Thursday, May 27, 2010

TJC Makes Changes to Ambulatory Center Survey

The Joint Commission has made changes to its ambulatory center deemed status survey process to align with the Centers for Medicare and Medicaid Services Conditions of Participation. The changes include:
  • Additional credentials file review for physicians
  • Additional review of licensed non-physician practitioner personnel files
  • Completion of Infection Control Worksheet
  • Review of closed medical records
  • Observation of one full surgery or procedure

The changes will extend the survey process by one day for centers performing more than 600 cases a year.

The Survey Guide for Ambulatory Health Care Organizations has been updated to reflect these changes and can be found here:

Source: The Joint Commission Ambulatory Advisor

Monday, May 24, 2010

CMS to Announce Proposed Rule on Telemedicine Credentialing

The May 25 issue of the Federal Register will include a notice of proposed changes to the Medicare and Medicaid Conditions of Participation (CoPs) regarding the credentialing and privileging of telemedicine providers.

The proposed rule would permit the governing body at a hospital where a patient is receiving telemedicine services to rely on information from a hospital where the provider is currently privileged (distant-site) when making its own privileging decisions. In order to rely on information from the distant-site, the hospital where services are being received must ensure that
  • "the distant-site hospital providing the telemedicine services is a Medicare-participating hospital;
  • the individual distant-site physician or practitioner is privileged at the distant-site hospital providing telemedicine services, and that this distant-site hospital provides a current list of the physician's or practitioner's privileges;
  • the individual distant-site physician or practitioner holds a license issued or recognized by the State in which the hospital, whose patients are receiving the telemedicine services, is located; and
  • with respect to a distant-site physician or practitioner granted privileges by the hospital, the hospital has evidence of an internal review of the distant-site physician's or practitioner's performance of these privileges and sends the distant-site hospital this information for use in its periodic appraisal of the individual distant-site physician or practitioner."

The proposed rule would also require that the periodic review information submitted to the distant-site include adverse events and complaints received about the physician or practitioner.

The proposed rule was created to address the redundant collection of information at both the distant-site and the site where services are received. CMS also recognized that the current requirements were burdensome on small hospitals where telemedicine would be an asset, but the collection of credentialing and privileging information for all telemedicine providers would be a burden.

Under the proposed rule, CMS estimates that the cost to hospitals to implement the rule will be minimal. In its cost analysis, CMS included a breakdown of the cost and time that would be spent by Medical Staff Coordinators or Medical Staff Credentialing Managers to prepare and send performance reports to hospitals receiving telemedicine services.

CMS is collecting comments through July 26. NAMSS has identified the telemedicine CoPs as a source of redundancy in the credentialing and privileging and is pleased to see that CMS is taking steps to streamline these processes.

To read the full announcement, click here:

Minnesota Preparing for Largest Nursing Strike in US History

Last Wednesday, the members of the Minnesota Nurses Association voted to approve a one-day strike that will affect hospitals in the Minneapolis-St. Paul area. The nurses are protesting proposed labor contracts that would set wage increases over the next three years at zero to two percent and proposed pension plans. The nurses are also protesting proposed staffing plans that would allow hospitals to send nurses home on slow days, or float nurses to other departments with higher need. The MNA argues that this staffing plan will overburden staff, leading to potential patient safety risks. The hospitals argue that these changes would allow them to maintain quality care without having to hire a larger volume of nurses, which would raise the cost of care to the patient.

12,000 nurses who are members of the MNA are currently contracted with hospitals in the Minneapolis-St. Paul area. The MNA provided the hospitals with notice of the planned strike. Hospital representatives are disappointed with the decision to strike, stating that there is still time to negotiate.

Several articles have raised questions on how the strike may affect patient safety. Some are worried that bringing in temporary nurses will cost hospitals millions of dollars. Others are worried that the strike will disrupt patient care, creating a higher safety risk to the patient.

Members of the MNA hope that an agreement with hospitals is reached prior to the June 1 contract expiration; however, they stated that they are ready to strike if a deal is not reached.

Sources: Minneapolis St. Paul Business Journal, Pioneer Press

Navigate MS.01.01.01 with NAMSS

Do you have questions about whether or not your bylaws are ready for the March 2011 implementation of MS.01.01.01? Are you still unsure about what changes need to be made? Register today to join attorney Michael Callahan of the American Health Lawyers Association and Harold Bressler, General Counsel of The Joint Commission, as they walk you through sample bylaws, explaining what meets the standard and what doesn’t.

In addition, learn how to re-evaluate the relationships among the medical staff, medical executive committee, and governing body under the new standard.

