Friday, March 30, 2012

Happy Doctor's Day!

Please join us in wishing our medical staffs a Happy Doctor’s Day.

The Origin of Doctors’ Day

Eudora Brown Almond was reared in the small Georgia village of Fort Lamar, and from early childhood was greatly impressed with the selfless devotion of the medical profession’s humanitarian service to mankind. She always carried in her heart fond memories of the gentle kindness of her family physician whose skill and understanding endeared him to his patients as both a beloved doctor and a revered friend.

Because of her affinity for the medical profession, Eudora Brown was destined to become a doctor’s wife. In 1920, she married Dr. Charles B. Almond and moved to Winder, Ga., where they made their home. Their happy and busy life together, serving their fellow men, was the guiding spirit that influenced her idea for a doctors’ day.

As she walked through the years beside her husband, sharing the dedication of his life to the practice of medicine, the charity and courage, and love and sacrifices in his daily ministry of healing humanity’s ills, Mrs. Almond became convinced that medicine is the greatest profession on earth, and doctors, the greatest heroes. This respect and appreciation of the noble achievements of the profession inspired her to present to her local Auxiliary the idea of having a day on which to honor the practitioners of the Medical Arts. The suggestion met with immediate approval and the Auxiliary adopted the following resolution in 1933:

"Whereas, the Auxiliary to the Barrow County Medical Society wishes to pay lasting tribute to her Doctors, therefore, be it,

"Resolved by the Auxiliary to the Barrow County Medical Society, that March 30, the day that famous Georgian, Dr. Crawford W. Long, first used ether anesthesia in surgery, be adopted as ‘Doctors’ Day,’ the object to be the well-being and honor of the profession, its observance demanding some act of kindness, gift or tribute in remembrance of the Doctors."

The first Doctors’ Day observance ever held was by the Barrow County Auxiliary on March 30, 1933. The Auxiliary mailed cards to the doctors and their wives. Flowers were placed on graves of the deceased doctors including that of Dr. Crawford W. Long. The ceremonies concluded with an elegant four-course dinner at the spacious home of Dr. and Mrs. William Randolph with appropriate toasts, tributes and responses, and the hope that hereafter, Doctors’ Day would continue to be observed on March 30 of each year.

When suggesting that physicians be honored, Mrs. Almond originally had in mind only the Winder and Barrow Country doctors. Little did she realize, when at last the cherished dream she carried within her heart for so many years became a reality, that it would include doctors in all parts of this country and across the seas as well. Our neighbors to the south of us in Cuba also celebrate a day in honor of the men and women fashioned after our Day of Commemoration.

And so, out of the gratitude of a little girl for her kindly family physician, and from the loving heart of a doctor’s wife, so justly proud of her husband whose work was his glory, emerged a most beautiful tribute to the medical profession—Doctors’ Day!

The Red Carnation is the Symbol of Doctors' Day

Red denotes:
Love -- Charity -- Sacrifice -- Bravery -- Courage

The analogy of the carnation is closely woven in medical science, so it is only fitting that this flower, so tailored by nature with its spicy scent, was
chosen as the symbol of Doctors’ Day.

Friday, March 23, 2012

FSMB celebrates 100 years!

The Federation of State Medical Boards (FSMB) is a national non-profit organization representing the 70 medical and osteopathic boards of the United States and its territories. FSMB leads by promoting excellence in medical practice, licensure, and regulation as the national resource and voice on behalf of state medical and osteopathic boards in their protection of the public.

Wednesday, March 21, 2012

Hugh Greeley Featured in Synergy

Learn about medical staff communication tools by taking a look into the future through the eyes of visionary, Hugh Greeley. Don’t miss Greeley’s article titled “Become Your Medical Staff’s Content Expert” in the March/April Issue of Synergy.

Thursday, March 15, 2012 New accreditation system will shift focus of resident training

ACGME says it is moving from a blueprint that stifles originality to one that allows more flexibility in graduate medical education.

