to ensure that all Americans have health coverage and receive quality, cost-effective care.

Even members of Obama's own party are skeptical about proposed plans. Moderate Blue Dog Democrats are countering Speaker Nancy Pelosi's (D-CA) claim that there are enough votes to pass the House's version of the bill. They claim that additional provisions need to be made to exempt small businesses from the requirement that all employers help pay for their employees' health coverage, and that there needs to be more language regarding offsets that will fund the government-run coverage option.

The Senate is also continuing negotiations on their version of the reform bill, with members of the Senate Finance Committee trying to figure out ways to raise revenue to fund the government health plan.

Sources: The Washington Post, CQ

Wednesday, July 22, 2009

Should Healthcare Be Rationed?

Peter Singer, Professor of Bioethics at Princeton University, proposes the rationing of healthcare as a solution to reducing costs. Singer suggests saving costly treatments for those who would benefit from them in the long-term, rather than to those who are expected to die within a few months to a year.

Although the idea of depriving someone of treatment sounds unethical, Singer argues that rationing already occurs in the current system, where those with private insurance can only access to the coverage they and their employers can afford, while those covered under Medicare and Medicaid are limited to those services with affordable copayment.

Singer urges the United States to consider a system used in other countries where public health coverage is provided at no cost, with the option to purchase additional private coverage. He believes that this, along with a system that rations healthcare expenses only to services that can provide years of quality living, is the best way for the United States to achieve the goal of healthcare reform, which is to provide coverage to all Americans.

To read the full article, click here:

Source: The New York Times

Increase in Outpatient Services in Unregulated Facilities

Americans are increasingly turning to outpatient services offered in doctors' offices rather than in hospitals or accredited ambulatory surgery centers. The July 20 Wall Street Journal article, "Seeking a Safer Surgery" examines the potential risks faced by patients.

Outpatient surgery in a doctor's office is favorable because it often costs less and is more accessible than scheduling the procedure in a hospital or ambulatory surgery center. However, many offices are not accredited by a recognized agency or certified by CMS, which require strict standards for training and facility conditions. Doctors are accountable only to their licensing standards. They may choose to have their offices accredited by the American Association for Accreditation of Ambulatory Surgery Facilities, The Joint Commission, or the Accreditation Association for Ambulatory Health Care, but many do not want to face the cost of surveying.

Many states have started imposing regulation on doctor's offices that offer outpatient surgery to diminish the potential safety risk.

To read the full article, click here:

Source: The Wall Street Journal

Tuesday, July 21, 2009

NAMSS Supports Task Force Revision of MS.1.20 (now MS.01.01.01)

The Joint Commission released a final revision of MS.1.20 in 2007 to address conflict in hospitals where members of the Medical Staff felt that the Medical Executive Committee no longer represented their interests. In 2008, The Joint Commission formed the MS.1.20 Task Force to address field concerns regarding the rationale, implementation, and language of the standard. This year, Task Force completed a proposed revision of MS.1.20 (now MS.01.01.01).

NAMSS commends the work of the MS.1.20 Task Force convened by The Joint Commission to create a workable compromise to the original revision, balancing elements that increase the voice of the Medical Staff, while promoting efficient hospital administration and governance. Past President Carol Ostermann, CPMSM, CPCS, represented NAMSS on the Task Force. Other groups represented on the Task Force include the American Medical Association, American Dental Association, American Hospital Association, Federation of American Hospitals, American College of Surgeons, and the American College of Physicians.

While the latest revision may require some bylaws changes in a number of facilities, we believe that it is a large improvement over the previous version, which potentially required a burdensome amount of policies and procedures to be placed within the medical staff bylaws. Improvements to the new proposal include:

  • Details of policies and procedures can be included in separate documents, rather than in the Medical Staff bylaws
  • The Medical Staff can delegate approval of policies and procedures to the Medical Executive Committee

The Joint Commission has given the Task Force organizations the opportunity to conduct field reviews of the proposed revision among their members. Each organization has been asked to provide The Joint Commission with their membership response by October 15, 2009. Based on this feedback, The Joint Commission will determine whether or not the proposed revision will be released to the entire field for review.

NAMSS has requested that The Joint Commission consider all comments and concerns voiced through the process and is willing to assist with any further revision or clarification after all responses have been collected and evaluated. NAMSS also intends to provide educational resources to the membership to help you understand the revision and how to implement it in your facility.

