Monday, November 21, 2011

NCQA Announces New ACO Accreditation

NCQA is announcing its new Accountable Care Organization (ACO) Accreditation. This first-of-its-kind program builds on patient-centered medical homes and provides an independent evaluation of organizations' ability to coordinate the high-quality, efficient, patient-centered care expected of ACOs. It helps providers make the challenging-though much-needed-transition to ACOs, which will be expected to have a "comprehensive and cohesive" approach to primary care.

The program evaluates organizations in seven categories:

1. ACO Structure and Operations
2. Access to Needed Providers
3. Patient-Centered Primary Care
4. Care Management
5. Care Coordination and Transitions
6. Patient Rights and Responsibilities
7. Performance Reporting and Quality Improvement

NCQA ACO Accreditation includes three levels, representing varying degrees of capability for coordinating care and reporting and improving quality.

Organizations that wish to apply for NCQA ACO Accreditation must complete an application. Information provided in the application will be used to determine eligibility. Find ACO publications that include the survey and information on how to apply and the data submission process here <>

An Educational Assessment is available for organizations in the early stage of ACO development or that are not currently pursuing accreditation. It provides the organization a chance to dialogue with NCQA about its performance against the standards and to receive an in depth review of areas to improve.

For more information about NCQA's ACO Accreditation and other NCQA evaluation programs, visit <> or contact NCQA Customer Support at 888-275-7585.

Wednesday, November 16, 2011

Interesting Case - Federal Health Care Quality Improvement Act Doesn't Allow Doctor to Sue for NPDB Report

Zoher, a medical doctor licensed to practice in Florida, applied for a staff position at Naples Community Hospital (NCH), a facility operated by defendant NCH Healthcare System Inc. (NCHS). NCH's board of trustees denied Zoher's application. It later made an adverse action report to the NPDB indicating that Zoher was denied an initial appointment and privileges.

Zoher brought suit against NCH and NCHS, seeking, in part, injunctive and declaratory relief under the HCQIA. Zoher contended that the NPDB Guidebook states that the denial of medical privileges based on a physician's failure to meet a hospital's established criteria is not a reportable event. A hospital should report a denial only if it was based on a lack of professional conduct by the physician, Zoher argued. He said NCH's denial of his privileges was based on his inability to meet the hospital's standards for appointment.

NCH moved to dismiss the lawsuit on the basis that the court lacked subject matter jurisdiction. In a decision by Judge John E. Steele, the court agreed.

The court found that it did not have jurisdiction because the only federal question at issue was Zoher's claim under the HCQIA.
The HCQIA was enacted to improve health care and reduce the number of incompetent physicians, the court said. In actions brought by physicians, the statute grants limited immunity from liability to individuals who participated in peer review activities that resulted in physician discipline, it said.

The HCQIA, however, does not grant a physician a private cause of action in connection with the peer review process, the court said. Since Zoher had no private right of action under the federal statute, there was no claim that arose under federal law in this case, and the court did not have subject matter jurisdiction, it concluded. Doctor's lawsuit against hospital that denied his application for staff appointment is dismissed because HCQIA does not provide for private right of action, federal court did not have subject matter jurisdiction over doctor's action.

A physician cannot recover damages from a hospital for allegedly mistakenly reporting a clinical action against him to the National Practitioner Data Bank (NPDB), a federal district court said Nov. 14 in dismissing the action (Zoher v. NCH Healthcare System Inc., M.D. Fla., No. 2:11-cv-86, 11/14/11).

The U.S. District Court for the Middle District of Florida noted that there is no private right of action under the Health Care Quality Improvement Act (HCQIA) and, therefore, Dr. Mina Zoher failed to state a claim within the court's federal question subject matter jurisdiction.

For full text of the court's opinion:

Thursday, November 10, 2011

From The Joint Commission

Record of Care, Treatment, and Services (CAMH / Hospitals)

Texting Orders
November 10, 2011

Is it acceptable for physicians and licensed independent practitioners (and other practitioners allowed to write orders) to text orders for patients to the hospital or other healthcare setting?

No it is not acceptable for physicians or licensed independent practitioners to text orders for patients to the hospital or other healthcare setting. This method provides no ability to verify the identity of the person sending the text and there is no way to keep the original message as validation of what is entered into the medical record.

Wednesday, November 9, 2011


The term “disruptive behavior” is changed in the standards

The term “disruptive behavior” in two elements of performance (LD.03.01.01, EPs 4 and 5) has been revised to “behavior or behaviors that undermine a culture of safety.” It has been brought to the attention of staff at The Joint Commission that the term “disruptive behavior” is not viewed favorably by some in health care, and it can be ambiguous for some audiences. For example, some physicians object that strong advocacy for improvements in patient care can be characterized as disruptive behavior.

Also, the phrase “disruptive behavior” may be used in the context of a care environment that has become temporarily unsettled by the behavior of a patient. The term was discussed with The Joint Commission’s Accreditation Committee and its Board of Commissioners. Because of the term’s potential for ambiguity, the new term better describes the problem that the standard is trying to address. The change will be made in the update to the accreditation manuals, which will publish in the spring of 2012.

Revised standard IC.02.04.01 on influenza vaccination for licensed independent practitioners and staff to be applicable to all accreditation programs

The Joint Commission has revised standard IC.02.04.01, strengthening the requirements to better reflect current scientific evidence and the national initiatives on influenza vaccination for licensed independent practitioners and staff. The revised standard is effective July 1, 2012 for the critical access hospital, hospital and long term care accreditation programs.

Monday, November 7, 2011

Happy National Medical Staff Services Awareness Week

As we celebrate National Medical Staff Services Awareness Week, let’s take a moment to reflect back and honor the 22 medical staff secretaries who met in California 40 years ago with a vision that has led us to where we are today. Now 4,600 members strong, we continue to grow together, influencing the ever changing face of healthcare. Volunteerism in our organization has played an important role in our success through the years. We take this opportunity to thank everyone who has given back to our profession through their volunteerism, nationally, or on a state of local level. Have a wonderful week!