New U. of M. Study Shows Wide Variation in Physician Disciplinary Actions

Based upon data available through the National Practitioner Data Bank (NPDB), researchers at the University of Michigan Medical School have found that lack of standardization across state lines results in wide variation in rates of disciplinary actions and malpractice claims.

"'In one state the punishment for a particular violation could be a fine, while in another state you could lose your license for doing the same thing,' says Dr. Elena Byhoff [one of the study's authors]. 'It has implications for the ability of physicians to move from state to state,' if their punishment in one state is not enough to keep a hospital or practice in another state from hiring them."

For the full story, click here.

NAMSS Payer Credentialing Roundtable Report Now Available

NAMSS has posted to our website the Payer Credentialing Roundtable Report that is a result of our discussion with industry leaders last May. Following on the success of the 2014 roundtable discussion on facility credentialing, NAMSS invited individuals from organizations across the healthcare industry to discuss the essential elements of payer credentialing. This discussion was yet another step in NAMSS’ continuing efforts to promote the important work of Medical Service Professionals (MSPs) and to bring about a better, more streamlined, more efficient credentialing system that protects patient safety.

The data elements included in the Roundtable Report were identified and vetted by NAMSS to recognize where standardization would create a more efficient and effective credentialing process. NAMSS’ assessment included a thorough review of the current credentialing system to identify efficiencies and deficiencies.

Beginning with another Roundtable discussion in May 2016, NAMSS will continue to engage its industry partners and lead the way toward a better credentialing system. This May’s Roundtable will focus on both the Model Credentialing Application developed by NAMSS as well as additional credentialing process reforms.

The Application is a comprehensive document based on best practices, which will also bring greater uniformity and simplicity to the credentialing system. Created by a task force of MSPs with subject matter expertise, and reviewed by multiple industry partners and state leaders across the country, the Application will alleviate the burden placed on practitioners and MSPs in completing and reviewing multiple, often duplicative, applications.

In addition to the Application, the Roundtable will provide a forum for NAMSS’ industry partners to collaborate on creative solutions to many of the other process deficiencies that inhibit the safe, quick and effective credentialing of healthcare practitioners.

NAMSS is proud to represent its more than 5,000 MSP members across the country in these important efforts. As the gatekeepers of patient safety and the beginning of the revenue cycle, MSPs remain crucial to moving the credentialing system into the 21^st century.

If you have any questions or would like to request further information regarding the Payer Credentialing Roundtable Report, please email David Tyson, NAMSS’ Government Relations Coordinator, at dtyson@namss.org.

CMS/AHIP Release Physician Quality Rating Measures

As reported by Amy Goldstein of The Washington Post, the Centers for Medicare and Medicaid Services (CMS) and America’s Health Insurance Plans (AHIP) have reached an agreement on quality ratings for physicians. As both public and private payers continue to increasingly link physician payments to value and quality rather than volume, these measures are meant to assist payers in quantifying a physician’s quality of care and treatment. For the full story from the Washington Post, please click here.

REUTERS: 1% of U.S. Docs Responsible for 1/3 of Malpractice Payments

In an article released on January 27, Gene Emery of Reuters writes that a large portion of the malpractice claims that result in payments to patients are caused by a small fraction of doctors in the United States.

Key Facts:

• "Almost one third of the cases were sparked by a patient's death. About 1 percent of physicians had at least two paid claims against them and those doctors accounted for 32 percent of paid claims."
• "One hundred twenty six doctors had more than five paid claims against them."
• "The median payment among all claims was nearly $205,000."
• "Doctors who accumulated two lawsuits where money was paid out were twice as likely to be successfully sued for malpractice a third time compared to doctors who only had one paid claim against them. Doctors with more than five paid claims were 12 times more likely to face a subsequent claim."
• "Compared to general practitioners, recurrence rates were roughly two times higher in the fields of obstetrics and gynecology, orthopedic surgery, plastic surgery and general surgery. The recurrence rate was highest for neurosurgeons, at 2.3 times that of GPs."
• "They found that physicians under age 35 were two thirds less likely to have to pay on a malpractice claim after an initial payment." 
• "The odds of paying out on a subsequent claim were 38 percent higher among male doctors than female physicians." 
• "Doctors trained outside the United States were 12 percent more likely to have to pay out on more than one claim."

Mr. Emery derived these statistics from an article published by Dr. David Studdert et al. in The New England Journal of Medicine, titled "Prevalence and Characteristics of Physicians Prone to Malpractice Claims."

New CMS Regulations Target Health Insurer Provider Directory Inaccuracies

As reported by Melinda Beck of the Wall Street Journal, health insurers may now face significant penalties under new regulations from the Centers for Medicare and Medicaid Services (CMS) for inaccuracies in their provider directories.

With the advent of these new regulations, health insurers may face fines “up to $25,000 per beneficiary for errors in Medicare Advantage plan directories and up to $100 per beneficiary for errors in plans sold on the federally run exchanges in 37 states,” writes Beck.

These new regulations are in response to the problem of patients being unable to identify in-network providers due to directory inaccuracies. This can result in unforeseen high out-of-pocket costs for patients.

Directory inaccuracies arise, and have become so widespread, because of frequent changes in provider information. As Beck writes, “Keeping directories up-to-date is difficult in part because relationships between doctors and hospitals are complex and frequently changing. Many physicians see patients in multiple locations and may be in different insurance networks at each one. According to LexisNexis Risk Solutions data, 30% of U.S. doctors change affiliations every year.”

CMS’ new regulations call for insurers to update their directories by contacting providers on a quarterly basis to verify information.

For more information, access the full WSJ article here.

After Successful 2015, Looking Forward to 2016!

For the first time in the association's history, NAMSS has surpassed 5,500 members in 2015, representing a nearly 15% increase in membership since 2011! The continued growth and success of our organization is due to the tireless efforts of our dedicated staff, as well as the unparalleled commitment of our members across the country. Not only do the Medical Service Professionals who comprise the NAMSS membership serve as the gatekeepers for patient safety at their hospitals, health systems, and other medical organizations nationwide, they also serve as critical and irreplaceable ambassadors for NAMSS.

A great debt of gratitude is also owed to our current president, Linda Waldorf, for her steady and competent leadership over this past year. Growth-oriented and ever strategic, we will continue to rely on her expertise and passion in the future.

Thank you to all who have contributed to NAMSS's success in 2015. We look forward to an exciting 2016! Happy New Year!

Burnout and Depression an Increasing Issue for Physicians

Two new studies out this week show that depression and professional burnout are becoming more common among America’s new, young doctors. According to the Washington Post, the first of these studies - published in the Journal of the American Medical Association - found that “nearly one third of doctors in the early stages of their careers screened positive for depression or had symptoms during their medical training.”

New physicians are particularly susceptible to depression in the years spent in internship and residency immediately following medical school due to long hours and taxing personal, physical and professional demands. One of the study’s authors, Dr. Douglas Mata, also attributed the rise in depression to the fact that many new physicians spend “40 to 50 percent of their time on the computer” completing clerical tasks, affording them fewer opportunities for rewarding and enriching clinical experiences.

“The implications for patients also are important. Depression among residents has been linked to poor-quality care and increased medical errors,” the Washington Post states.

The second study, conducted by researchers at the Mayo Clinic, found that burnout is also an increasingly prevalent issue among doctors, with over 50% of physicians reporting that they “felt emotionally exhausted and ineffective” or that “work was less meaningful,” according to the Washington Post.