NAMSS appreciated the opportunity to work with The Joint Commission and the members of the Task Force in a participatory process to ensure that MS.01.01.01 works toward the goal of providing safe, quality patient care. We hope to continue working with The Joint Commission and other organizations to ensure that the perspective of the medical services professional is included in the development of healthcare policies.

The Joint Commission’s official announcement can be found in the July 15 issue of Joint Commission Online and in the next issue of Perspectives.

A link to the proposed revision and survey was sent to the membership via e-mail and will be posted on the NAMSS website in the coming days.

If you have any questions or comments regarding MS.01.01.01, NAMSS’ position on the proposed standard, or did not receive the original eBlast announcement, contact Christine Perez at

Thursday, July 9, 2009

California Physician Assistant Convicted of Medicare Fraud and Identity Theft

Los Angeles physician assistant Ronald Luis Bradshaw, an employee of Glenmountain Medical Group, was convicted of four counts of healthcare fraud, conspiracy to commit healthcare fraud, and aggravated identity theft on June 30 for stealing a doctor’s identity to collect $7.7 million in Medicare payments (United States v. Bradshaw).

A report by the Department of Justice states that from April 2005 to April 2008, Bradshaw ordered tests and prescribed durable medical equipment to Medicare beneficiaries under the apparent supervision of a doctor.

The doctor testified that he had never worked at the Glenmountain facility and that Bradshaw had written the prescriptions using his UPIN without his knowledge.

The Department of Justice and the Department of Health and Human Services have formed the Health Care Fraud Prevention and Enforcement Action Team (HEAT) to combat fraudulent healthcare claims such as this one. HEAT currently has teams in Los Angeles, Detroit, South Florida, and Houston.

MSPs have the ability to help in the battle against healthcare fraud. When credentialing Allied Health Professionals, ask yourself, “Did I remember to confirm the AHP’s supervising physician?” Also, examine current practices at your facility. Do you have best practices and procedures in place for ensuring that UPINs are kept confidential?

Healthcare fraud is costing the system millions of dollars. By asking yourself the two questions above, you can not only ensure that you have verified the identity of an AHP, but you can also prevent the types of fraud illustrated in this case, which drain funding from the beneficiaries who truly rely on Medicare and Medicaid coverage.

Source: BNA

CMS Renews TJC's Deeming Authority for Critical Access Hospitals

The Centers for Medicare and Medicaid Services (CMS) has renewed The Joint Commission's (TJC) deeming authority for the accreditation of critical access hospitals through November 21, 2011.

“Critical access hospitals are an important safety net, providing Medicare beneficiaries living in rural areas with the care that they need,” says Mark Pelletier, R.N., M.S., executive director, Accreditation and Certification Services, The Joint Commission. “The Joint Commission is pleased to collaborate with CMS to provide quality oversight for these important providers of rural health care.”

Critical access hospitals serve rural areas, and usually located over 35 miles from another hospital. They receive cost-based reimbursement from Medicare. There are currently over 1,000 critical access hospitals nationwide.

Tuesday, July 7, 2009

Hospitals Agree to Contribute $155 Billion to Cover the Uninsured

The Washington Post reports that the American Hospital Association, the Federation of American Hospitals, and the Catholic Health Association have agreed to contribute $155 billion over the next ten years to help provide coverage for the uninsured.

By agreeing to the plan, which involved discussions with members of the Obama Administration and Senate Finance Committee, the hospital associations recognized that they will receive lower payments for services under Medicare and Medicaid and for services provided to the uninsured.

The agreement follows a similar revenue reduction agreement reached with pharmaceutical companies made two weeks ago.

To read the full article, click here:

Source: The Washington Post

Monday, July 6, 2009

CMS Proposes 21.5% Physician Pay Cut and Other Measures for 2010

The proposed Medicare Physician Fee Schedule (PFS) projects a 21.5% cut in physician payments for 2010. CMS expects that the cut will be offset by proposals in President Obama's plans for health reform, which will reduce future cuts and will increase payments for primary care physicians.

CMS' proposal also includes the following:
  • Reallocating a higher proportion of professional liability insurance costs to physicians with the highest malpractice costs;

  • Reducing payments for imaging services to provide increased payments for services such as primary care;

  • And encouraging participation in the Electronic Prescribing Incentive Program and the Physician Quality Reporting Initiative.

