NPDB-HIPDB News: Enhancements Simplify Multiple Data Bank Processes

Enhancements Simplify Multiple Data Bank Processes
On January 23, 2012, the Data Bank will introduce a number of enhancements aimed at streamlining processes for many Data Bank reporters and queriers, including State Licensing and Certification Agencies and Data Bank Administrators who are responsible for registering their organizations. The changes, summarized below, have the potential to benefit a large segment of the Data Bank community.

Report Forwarding to State Boards
One of the main new features coming to the Data Bank in January will eliminate the need for reporters to mail a copy of Data Bank reports to their relevant State Licensing Board. Reporters of Medical Malpractice Payments, Clinical Privilege, and Professional Society actions must print and mail a copy of the report to the appropriate State agency. Now, the Data Bank will make it easier for reporting organizations to comply with this requirement by enabling them to transmit reports electronically to State Licensing Boards that opt to participate in the new feature.

The automatic report forwarding option requires dual authorization-first by State Boards that must elect to participate, and subsequently by reporters at the time they submit each report. Electronic forwarding will not occur unless both sides agree to the exchange. To take advantage of this feature, each State Board that opts for report forwarding will verify the health care practitioner types they license or certify and agree to receive the reports electronically. Refer to the new State Board Profile page in Figure 1. Reporting organizations will choose to electronically forward their reports to the relevant agency on a report-by-report basis. Electronic report forwarding facilitates compliance with the law, and reporters who take advantage of it no longer need to remember to print and mail paper reports to State Boards.

In cases where a State Board declines to participate, or if a reporting organization prefers not to use the new feature for submitting a report, reporters remain responsible for sending a copy of the Report Verification Document to the appropriate State Board. The new service will be available initially through the Integrated Querying and Reporting System (IQRS). All State Boards will have a new State Board Profile button on the Administrator Options page, where they may enroll in the service, withdraw their agreement to participate, or modify their profile at any time.

Figure 1 State Boards must select the practitioner categories they license or certify when they first set up their profiles. This measure is designed to prevent inadvertent disclosures to the wrong licensing agency.
Please refer to the link below to access Figure 1

After a report is forwarded electronically, both the reporter and the Board will receive a Notice of Action via email and Data Bank correspondence, notifying them that a report was filed. Another email will notify the reporter when the report is viewed, or if a State Board fails to view a report within 7 days. Figure 2 depicts in more detail how the report forwarding process works. Several mechanisms will help track activity among electronically forwarded reports: The Historical Report Selection page may be used to find reports that have been electronically transmitted to State Boards; and the monthly Data Bank summary email for both reporters and State Boards will include information about the number of reports forwarded electronically and whether the reports were viewed. Use of this convenient report forwarding feature will require less manual work and enable the sending and receiving of required reports more quickly.

Figure 2. State Boards and reporting organizations may elect to use the new report forwarding feature. The process is outlined above.
Please refer to the link below to access Figure 2

Registration Enhancements
Another important enhancement taking place in January is a more intuitive entity registration process. This enhancement will simplify an entity's determination of its statutory authority by having the entity answer a few straightforward questions about its organization. As organizations re-register, they also will be able to select additional primary functions to more accurately describe their organizations.

Professional School Report Fields
The professional school report field will be expanded to include schools for chiropractors as well as the existing physician occupations.

Eliminate Mailing of Paper Reports
The Data Bank will begin transitioning toward more reliance on online report change notices instead of sending paper copies by mail. Since 2008, organizations have received report change notices via paper as well as electronically. Most organizations view these notices electronically but have not explicitly opted out of the paper copy, so the January enhancement will complete the transition to on-line report viewing. Organizations that have never reviewed a report change notice online will be given instructions on how to do so and over time they, too, will transition to electronic viewing. Report subjects who currently receive a paper Subject Notification Document will receive instructions on how to view the report online through the Report Response Service. This will not only help protect personally identifiable information by reducing the amount of sensitive information that is sent by mail service, but it also will reduce the amount of paper we print by about 50 percent. Be sure to take advantage of these new features as they become available on January 23rd.

