Thursday, April 29, 2010

Missouri Legislation Proposes 45-Day Credentialing Window

Missouri House Bill 2450 (HB 2450), the "Prompt Credentialing Act," would require every health carrier in the state to complete verification of a physician's credentials and to make a credentialing decision within 45 days after receiving a complete application. If a decision is not made within the timeframe, then the health carrier must grant provisional credentialing status until a final determination is made. The bill also requires health carriers to retroactively compensate physicians for services rendered since the date of his or her application.

Making credentialing decisions more efficient is certainly a positive step. However, did lawmakers adequately consider the factors that play into the credentialing process when setting this timeframe? For example, hospitals with a delegated agreement would have a hard time meeting a 45 day timeframe. Also, the 45 day window doesn't encourage physicians to complete the application any faster, since it is imposed on the credentialing verification process.

Finally, what if additional investigation needs to be done on a physician's record and the 45 day timeframe lapses? Are hospitals comfortable with having a member on the medical staff with provisional status if they are still investigating a possible "gap" in his or her file?

NAMSS will work with members in Missouri to ensure that any concerns are communicated to lawmakers before this piece of legislation is voted upon. The bill currently has a proposed effective date of August 2010.

What are your thoughts on this issue? Do you have a credentialing timeframe in your state? If so, how long is it, and have you run into any problems because of it? Share your thoughts in the comment field below this post on the NAMSS Blog website.

To read Missouri HB 2450, click here:

Wednesday, April 28, 2010

HFAP Implements New Patient Safety Standards

This year, Healthcare Facilities Accreditation Program (HFAP), based in Chicago, IL, developed patient safety standards based on the National Quality Forum’s (NQF) 34 Safe Practices.
The elements that contribute to patient safety as defined by the NQF are:
  • Leadership must ensure structures are in place for organization-wide awareness and compliance with safety measures including adequate resources and direct accountability.
  • Measurement, analysis, and feedback must track safety and allow for interventions.
  • Team-based patient care with adequate training and performance improvement activities must be organization-wide.
  • Safety risks must be identified continuously and interventions taken to reduce patient risk.

HFAP has already implemented several standards that promote the 34 Safe Practices of the NQF. The 34 Safe Practices address areas such as leadership, medication reconciliation, and wrong-site surgery.

For more information, visit HFAP's website at:

Monday, April 19, 2010

California Doctor Pleads Guilty to Fraudulent Medicare Billing

On April 14, Dr. Glen R. Justice pleaded guilty to five counts of healthcare fraud. In addition to upcoding insurance claims, Justice submitted fraudulent claims to Medicare and other insurers for cancer medications that were never given to patients. (United States v. Justice)

Justice admitted that his scheme took place between 2004 and 2009 and that he had collected payments totalling up to $1 million.

The number of reports of practitioners bilking Medicare and Medicaid continues to grow. This is especially disconcerting in the midst of health reform, since these fraudulent payments are taking up funds that can be used to provide real coverage and care to patients. These fraud cases only highlight the need for better regulation of these programs and safeguards for catching practitioners in the act of fraudulent billing.

Source: BNA

Thursday, April 15, 2010

Report Emphasizes Importance of Safety in Medical Education

Unmet Needs: Teaching Physicians to Provide Safe Patient Care, a report by the Lucian Leape Institute at the National Patient Safety Foundation, suggests that more focus on patient safety, communication, and teamwork needs to be incorporated into the medical school curriculum.

Lucian Leape, MD, adjunct professor of health policy at the Harvard School of Public Health, said that too many new doctors are graduating without the leadership and communication skills that would help them to speak out when they witness an unsafe practice or event. Leape also called on hospitals to enforce a "culture of safety" in their facilities, which includes controlling disruptive patient behavior and encouraging professionalism.

A full copy of the report can be found here:

Tuesday, April 13, 2010

Intern Fails in ADA Claim Against Hospital

The Fourth Circuit of the US Court of Appeals recently decided that Dr. Frank Shin, a medical intern with the University of Maryland Medical System Corporation (UMMSC), did not qualify as a disabled person under the Americans with Disabilities Act (ADA).

Shin entered the UMMSC program as an intern in 2006 and had received favorable reviews. Soon his performance declined and error rate increased. UMMSC's program director had Shin contact the Employee Assistance Program and also made arrangements to decrease Shin's patient load, to excuse him from participation in certain internship requirements, and to have him to to work under a supervised probation period. At the end of the probation period, Shin's supervising physicians reported that he should be discontinued from providing direct patient care.

UMMSC continued to accommodate Shin, who was diagnosed with ADD in 2007. Shin's doctor reported that although Shin's condition had improved in 2007, he was still unfit to perform the essential functions of his job. Shin was subsequently terminated, and then brought a lawsuit against UMMSC, claiming that he was terminated in violation of the ADA.