The proposed rule can be found in the Federal Register. It is open for public comment until August 31, with the final rule going into effect on November 1.

To read the proposed rule, click here:

Tuesday, June 30, 2009

Last Call for Redundant Standards Survey

Do you find yourself performing duplicative work because of redundant standards?

NAMSS has partnered with the National Credentialing Forum (NCF) to identify the top redundant credentialing standards that are creating unnecessary time and cost burdens in medical services offices nationwide.

If you find yourself wasting time on repetitive tasks due to overlapping standards, NAMSS asks that you help us with this project by completing the following survey:

The data collected through this survey will help NAMSS and the NCF promote the need for streamlined credentialing standards so MSP time can be better spent on effective quality measures, not on completing tasks that have already been performed.

Thursday, June 11, 2009

Georgia High Court Rules Routine Credentialing Information Discoverable

The Georgia Supreme Court has ruled that "routine credentialing information" is not protected from discovery under state medical and peer review laws unless the information contains a peer review evaluation of actual medical services provided.

The ruling stems from a medical malpractice suit by Thurman Meeks against the Hospital Authority of Valdosta and Lowndes County and Dr. Terry Tri. Meeks alleged that the hospital was negligent in credentialing Tri to perform the surgery that preceded his wife's death.

The Court affirmed a decision at the appellate level, which ruled that statutory privileges only protect evaluations by a peer review committee regarding a provider's performance to gauge his or her ability to provide quality care. The privilege does not extend to "routine credentialing information," which includes the provider's education, training, and employment history.

The Court clarified that this rule would apply even to hospitals that delegate full review of the credentialing file to a peer review committee. Applying the privilege to routine credentialing information just because it is peer reviewed in this instance, says the Court, would be unfairly prejudicial to those seeking to file negligent credentialing claims.

The Court's full opinion can be found here:

Source: BNA

Wednesday, June 10, 2009

The Joint Commission Updates Definition of "Physician"

The Joint Commission has made changes to the definition of "physician," which will apply to hospital programs starting July 1, 2009.

The change amends the definition in the Comprehensive Accreditation Manual for Hospitals to reflect the definition of "physician" used by CMS. The new definition recognizes the following groups as "physicians," based on state licensure requirements:
  • Doctors of medicine and osteopathy
  • Doctors of dental surgery or dental medicine
  • Doctor of podiatric medicine
  • Doctors of optometry
  • Chiropractors

This change will affect several Elements of Performance. The latest revision of accreditation requirements have been updated to show when an EP applies to a doctor of medicine or osteopathy, or a physician under the CMS definition.

The change in definition has been made to comply with CMS requirements for deemed status.

More information on this change, including the new definition of "physician," can be found in the June 2009 issue of Perspectives.

For the revised accreditation requirements, click here:

Monday, May 11, 2009

FTC Delays Physician "Red Flag" Rules

The Federal Trade Commission (FTC) has delayed the May 1 implementation deadline of the "red flag" rules for physicians, setting a new compliance deadline of August 1, 2009. The red flag rules require creditors to have written policies for preventing and handing cases of identity theft. Physicians fall under the act because they receive deferred payment through insurers.

The American Medical Association (AMA) and other groups claim that the red flag rules place an unnecessary burden on physicians, especially small practice groups. They also claim that the protections intended under the FTC rules are already addressed under HIPAA.

Source: AMNews

Industry Groups Pledge to Cut Healthcare Costs by $2 Trillion

The White House has announced that several healthcare industry groups have pledged to help reduce healthcare spending by 1.5 percent a year over the next ten years. These groups promised to help reform the healthcare system to make it more cost efficient.

The groups, which include the American Medical Association, American Hospital Association, American Health Insurance Plans, and the Pharmaceutical Research and Manufacturers of America, have not outlined a specific plan for how they plan to save the US $2 trillion, despite increasing healthcare costs. They plan to disclose more details after meeting with President Obama.

Areas of focus for reform include: standardization, use of evidence-based best practices and treatments, health information technology, administrative simplification, and the use of quality-based incentives.

Source: The Washington Post

Friday, May 8, 2009

AMA Fifth Pathway No Longer in Effect Starting July 1, 2009

The AMA will discontinue the Fifth Pathway Program after July 1, 2009. The Fifth Pathway allowed students at a foreign medical school to complete their clinical work at a U.S. institution, with eligibility for U.S. residency training and licensure.