Health Care Reform Law Will Streamline Data Bank Operations
Last year's health care reform law, the Patient Protection and Affordable Care Act of 2010, included a provision to streamline Data Bank operations. Section 6403 of the Affordable Care Act was designed to eliminate duplicative data reporting and access requirements between the National Practitioner Data Bank (NPDB) and the Healthcare Integrity and Protection Data Bank (HIPDB). The statute requires the Secretary of the U.S. Department of Health and Human Services (HHS) to establish a transition period to transfer all data in the HIPDB to the NPDB and, once completed, to cease HIPDB operations. Information previously collected and disclosed through the HIPDB will then be collected and disclosed through the NPDB. The statute's intent is to transition HIPDB operations to the NPDB while maintaining reporting and querying requirements. HHS is drafting a Notice of Proposed Rulemaking to implement Section 6403 and anticipates its publication in the Federal Register in the near future.

Security in Review: Exercising Vigilance
Security is a continuous, high-priority activity at the Data Bank, and in recent years we have implemented an exceptional number and variety of improvements. Some security enhancements were highly visible to Data Bank users, while others may not have been generally obvious. Recent initiatives have included encrypting personally identifiable information, masking data, strengthening password protocols, requiring challenge questions, introducing secure messaging, and changing the way entities and users register with the Data Bank by implementing e-authentication.

There are numerous categories of security threats that all information systems must address to safeguard their information assets. In today's technological environment, the Data Bank is susceptible to a variety of threats, including:

- Identity threats leading to fraudulent access.
- Risk of data corruption.
- Improper data disclosure.
- Physical storage safety.

As technology evolves, the risks to information systems become more sophisticated and more numerous. Data Bank security initiatives reflect an ongoing commitment to confront these challenges promptly and thoroughly by following security standards and guidelines prescribed by the National Institute of Standards and Technology (NIST). For the Federal Government especially, adherence to NIST standards is compulsory and provides the foundation for an effective security policy.

NIST may issue any number of recommendations in a given year. As each new standard is published, the Data Bank must determine how best to incorporate these requirements into the framework of its system architecture, while taking into account its own requirements for meeting the needs of Data Bank users. The ongoing reassessment of security is a process that entails a great deal of planning and preparation, and often the renegotiation of priorities. In essence, security is a constant balancing act between risk and usability, with the ultimate goal of ensuring the safety of Data Bank information.

As we begin a new year, the Data Bank urges its users to review their work areas where threats may exist, from safeguarding physical assets at workplaces to restricting access where and when it is needed. As technology advances, the need for security will remain a challenge that requires continuing vigilance. Safe practices result in secure data, and the entire Data Bank community plays an important role in bringing that about.

Reporting Responsibilities for Health Plans
Health plans exercise an enormous influence on the delivery of health care in the United States. By reporting to the Data Bank, health plans help to protect patients from incompetent practitioners and to stop fraudulent health care practices. The Healthcare Integrity and Protection Data Bank (HIPDB) defines a "health plan" as a plan, program, or organization that provides health benefits, whether directly through insurance, through reimbursement, or otherwise. Examples of health plans include health maintenance organizations, third party administrators, and health insurance companies.

Health plans are required to report to the HIPDB and, in some cases, the National Practitioner Data Bank (NPDB). This article provides a brief overview of the dual eligibility requirements for health plans and their associated reporting responsibilities.

HIPDB Reporting Requirements
HIPDB regulations specify two types of final adverse actions that health plans must report: health care-related civil judgments and "other adjudicated actions or decisions." These actions must be reported to the Data Bank within 30 days of the action being taken. Table 1 describes each HIPDB reporting requirement, identifies the type of Data Bank report that a health plan would use to submit information about an action, and provides examples of reportable actions.