Upon registering for the webinar, you will receive a link to a site where you can submit your questions in advance, giving you the opportunity to “custom-design” the content of the session. Based on your questions, the speakers will provide substantive guidance on the most-pressing issues for MSPs.

Cost is $49 for NAMSS members, $69 for non-members, and $10 for each additional CE certificate. Participants will receive 1.5 CE credits.

This webinar also will be recorded and available in the NAMSS Online Store following the live event. If you have questions, please e-mail

Friday, May 21, 2010

FSMB Discusses the Collection of Physician Data under the Proposed MOL Framework

In April, the Federation of State Medical Boards (FSMB) released a report outlining the implementation of the Maintenance of Licensure (MOL) program. Many NAMSS members have already started to ask questions about how the MOL may affect the credentialing process.

Frances Cain, Director of Post-Licensure Services for FSMB has provided the following information. Feel free to leave any questions or comments that you may have for FSMB and Ms. Cain in the blog's comment field.

Although FSMB has adopted a framework for MOL, there are still some questions as to how state medical boards might implement MOL and how it may look “on the ground” for physicians. The FSMB has recently established a MOL Implementation Group, which has been charged to create a template to assist state medical boards in implementing MOL. This will include a more detailed exposition of the options for complying with MOL that fall outside of Board-certification. FSMB hopes to have this report out for comment in the fall, and will send a copy to NAMSS.

There have been many questions about the types of data physicians may have to collect in order to comply with MOL and how that information may be used by the state medical board. To date, all of the committees and workgroups that FSMB has convened to explore the issue of MOL and to develop the MOL framework that was adopted by our House of Delegates last month have all been very sensitive to the concerns of physicians about the privacy of their data. As such, the final report and MOL recommendations that were adopted by FSMB as policy includes the following statement:

“Practice performance data collected and used by physicians to comply with MOL requirements should not be reported to state medical boards. Third party attestation of collection and use of such data (as part of a professional development program) will satisfy reporting requirements.”

Therefore, under the proposed MOL framework, physicians could be able to comply with MOL through participation in the very same activities in which they are already participating (e.g., CME, procedural hospital privileging, 360 evaluations, medical professional society/organization clinical assessment/practice improvement programs, CMS and other similar institutional-based measures). Participation in these activities could be verified by the state medical board through third-party attestation, rather than direct reporting of the data. A more detailed listing of proposed activities that physicians could use to comply with each of the three components of MOL are provided in the MOL Advisory Group report (see pages 79-80 of the adopted MOL policy report at

To use the example of CME, under MOL a state medical board may choose to require that CME used for license renewal be related to the physician’s area of practice; however, the board could use the same system it currently has in place (i.e., a random audit of a small group of licensees) to verify physicians’ compliance with those requirements.

Although central to the FSMB’s proposed MOL framework is the concept that each state medical board would adopt its own guidelines for applying MOL, through our Implementation Group and future pilot projects with individual state medical boards, we would hope to develop recommendations that will be consistent across state lines. MOL will be an “evolutionary” process and will require much thought such that it provides public protection while paying attention to the concerns of physicians and the resources available to state medical boards.

FSMB encourages input from all stakeholders as we proceed with this task.

Tuesday, May 18, 2010

Utah Supreme Court Recognizes Negligent Credentialing as a Valid Claim

On May 14, the Utah Supreme Court recognized negligent credentialing as a valid cause of action in a legal claim against a hospital in Archuleta v. St. Mark's Hospital.

The plaintiff, Tina Archuleta, had undergone a laparotomy procedure performed by Dr. R. Chad Halversen at St. Mark's Hospital. Two days later, she was admitted to another facility, experiencing pain and complications from the procedure. Archuleta underwent six surgeries to correct the procedure.

Archuleta filed a suit against Halversen and St. Mark's Hospital. In her complaint against the hospital, she claimed that St. Mark's "failed to seek consult when appropriate, inadequately trained healthcare provider employees, negligently credentialed. . . [Dr.] Halversen and generally fell below the standard of care."

The district court dismissed her negligent credentialing claim, stating that such action was barred by the sections of the Utah Code that protect the dissemination of peer review information. The Utah Supreme Court ruled that the district court was incorrect in its application of the code, ruling that "the immunity contemplated under the statue operates between a doctor whose credentials are under review and the suppliers of information and decision makers; it does not contemplate immunity between a patient and a hospital."

In its opinion, the Utah Supreme Court stated that there is a public interest in recognizing negligent credentialing claims because there is a "foreseeability of harm to patients where hospitals fail to properly investigate a doctor's qualifications" (citing Johnson v. Misericordia), and because of the "superior position [of hospitals] to monitor and control physician performance" (citing Domingo v. Doe).