The Fifth Pathway certificate, not a U.S. medical diploma serves as the credential for students under this program. The January 2009 entering class will be the last class recognized under the program.

The following four pathways will still be recognized for entry into residency training in U.S. medical schools:

1. Graduation from a U.S. medical school
2. Certification by the Educational Commission for Foreign Medical Graduates (ECFMG)
3. Full and unrestricted licensure by a U.S. licensing jurisdiction
4. Passing the Spanish language licensing examination in Puerto Rico.

Source: AMA

Thursday, April 23, 2009

Hospitals Recognizing Need for Emergency Planning Thanks to HHS Efforts

The University of Pittsburgh reports that since 2002, states have taken significant steps to raise awareness of the need for medical emergency managements planning, thanks in part to the Department of Health and Human Services' Hospital Preparedness Program (HPP). The report highlights the fact that many states have already created emergency hospital staffing and medical supply plans.

The HPP was established by the Department of Health and Human Services in 2002 to help hospitals prepare response plans to terrorist attacks, natural disasters, and other widespread incidents that may cripple a community's ability to provide emergency health care. Areas studied by the HPP include: interoperable communication systems, hospital evacuation, decontamination plans, and bed and personnel management.

Although improvements have been made, the report recognizes that additional efforts are still needed, including better coordination among regional Healthcare Coalitions.

The full report can be found here:

Source: Department of Health and Human Services

Wednesday, April 15, 2009

Update to NCQA Article in March/April 2009 Synergy

In the Mar/Apr 2009 issue of Synergy, there is an update to the CE article titled, “NCQA Delegation Requirements,” by Melinda Orlando. On page 14 of her article, she says, “For a detailed explanation of NCQA’s 8/30 methodology, see”

Please note that this information has moved on the NCQA Web site to here: Scroll down to the bottom of the page and click on the link under 5.1.01, Explanation of "8 and 30" File Sampling Procedure.

Wednesday, April 8, 2009

2009 TJC Revised Hospital Accreditation Requirements and Scoring Categories Available Online

The Joint Commission (TJC) has updated its Revised 2009 Hospital Accreditation Requirements. The Requirements, originally released on March 26, now include scoring categories.

TJC revised its hospital accreditation standards following discussions with CMS regarding its deeming application. TJC originally released 165 new and revised requirements. The new version includes 87.

The Revised 2009 Hospital Accreditation Requirements and further information can be found at:

Tuesday, April 7, 2009

CONNECT Helps Make Health IT Interoperable

The Federal Health Architecture, an initiative of the Office of the National Coordinator for Information Technology (ONC) has released CONNECT, free software which will allow existing health IT systems to connect to the the Nationwide Health Information Network (NHIN).

The NHIN will serve as the "network of networks," allowing previously non-interoperable health IT systems to connect and share data with each other. Standards for the NHIN were developed by the Secretary of Health and Human Services based on public and private interoperability specifications. The ONC is currently working on the legal framework of information sharing over the NHIN.

"This software will strengthen our health systems' ability to share data electronically and provide a wide range of benefits to citizens," said Robert Kolodner, M.D., National Coordinator for Health Information Technology. "Benefits include up-to-date records available at the point of care; enhanced population health screening; and being able to collect case research faster to facilitate disability claims, as demonstrated by transfers of information already underway between the Social Security Administration and MedVirginia, a regional health information organization."

More than 20 federal agencies will use CONNECT to access the NHIN, including the Department of Defense, Department of Veterans Affairs, Social Security Administration, and the Centers for Disease Control and Prevention.

Organizations can download CONNECT for free at: Although the download is free, organizations will be responsible for the implementation and maintenance costs of using the program.

Source: Department of Health and Human Services

Thursday, April 2, 2009

Physician Leaders Call for Limits on Industry Contributions to Professional Associations

Medical leaders called on physicians to reject funding from pharmaceutical and medical device industries to preserve patient safety and physician integrity. This view is published in the April 1 Journal of the American Medical Association.

The article is authored by 11 present and former medical society leaders who believe that professional medical associations (PMAs) need to distance themselves from industry groups. While the group feels that the ideal relationship would involve no corporate contributions; they recognize that many PMAs rely on these contributions to fund continuing medical education (CME) courses that help the professional development of physicians. Therefore, the group suggests that no more than 25 percent of a PMA's budget be derived from industry contributions.