NPDB Reporting Requirements
The NPDB definition of a "health care entity" includes organizations that provide health care services and have a formal peer review process to further quality health care. The phrase "provides health care services" means the delivery of health care services through any of a broad array of coverage arrangements or other relationships with practitioners, either by employing them directly or through contractual or other arrangements. The definition, therefore, may include a range of managed care organizations or other types of health plans.
Health care entities are required to report adverse clinical privileges and panel membership actions to the NPDB within 30 days of the action being taken. Table 2 lists the specific NPDB reporting requirements for health plans that are "Health Care Entities." In addition, any entity, including a health plan that makes medical malpractice payments for the benefit of a health care practitioner, must report those payments to the NPDB.

Table 1. HIPDB Reporting Requirements for Health Plans
Please refer to the link below to access Table 1.

http://www.npdb-hipdb.hrsa.gov/news/newsletters/jan2012Newsletter.jsp#User

The Joint Commission issues Sentinel Event Alert on Health Care Worker Fatigue

December 14, 2011

Today, The Joint Commission issued a new Sentinel Event Alert: Health care worker fatigue and patient safety. The Alert urges greater attention to preventing fatigue among health care workers and suggests specific actions for health care organizations to mitigate the risks. An article in the November 2007 issue of The Joint Commission Journal on Quality and Patient Safety reported that nurses who work more than 12-hour shifts and residents working recurrent 24-hour shifts were involved in three times more fatigue-related preventable adverse events. In addition, health care professionals who work long hours are at greater risk of injuring themselves on the job.

The Alert addresses the effects and risks of an extended work day and of cumulative days of extended work hours. The Joint Commission Alert recommends that health care organizations:

• Assess fatigue-related risks such as off-shift hours, consecutive shift work and staffing levels.
• Examine processes when patients are handed off or transitioned from one caregiver to another, a time of risk that is compounded by fatigue.
• Seek staff input on how to design work schedules that minimize the potential for fatigue and provide opportunities for staff to express concerns about fatigue.
• Create and implement a fatigue management plan that includes scientific strategies for fighting fatigue such as engaging in conversation, physical activity, strategic caffeine consumption and short naps.
• Educate staff about good sleep habits and the effects of fatigue on patient safety.

The Joint Commission also suggests that health care organizations encourage teamwork as a strategy to support staff who work extended work shifts or hours. For example, use a system of independent second checks for critical tasks or complex patients. Also, organizations should consider fatigue as a potentially contributing factor when reviewing all adverse events, and educate employees on the importance of good sleep habits, including ensuring their rest environment.

http://www.jointcommission.org/assets/1/18/SEA_48.pdf

The Joint Commission Posts Final Telemedicine Requirements

December 14, 2011

Final revisions to requirements related to the credentialing and privileging of telemedicine practitioners in hospitals and critical access hospitals.
Standards LD.04.03.09, MS.13.01.01, and MS.01.01.01

Prepublication Standards – effective immediately:
http://www.jointcommission.org/assets/1/6/PrePub_20111209_Telemedicine_HAP.pdf

URAC's revised standards to five accreditation programs

“URAC's Health Network standards have been revised to elaborate on the provider relations program, and to provide clarification on the credentialing phase-in process for Health Networks. Additionally, these standards as well as the Provider Credentialing standards now allow for delegation oversight of the credentialing process to occur remotely. Further revisions to the Provider Credentialing program increased patient protection by requiring procedures that prevent a provider from being listed in a provider directory prior to being credentialed. Requirements for primary source verification of licensure were also clarified.”

More details can be found at the following link:

https://www.urac.org/press/cmsDocument.aspx?id=772

The Joint Commission: Standard IC.02.04.01 Influenza Vaccination for Licensed Independent Practitioners and Staff

December 2, 2011

This voice recorded slide presentation below focuses on revised Standard IC.02.04.01 Influenza Vaccination for Licensed Independent Practitioners and Staff, for Critical Access Hospitals, Hospitals and Long Term Care accreditation programs. This revised standard will go into effect on July 1, 2012. During the presentation each of the nine elements of performance will be reviewed.