Carolyne Krupa, March 12, 2012

The Accreditation Council for Graduate Medical Education is revamping how it accredits graduate medical education programs in an effort to foster innovation and alleviate administrative burdens.

Starting in 2013, the Next Accreditation System will begin to shift away from a system described by many as too prescriptive and inflexible, said ACGME CEO Thomas Nasca, MD. The new system is designed to allow GME programs to better train physicians to meet the needs of today's changing health care system.

"If there is a criticism of our GME system, it is that it is slow to adapt to new needs," Dr. Nasca said. "We believe this new model is much better than our existing model in providing the impetus for the innovation to help [programs] improve and grow."

Details of the system have yet to be finalized, but it will include waivers from certain ACGME rules for high-performing programs. The system, announced online Feb. 22 in The New England Journal of Medicine, will be piloted in seven specialties starting in July 2013 and expand to the remaining 19 core specialties in 2014.

The current system has been in place since the ACGME was founded in 1981. At that time, there were disparate training programs for 28 specialties and subspecialties, and the ACGME's goal was to standardize the way all programs were evaluated. Uniform standards have since been established, but the system is criticized as being too rigid for today's more than 130 specialties and subspecialties, Dr. Nasca said.

"The price of those prescriptive standards has been to stifle innovation," he said.

Providing flexibility
Under the new system, programs with strong accreditation performance will be allowed to have a waiver from some of the ACGME standards that govern how residents are trained. For example, all programs are required to have residents go on teaching rounds, where they are introduced to patients and discuss their cases in groups with a faculty member at the bedside. In the new system, well-performing programs still would be required to do teaching rounds but could determine for themselves how those rounds are run.

"If I have a program that has excellent survey results, and if board scores continue to be excellent, why do I care how they do their teaching rounds?" Dr. Nasca asked.

More than 80% of ACGME-accredited programs are high performing and will be allowed some flexibility for innovation, he said.

The system will emphasize the six core competencies that the ACGME announced in 1999: patient care; medical knowledge; practice-based learning and improvement; interpersonal and communication skills; professionalism; and systems-based practice. Program directors will be required to submit data to the ACGME from resident evaluations on those competencies that they already do every six months.

Committees for each specialty will review data annually to evaluate trends in key performance measurements. ACGME representatives will visit sponsoring GME programs every 18 months. But longer, more detailed accreditation visits will be done every 10years, as opposed to every four to five years, Dr. Nasca said.

Waiting for specifics
The Alliance for Academic Internal Medicine is optimistic about the changes, said AAIM President D. Craig Brater, MD, the Dean & Walter J. Daly Professor at Indiana University School of Medicine in Indianapolis. AAIM is a consortium of specialty organizations representing internal medicine departments at medical schools and teaching hospitals in the U.S. and Canada.

"The notion is now the time should be spent in having those kind of broader discussions looking at how individuals are really doing, rather than checking boxes about prescriptive stuff -- which is great," Dr. Brater said. "No one knows the residents better than the program leadership. They spend countless hours with these residents."

The new ACGME accreditation program keeps the same 6 core elements it has had since 1999. But change always comes with some difficulties. Dr. Brater said he anticipates some "bumps in the road," but AAIM is developing tools and guidance for program directors to help make the transition as smooth as possible.

Mark Friedell, MD, president of the Assn. of Program Directors in Surgery, said many program directors are unclear about how the new system will work and are awaiting more specifics.

"My biggest concern would be that this not cause more work for us to do, and hopefully make it easier to manage accreditation," said Dr. Friedell, chair of the University of Missouri-Kansas City Dept. of Surgery. "I have more questions now than I did before. I'm just waiting for all of the details to come out."

Tuesday, March 13, 2012

BNA: New Social Media Pose Legal Risks For Health Care Providers, Attorneys Say

Ralph Lindeman, March 9

The explosive growth of blogs, Twitter, Facebook, and other social media creates new legal risks for health care professionals in areas ranging from privacy to employment, legal experts warned at a panel discussion March 8.