The court rejected Shin's claim, stating that in order to qualify for accommodations under the ADA, an individual must be able to perform the "essential functions of his job" with reasonable accommodation. The court ruled that Shin was unable to perform the essential functions of his job and that a reduced workload was not a reasonable accommodation under the ADA.

This situation highlights several issues for hospitals. How much does a hospital need to do in order to accommodate a physician? The ADA is typically dealt with by HR professionals. Medical services departments may want to reach out to their HR departments to learn more about the ADA and how physician performance reviews can play a role in the enforcement of this law.

Source: Ogletree Deakins

Monday, April 12, 2010

TJC Hosts MS.01.01.01 Audioconference

From The Joint Commission:

Chuck Mowll, executive vice president of Business Development, Government and External Relations, and Robert Wise, M.D., vice president of the Division of Standards and Survey Methods, will discuss revised medical staff bylaws standard MS.01.01.01 during a free one hour telephone conference call for Joint Commission-accredited hospitals and critical access hospitals on Thursday, April 22, at 11 a.m. P.T. / noon M.T. / 1 p.m. C.T. / 2 p.m. E.T.

MS.01.01.01, formerly known as MS.1.20, is designed to contribute to patient safety and quality of care through the support of a well-functioning, positive relationship between a hospital’s medical staff and governing body. The revisions are based on the unanimous recommendations of an 18-member expert task force.

The speakers will discuss:
· Why the standard changed
· How the standard impacts quality and safety of patient care
· What requirements are changing
· When these changes take effect

If you would like to participate in the call, click on the link below to complete the registration form.*

Upon registration you will immediately be provided the toll-free telephone number and pass code. Please print out the page or write down the telephone number and pass code. You will NOT receive an e-mail confirmation.

If you are unable to participate on the call, a transcript and a playback option will be available on The Joint Commission Connect, your secure extranet site, following the program.

To register for the April 22 call, click on the link below or copy and paste it into the address bar of your browser.

* One line per hospital, please

FSMB Report Shows 6% Increase in Disciplinary Actions Against Physicians

According to the Federation of State Medical Board's (FSMB) Summary of 2009 Board Actions report, 342 more disciplinary actions were taken against physicians in 2009 than in 2008, representing a 6% increase.

For the report, the FSMB monitored the actions of 70 state medical and osteopathic boards. FSMB assessed the Composite Action Index (CAI) of each state board, which is an average of the number of disciplinary actions taken by the board and the total number of licensed physicians in the state.

The New Hampshire and South Dakota medical boards were shown to have the highest increase in their CAIs between 2008 and 2009. The Florida Board of Osteopathic Medicine and the South Carolina Board of Medical Examiners had the largest decrease between 2008 and 2009.

To read the FSMB report, click here:

Sources: FSMB, Modern Healthcare

Tuesday, April 6, 2010

Case of Illinois Doctor Shows Importance of Evaluating Outpatient Practice

Illinois physician Sukhdarshan S. Bedi was recently sentenced to eight months of prison and eight months of home confinement for health care fraud, illegally dispensing a controlled substance, and other charges. Bedi's clinics, Marion Family Health Care, Harrisburg Family Healthcare, and Galatia Medical Center Corp. were sentenced to one year of probation for health care fraud and illegally dispensing controlled substances.

Bedi and his clinics were involved in a scheme to prescribe controlled substances without a legitimate medical use, and to submit Medicare claims for these illegal prescriptions. Bedi allowed nurse practitioners and physician assistants to write these prescriptions using pre-signed forms, even though writing prescriptions for the controlled substances was outside their scope of practice.

This case is a reminder of the importance of considering both inpatient and outpatient practices of physicians for membership, even if they are not granted privileges.

Source: BNA

Friday, April 2, 2010

New Medical Schools May Not Address Shortage of Doctors

An article in American Medical News reports that despite the number of new medical schools set to open in the coming years, the doctor shortage may continue. The article says the cause lies with the lack of compensation for new doctors.

The AMA is calling for the elimination of a cap on the number of Medicare-paid residents at hospitals, which has kept some potential students from enrolling in medical school. Also, there continues to be the problem of increasing student debt. This forces students to seek positions in higher paying specialties, rather than in primary care, where the shortage will hit the hardest.

Furthermore, the number of new medical school enrollees is not expected to offset the number of physicians expected to retire in the coming years, contributing to the expected shortage of 125,000 doctors by 2025.

In the coming years, there will be an increased need for primary care physicians. This article suggests that the solution may not be increasing the number of medical schools, but to find economic ways to lure students to this field.