The group says that PMAs are responsible for educating physicians on the latest advancements in their field and must not appear financially biased in its presentation of new treatment options. According to the group, accepting industry funds for education creates a potential situation where programs are slanted to support the sponsoring company's drug, device, or procedure. The group urges PMAs to form CME committees which would accept non-restricted industry funds and distribute them among educational programs to ensure fairness. Many PMAs have already rewritten their codes of conduct to prevent potential conflicts of interest.

The group says that strict restrictions are only needed for educational funds. Industry presence through advertisements and exhibit hall appearances are clear marketing activities and are less likely to influence a physician's medical judgment.

Congress has also voiced its support for industry-physician transparency. Sen. Chuck Grassley (R-IA) and Sen. Herb Kohl (D-WI) have introduced the Physician Payments Sunshine Act (S. 301), which would require companies to report all gifts and payments to physicians totalling more than $100 a year to the Department of Health and Human Services. Those who fail to report would face fines of up to $1 million.

Source: BNA

Monday, March 30, 2009

ABMS Develops New Assessment Requirements

The ABMS Maintenance of Certification program will require boards to implement processes described as promoting “continuous professional development and assessment," replacing the traditional re-certification exams currently taken by physicians.

Board processes for documenting continuing education and self-assessment requirements must be implemented by 2011. Processes for documenting practice-based assessment and quality-improvement requirements must be implemented by 2011.

Member boards must also require physicians to undergo a patient safety self-assessment program by 2012. The assessment will focus on the communication skills of physicians who have direct contact with patients and with peers. Communication skills will be measured using the Consumer Assessment of Healthcare Providers and Systems survey (CAHPS) and other tools.

Source: American Board of Medical Specialties

Thursday, March 26, 2009

Changes in TJC Standards to Meet CoP Requirements

The following update was released by The Joint Commission PTAC:

In January 2009, The Joint Commission posted 165 new and revised requirements as part of its hospital deeming application to the Centers for Medicare & Medicaid Services (CMS). Following successful discussions with CMS, a number of those requirements were considered equivalent to existing elements of performance or were already addressed in The Joint Commission survey process. As a result, the number of new and revised requirements has been reduced to 87. These updated Conditions of Participation (COP)-related requirements are posted online, along with a side-by-side comparison between the standards posted on January 5, and the March 26 release.

Hospitals will be surveyed on these requirements from April 6 through June 30, 2009; however, non-compliance will not impact the accreditation decision. Hospitals will receive feedback separate from the Official Accreditation Decision Report on their efforts to meet these requirements. Beginning July 1, 2009, non-compliance will impact the accreditation decision.

Organizations should note that CMS’ final decision regarding the deeming application will be made later this year, and there may be further changes to the standards based on that decision. The Joint Commission remains confident that it will receive deeming authority.

To view the requirements visit The Joint Commission website, or

Wednesday, March 25, 2009

DEA Updates

Change in Renewal Policy

Starting April 1, 2009, registrants will no longer have up to 7 months following the expiration of their DEA number to renew with the ability to retain their original number.

Registrants will now have to renew their DEA number within 30 days following its expiration in order to keep their original number. Registrants are still barred from handling controlled substances if their number is expired.

Locum Tenens Policy

The DEA website provides the following policies in regard to DEA registration for locum tenens practitioners:
  • A practitioner can apply for a separate DEA registration in each state where they plan to administer, dispense, or prescribe controlled substances;
  • As an alternative, if the practitioner will be working solely in a hospital/clinic setting, they may use the hospital’s DEA registration instead of registering independently with DEA if the hospital agrees and the situation warrants;
  • The practitioner may transfer their existing DEA registration from one state to another as needed by contacting ODR, or requesting the change on-line at DEA will investigate these modifications of registration as if they were new applications. DEA will issue a new DEA certificate with the appropriate changes if DEA approves the modification.
  • The CSA requires a separate registration for each principal place of business or professional practice where controlled substances are manufactured, distributed, or dispensed, as set forth in 21 U.S. C. § 822(e). DEA has provided a limited exception to this requirement in that practitioners who register at one location in a state, but practice at other locations within the same state, are not required to register with DEA at any other location in that state at which they only prescribe controlled substances, as specified in 21 C.F.R. §1301.12(b)(3).

For more information, visit the DEA website at:

Source: Drug Enforcement Division, Office of Diversion Control