http://influenza.s3.amazonaws.com/start.html

Additional Resources:

http://www.jointcommission.org/influenza_vaccination_prepublication/

http://www.jointcommission.org/assets/1/6/JC_influenza_myths.pdf

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 <http://r20.rs6.net/tn.jsp?llr=hwcha7cab&et=1108718706510&s=58973&e=001g2oSgZFU93v1ai9HlLaO2mIgMS5hkJT0rona2CRTraw80uXv3FJfo-jnFwSusjzolX_zRQI_VK65KAWjXgBCx4myHPCIwUYRpBd0YgxNo5AVYgntZ6eVsaNZFP5ptcBBADtA-Z3yP-uTATrMx0a6rw>


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 www.ncqa.org <http://r20.rs6.net/tn.jsp?llr=hwcha7cab&et=1108718706510&s=58973&e=001g2oSgZFU93tvrB2YUyfxsPYKLBElWqyT8ZNKvF29iLOd-NrAlP3YT8MRGpJe-eDIC8RL4GN83j-C7acHnfFjE5dVXB75o-LYFwEbQ2kmBfI> or contact NCQA Customer Support at 888-275-7585.

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: http://op.bna.com/hl.nsf/r?Open=mapi-8nmlb9.

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.

http://www.jointcommission.org/standards_information/jcfaqdetails.aspx?StandardsFAQChapterId=79&StandardsFAQId=401

NEWS FROM THE JOINT COMMISSION

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.

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!

Remember the Kadlec Case?

Although Lakeview Medical Center was dropped from the case, the courts found the physician who wrote the glowing reference for Dr. Berry, guilty of engaging in negligent misrepresentation with a 8.2 million dollar penalty. Read the full story below.

Our thanks to the MSSP Yahoo Group for forwarding us this story!

http://www.outpatientsurgery.net/news/2011/10/20-Anesthesiologist-Pays-8-2M-for-Praising-Error-Prone-Colleague

CMS Recognizes The Joint Commission's Critical Access Hospital Accreditation

Elizabeth Eaken Zhani October 19, 2011


The Department of Health and Human Services’ Centers for Medicare & Medicaid Services (CMS) has again granted The Joint Commission deeming authority for the accreditation of critical access hospitals.

The CMS designation means that critical access hospitals accredited by The Joint Commission may choose to be “deemed” as meeting Medicare and Medicaid certification requirements. CMS found that The Joint Commission’s standards for critical access hospitals meet or exceed those established by the Medicare and Medicaid program. CMS’ notice of approval, which was published September 23 in the Federal Register, becomes effective November 21, 2011 and runs through November 21, 2017.

“The Joint Commission is pleased to once again receive this recognition for its accreditation of critical access hospitals, which are vital to the health of Americans, especially residents of rural areas,” says Mark R. Chassin, M.D., FACP, M.P.P., M.P.H., president, The Joint Commission. “This public-private collaboration between CMS and The Joint Commission creates the necessary quality and safety oversight framework for these hospitals.”

Critical access hospitals have no more than 25 acute care beds and have an annual average length of stay per patient of 96 hours. These hospitals, which are typically located more than 35 miles from another hospital, receive cost-based reimbursement from Medicare.

Accreditation is voluntary and seeking deemed status through accreditation is an option, not a requirement. Organizations seeking Medicare approval may choose to be surveyed either by an accrediting body, such as The Joint Commission, or by state surveyors on behalf of CMS. All deemed status surveys are unannounced.

In addition to critical access hospitals, The Joint Commission has federal deeming authority for advanced diagnostic imaging, ambulatory surgery centers, clinical laboratories, durable medical equipment suppliers, home health, hospice, hospitals and psychiatric hospitals.




http://www.pwrnewmedia.com/2011/joint_commission/cah_deeming/

NPDB Posts New Data on Reporting Compliance Status of Government Agencies

This is National Healthcare Quality Week. Please join me in wishing our Healthcare Quality Professionals a Happy Week and Thank them for all they do!

Quality and patient safety professionals are an integral part of the success of today’s modern healthcare system. They impact every aspect of the healthcare process in facilities large and small, from major metropolitan health centers to local long-term care facilities.