To read the full opinion, click here:

Monday, May 17, 2010

HASC Proposes Coordinated Care System

A proposal by the Hospital Association of Southern California (HASC) calls for the formation of a single foundation that would supply hospitals in the area with physicians and centralized administrative functions. The foundation would work with various physician groups and contract physicians on behalf of several hospitals. HASC says that the creation of a single foundation working with several hospitals, which is different from the current system where each hospital usually has its own foundation, would promote efficiency and better coordinated care.

The plan has raised some concerns from those who believe that the plan limits competition by area physicians who are not part of the foundation. HASC argues that competition will not be harmed since hospitals would not acquire their whole workforce from the foundation. The foundation will primarily help smaller facilities that have a harder time recruiting physicians.

The proposed plan has not been passed, but it does highlight the changing relationships between hospitals and physicians and the impact that it can have on the healthcare market.

The following article from The Wall Street Journal outlines the HASC plan and the arguments for and against it:

Source: The Wall Street Journal

Tuesday, May 11, 2010

Physician Specialties Generating Hospital Revenue

Modern Physician reports that the 2010 Merrit Hawkins Physician Inpatient/Outpatient Revenue Survey reported that the 17 physician specialties experienced a 3% increase in average annual net revenue generated since 2007. In 2010, the specialties reported an average annual net revenue of $1.54 million for their hospitals.

The article emphasizes that although the specialties may be revenue generating, hospitals must remember that health reform incentives will be based on the availability of access to primary care and preventative services. The survey results, which reported a drop in primary-care revenue, may look completely different in a few years once the health reform provisions are implemented.

To read the full article, click here (free subscription required):


Friday, May 7, 2010

Submit Your Thoughts for an Upcoming Synergy Article

This year, NAMSS and CAQH are collaborating on the shared goal of identifying ways to increase efficiencies in the credentialing process. An upcoming issue of Synergy will feature an article on CAQH’s Universal Provider Datasource (UPD) and application. For this article, we are looking for feedback from the membership with your thoughts as a user of the UPD and CAQH application. The article will highlight the feedback of the membership and will provide an update on how CAQH is working to make the UPD system easier to use.

The NAMSS Industry & Government Relations Committee has already provided comments to CAQH with ideas on how to improve their application for the hospital-user community. NAMSS is pleased that CAQH is reviewing the committee’s proposed changes for inclusion in a future version of their application. CAQH wants to hear more about your experiences so we can work together and can continue to make the application and UPD system more user-friendly for providers and credentialing professionals.

Here is your chance to share your experiences on using the system with both the NAMSS membership and CAQH. To provide your experiences for the article, complete the following survey by Friday, May 21:

Questions can be sent to

Thursday, May 6, 2010

VA Limiting Surgeries to Improve Care and Quality

Officials at the Department of Veterans' Affairs have announced that surgeries at some VA facilities will be limited based on the agency's "surgery complexity initiative." The initiative grades VA hospitals based on their medical staffing, equipment, and diagnostic capabilities. The complexity of surgical procedures are compared against the grade received by a facility to determine if the facility is capable of performing certain procedures.

66 facilities have been approved to perform complex procedures (cardiac, brain pancreas surgeries, etc.). 33 have been approved for intermediate procedures (joint replacement, colon ressections, etc.). 13 facilities are limited to standard procedures (hernia repair, ear, nose, and throat surgeries, etc.).

The VA said that they will assist with transportation to facilities if a patient needs to go to a distant hospital for a procedure due to the limitations. The VA said that this system is part of its response to improve quality after problems were discovered at the VA hospital in Marion, IL.

Source: Army Times

Tuesday, May 4, 2010

Angie's List Encourages Patients to Make Sure Their Healthcare Providers Are Licensed

Angie's List, a consumer-focused website that allows people to post review services and contractors, recently released an article encouraging patients to check to make sure their healthcare providers are practicing under a current license.

91 percent of respondents said that it is "crucial that their health care providers are licensed," yet most respondents do not check for licensure themselves.

The article presents several interesting situations of unlicensed medical professionals and the potential dangers of having these providers see patients. The article does recognize that many of the "unlicensed" professionals are simply professionals who have let their license expire. Matt Haddad, CEO of Medversant, noted the importance of seeing a properly credentialed provider.

This article is good at highlighting the value of the MSP from the consumer perspective. Patients should not have to ask their providers for proof of licensure when they enter a hospital or call an office to schedule an appointment. They should be able to seek care, knowing that their provider is licensed and competent. It is our job as MSPs to keep sanctioned providers away from patients, and to ensure that providers know the importance of licensure and do not let it lapse.

To read the full article, click here:

Source: Angie's List