“The biggest problem” in health care caused by social media communication “is a lack of control over patient confidentiality,” said Jennifer R. Breuer, a partner and vice chair of the health care practice group at Drinker Biddle & Reath in Chicago, which sponsored a webinar titled “The Rise of Social Media in Health Care.”

The Health Insurance Portability and Accountability Act of 1996 (HIPAA) prohibits health care providers from using or disclosing individually identifiable health information, she noted, adding, “Yet it's very easy to inadvertently disclose patient health information through social media.”

Citing one recent example, Breuer told of a pediatric nurse who posted on her Facebook page a photo of a child in a hospital bed, along with a request for prayers before the child was to undergo brain surgery. The nurse said she did so at the request of the child's parents.

“Even so, the nurse should have obtained a HIPAA-compliant, signed authorization from the parents,” Breuer said. “Without authorization, the nurse was bound by HIPAA to safeguard the child's personal health information.”

Live Tweets of Coronary Bypass
Social media also expose hospitals and other health care providers to risks beyond privacy concerns, Breuer said. In late February surgeons at Memorial Hermann Hospital in Houston “live-tweeted” a double coronary artery bypass, with one surgeon tweeting, posting photos to the hospital's Facebook page, and responding to questions while another surgeon performed the operation.

“Whether there was a privacy violation is unclear,” Breuer said, because the operation did not show readily identifiable images of the patient. “But what about malpractice risk if something went wrong?” she asked. The surgery was sent to more than 4,000 Twitter followers in real time with photos and videos, she said.

Blogs sponsored by hospitals and other providers may also pose legal risks through such features as “Frequently Asked Questions,” or “Ask the Professional,” Breuer noted. “You need to consider whether you are creating a physician-patient relationship,” she advised.

Moreover, when the “patient” and medical blog are in different states, there may be problems with practicing medicine without a license, she noted, because the controlling law is where the “patient” is, not the physician. To reduce risks, providers should avoid diagnosing specific medical problems or providing specific medical advice, Breuer said.

Labor Law Issues Arise
Like other businesses, hospitals and other health care providers need to be aware of how social media affect employment relationships, said Stephanie Dodge Gournis, a partner with Drinker Biddle & Reath's labor and employment practice.

In the area of labor law, employers need to be careful about interfering with social media communications between employees, Gournis said. For example, the National Labor Relations Board has said employees are free to engage in communications with other employees that their employer may consider “rude, discourteous or disloyal,” she noted. The NLRB considers such communications to be protected as “concerted activity” under the National Labor Relations Act.

The NLRB will consider unlawful “any social media policy that employees could reasonably interpret to prohibit protected activity,” Gournis said.

“Most of the health care provider policies that I'm seeing today are not going to meet the NLRB standards,” Gournis said.

Allowable Topics in Policies
Specific topics that can be addressed in employer social media policies, Gournis said, include:

• prohibitions against employee release of personal health information;
• prohibitions against release of confidential business information and trade secrets;
• requirements that employees include disclaimers when discussing provided services; and
• prohibitions on employee violations of law, including discrimination, harassment, and

Beyond company social media policies that affect employees, Gournis said, “Social media has become the smoking gun in all sorts of discrimination and harassment claims, wrongful termination and defamation claims, and negligent referral claims.”

She added: “Now we have the paper trail or comment trail that shows either communications by managers directed toward employees or co-workers toward one another. All these types of issues create additional challenges and legal risks that [a company's human resources department] is going to have to answer.”

Employees' Heavy Use Poses Challenges
In addition, “There is a tension,” said Gournis, between how employees perceive their right to use social media at work and how employers view their right to monitor social media use.