A quality professional addresses many issues in the healthcare workplace:

• medication reconciliation
• mortality and incident rate reduction
• risk management
• core measures
• patient safety
• quality management
• quality improvement.

Healthcare quality professionals ensure their facility meets specific requirements set forth by accrediting bodies for healthcare organizations and programs, such as The Joint Commission and Centers for Medicare & Medicaid Services.

http://www.npdb-hipdb.hrsa.gov/news/reportingCompliance.jsp.

CMS releases proposed Hospital CoPs

Below are the proposed rules published by the Centers for Medicare and Medicaid Services’ (CMS’) in line with their commitment to the general principles of the President’s Executive Order 13563, released January 18, 2011, entitled “Improving Regulation and Regulatory Review.” In these proposed rule CMS seeks to reduce the regulatory burden placed on hospitals by identifying a number of existing hospital CoPs that they believe could be reformed, simplified, or eliminated in order to reduce unnecessary burden and costs placed on hospitals and critical access hospitals (CAHs) under existing regulations. These revisions are open for comment. Please see the first few pages of the document which lists authorized means to submit comment and the deadline to do so.

Some points of interest are:

Governing Body
Revise and clarify the governing body requirement to reflect current hospital organizational structure whereby multi-hospital systems have integrated their governing body functions to oversee care in a more efficient and effective manner. Specifically, CMS proposes to revise §482.12 to state that “There must be an effective governing body that is legally responsible for the conduct of the hospital.”

Medical Staff Organization
Proposing changes to the more direct responsibilities for the organization and accountability of the medical staff. Presently, the hospital may assign these management tasks to either an individual doctor of medicine or osteopathy or, when permitted by State law of the State in which the hospital is located, a doctor of dental surgery or dental medicine. CMS proposes to expand the list to include doctors of podiatric medicine (DPMs). This change would permit a podiatric physician to serve as the president, or its equivalent, of a
hospital’s medical staff in a significant number of states.

CMS is seeking comments on whether their language is clear on the single organized medical staff as it currently allows for a multihospital system to have the option of a single organized medical staff responsible for the quality of medical care provided to patients by all of the hospitals in the system, however does not state it in those words. However, CMS is not sure if this is clear to stakeholders and welcomes comment.

Allied Health Professionals:
Propose to revise language to clarify that a hospital may grant privileges to both physicians and non-physicians to practice within their State scope of practice, regardless of whether they are also appointed to the hospital’s medical staff. That is, technical membership in a hospital’s medical staff would not be a prerequisite for a hospital’s governing body to grant practice privileges to practitioners.

Changes and clarifications regarding medical staff and privileging would allow hospitals to substitute and rearrange actual delivery of care. In particular, use of Advanced Practice Nurse Practitioners (APRNs) and Physician Assistants (PAs) in lieu of higher-paid physicians could provide immediate savings to hospitals. CMS welcomes comments on their saving assumptions which are outlined in the full text.

http://www.ofr.gov/OFRUpload/OFRData/2011-27175_PI.pdf

ABMS Now Publicly Reports Physicians' Status of Meeting Maintenance of Certification Program Requirements

Lori Boukas, October 11, 2011

The American Board of Medical Specialties (ABMS) announced today that it has begun reporting publicly whether physicians who are Board Certified by one or more of the 24 ABMS Member Boards are meeting the ABMS Maintenance of Certification® (ABMS MOC®) program requirements established by their certifying Board(s). The public reporting initiative is being rolled out during the next year beginning with seven Member Boards, including the American Board of Dermatology, American Board of Family Medicine, American Board of Nuclear Medicine, American Board of Otolaryngology, American Board of Physical Medicine and Rehabilitation, American Board of Plastic Surgery and American Board of Surgery. The remaining 17 Member Boards will make the MOC status of their Board Certified physicians available in August 2012 or sooner.