A workplace survey conducted by Deloitte in 2009 revealed that 22 percent of the employees surveyed said they visited social networking sites five or more times per week, Gournis noted. Seventy-four percent of the employees surveyed said it was “easy” to damage an employer's reputation on social media.

In the case of disgruntled employees, she said, “They know how much damage they can do to an employer by using social media as a megaphone.”

Monday, March 12, 2012

Synergy to Feature a Joint Commission Surveyor's Perspective

Dr. Larry Kachik, Joint Commission Surveyor, attended the National Credentialing Forum in February. He shares his takeaways from this informative gathering of industry leaders in his upcoming Synergy article.

His article reviews the characteristics of organizations with high-functioning OPPE and FPPE processes. How does yours measure up? Don’t miss this informative article in the March/April issue of Synergy.

Friday, March 9, 2012

ECFMG Launches Electronic Verification of Medical Credentials

February 28, 2012

The Educational Commission for Foreign Medical Graduates (ECFMG), a world expert on international medical schools and the credentials they issue, is pleased to announce the launch of an electronic process for verifying the medical education credentials of international physicians who seek entry into the U.S. health care system.

In January 2012, after more than a year of intensive development, a pilot of ECFMG’s electronic Credentials Verification program was launched with participation from approximately 20 international medical schools. Participating institutions use Credentials Verification to electronically receive and verify the medical education credentials of their students and graduates who apply to ECFMG.

For more than 50 years, through its certification program, ECFMG has assessed whether international medical graduates are ready to enter U.S. graduate medical education programs. As part of this certification program, ECFMG requires international physicians to provide copies of their medical education credentials, specifically medical diplomas and transcripts. Since 1986, ECFMG has verified applicant credentials by mailing copies directly to the issuing institutions. The electronic Credentials Verification program represents a significant advance over the paper primary-source verification process, benefiting medical schools and their students/graduates while maintaining ECFMG’s rigorous standards for primary-source verification.

ECFMG’s President and Chief Executive Officer, Emmanuel G. Cassimatis, M.D., comments, “ECFMG’s role in verifying the medical education credentials of international physicians is critical to protecting the public. Electronic Credentials Verification revolutionizes the way we perform this vital function.”

To read the press release:

ECFMG's Certification Program:

amednews: Arkansas court rejects expert witness provision in medical liability cases

The 2003 rule required experts to practice in the same specialty as defendant physicians.

Alicia Gallegos, Feb. 6, 2012.

The Supreme Court of Arkansas has struck down a key provision of the state's tort reform law, ruling that expert witnesses in medical liability lawsuits no longer must practice in the same specialty as defendant doctors.

The decision is another setback for physicians who have seen most reform measures overturned by the courts since the law's 2003 enactment.

"We're extremely disappointed that the state Supreme Court has decided to circumvent the will of the Legislature, which is obviously charged with representing the people of the state," said David Wroten, executive vice president of the Arkansas Medical Society. "Each provision of the tort reform was enacted for a specific purpose."

The ruling stems from a lawsuit filed by Teresa Broussard, who in 2006 underwent a parathyroidectomy performed by general surgeon Stephen Seffense, MD. After the surgery, Broussard said she noticed a burn near the incision.

She was prescribed steroids and pain medication, said Gerry Schulze, Broussard's attorney. She was released from the hospital but returned to the emergency department a few days later complaining of pain from the burn.

State courts have issued mixed rulings on tort reform provisions. During her hospitalization, nephrologist Michael Coleman Jr., MD, treated Broussard for an unrelated condition and consulted with a dermatologist about the burn, records show. Doctors told Broussard she had a second-degree chemical burn but that it should improve within two weeks, Schulze said.

Broussard sued Dr. Coleman and Dr. Seffense in 2007, accusing them of improperly addressing and treating the burn. She said their delay led to skin grafts and other painful procedures at a local burn center. The doctors denied any wrongdoing.

During discovery, a specialist in forensic medicine testified as an expert witness for Broussard. Attorneys for the doctors requested the case be thrown out because the expert witness was not in the same specialty as the physicians sued, as required by state law.

A lower court ruled for the doctors. Broussard appealed.

The Supreme Court on Jan. 19 reversed and remanded the case to the lower court. The same-specialty rule is unconstitutional because it violates the separation-of-powers doctrine, the high court said.

"The authority to decide who may testify and under what conditions is a procedural matter solely within the province of the courts ... and pursuant to the inherent authority of common-law courts," the court said in its opinion. "The trial court controls the admissibility of evidence and the determination of applicable law and always has the inherent authority to secure the fair trial rights of litigants before it."

Tort reform law weakening
The provision mandating that expert witnesses practice in the same specialty as defendants was unnecessary, Schulze said.

"A lot of times, the nature of the negligence doesn't have anything to do with the specialty," he said. The requirement led to hiring multiple expert witnesses, he added.

Schulze said the high court has procedural standards in place to ensure that expert witnesses for both sides are qualified to testify. Procedural court rules provide judges with the discretion to decide whether a witness has enough knowledge to act as an expert.

The ruling will make it more difficult for lawsuits to be dismissed early, said Vicki Bronson, an attorney for the doctors. She believes the lower court will again throw out the Broussard case.

The plaintiff's expert witness is unqualified to testify, regardless of the same-specialty rule being overturned, she said. The defense plans to prove the witness does not meet procedural court criteria for qualified experts.

The court's decision means expert witnesses have the potential to hold physicians to a different standard of care than their specialty is otherwise required to provide, Wroten said. Although the ruling doesn't stop a judge from excluding witnesses, it sends the message that tort reforms enacted by the state will not stand.

When the state's reform package was approved, the provisions said that a liability suit could not proceed without an affidavit of merit, that cases be filed in the same county where the alleged negligence occurred and that plaintiffs could sue only for medical costs owed as opposed to billed charges. The reforms addressed joint and several liability and incorporated the expert witness rule. Courts in the state have thrown out all but the venue and joint and several liability provisions.

It's too early to tell how the Broussard case will impact the medical liability market, Wroten said. But doctors expect the court rulings against reform provisions probably will erode the reform law's success. Improvements due to the law included more medical liability insurance carriers coming to the marketplace and a slowed growth rate of insurance premiums for doctors, Wroten said.

In recent years, state courts have issued mixed rulings on tort reform provisions. The 5th District Court of Appeals in Texas in September 2011 upheld the state's certificate-of-merit requirement for medical liability cases. The Maryland Court of Appeals in 2009 validated a measure requiring certain qualifications for expert witnesses in medical liability cases, including that the witness must be involved in active participation in the medical profession and contribute in some form to its advancement.

However, the Washington Supreme Court in 2009 ruled unconstitutional a state law requiring plaintiffs, as the start of a lawsuit, to submit a statement from a medical expert certifying there is a reasonable basis for a suit's allegations.

Case at a glance
Is an Arkansas requirement that expert witnesses be the same specialty as defendant doctors constitutional?

The Supreme Court of Arkansas said no. The court overturned the requirement, ruling that the provision violated the separation of powers doctrine.

Impact: Expert witnesses in medical liability cases can practice in specialties other than that of the physician sued.

Teresa Broussard v. St. Edward Mercy Health System Inc., Supreme Court of Arkansas, Jan. 19

Tuesday, March 6, 2012

NAMSS' Managed Care Task Force

I was visiting with one of our NAMSS members the other day who is in managed care. He mentioned that he does not see a lot of information from NAMSS on managed care standards.

The NAMSS board believes that as hospital and managed care environments become more closely aligned, NAMSS members can greatly benefit from a better understanding of both sides of these credentialing fields.

NAMSS responded to this opportunity by creating a task force comprised of many of our managed care industry leaders to research the opportunities for this market. Don’t miss the article by Amy Niehaus that reveals the results of this task force’s findings in our upcoming Synergy.