Some Member Boards have already been reporting the MOC status of their Board Certified physicians in alternate formats. For the first time, however, ABMS will serve as the central repository for the MOC status of physicians from all 24 ABMS Member Boards, which will be reported publicly in the same format. The MOC status of physicians Board Certified by an ABMS Member Board(s) will also be displayed by ABMS licensees, official display agents and on www.CertificationMatters.org.

“We’re honoring our pledge of increased transparency to the public by providing easy access to important information about individual physicians,” said Kevin B. Weiss, MD, ABMS President and CEO. “This is a significant milestone in ABMS history. The public can be confident that physicians who are meeting the requirements of the ABMS MOC program are committed to lifelong learning and ongoing self-evaluation.”

Board Certification is a voluntary process that assesses a physician’s competence in his or her specialty. To maintain their certification, physicians may participate in an ABMS MOC program, a rigorous process that continually assesses and enhances their medical knowledge, judgment, professionalism, clinical techniques and communications skills. For some ABMS Member Boards, physicians who were Board Certified before those Member Boards established their MOC programs are not required to participate in the ABMS MOC program created by their Member Board(s).

To obtain information regarding whether a specific physician is required to participate in the MOC program of his or her certifying Board(s), please contact that ABMS Member Board(s) directly.

“The ABMS MOC program is being incorporated into the credentialing process and is recognized as an important quality marker by insurers, hospitals, quality and credentialing organizations, the federal government and the public,” said Dr. Weiss. “We’re pleased to serve as the clearinghouse with the launch of the initial data from seven Member Boards, and look forward to full Member Board participation by this time next year.”

For those seven Member Boards participating in the initial rollout, the results of researching a physician’s status will show the name of the physician, the name of the ABMS Member Board(s) that certifies the physician and include a “yes” or “no” response to the question of whether the physician is meeting the MOC requirements of that Member Board(s). It will also include a link to the website of the physician’s certifying Board(s).

The types of tools and programs that physicians can use to meet the requirements of an MOC program vary by specialty. ABMS Member Boards tailor their MOC programs to the needs of their specific medical specialties.

http://abms.org/News_and_Events/Media_Newsroom/Releases/release_Announcing_PublicReportingMeetingMOC_10112011.aspx

amednews.com: 5 ways to manage your online reputation

Hello Members. Here is a good article from the AMA that affects all of us as well as your medical staffs:

5 ways to manage your online reputation
Pamela Lewis Dolan, Sept. 12, 2011

In the days of social media, negative online content could have far-reaching legs and a devastating impact on a physician unless it's managed efficiently.
By Pamela Lewis Dolan, amednews staff. Posted Sept. 12, 2011.

Even if some physicians themselves are not online, their names, comments on their style of practice, and complaints or compliments about them probably are.

All of the online content devoted to a particular physician could negatively impact his or her reputation, and subsequently his or her business, if steps aren't taken to manage that content and -- when necessary -- defend it. This is often referred to as online reputation management.

Online reputation management has become big business, as evidenced by the number of radio and online ads offering to help physicians. But physicians can manage their own reputations, help build positive ones, and prevent negative content from turning into a crisis that needs to be dealt with professionally.

As quickly as online content can spread, especially in the age of social media, experts say online reputation management should be a key component to any business plan.

"The best defense in these cases is good offense," said Scott Sobel, president of Media and Communications Strategy, a Washington-based public relations firm specializing in crisis management.

Christian Olsen, vice president of Levick Strategic Communication's digital and social media practice, said social media has changed the dynamics of reputation management, because in addition to physicians communicating with their patients, their patients are now communicating with one another on social media websites.

For most physicians, there are five simple steps they can take to manage and maintain a good reputation online. For others, managing their online reputations may require more time and expertise than they have available.

One: Google yourself
Olsen said many make the mistake of thinking that because they don't have a website or are not involved in social media they are not online. "It just means your voice is not being heard in a conversation about you," he said.

The first step in managing a reputation is knowing what there is to manage. Reputation management experts recommend that physicians conduct Google searches on themselves at least once a month, preferably more often. Things can spread quickly online, so seeing what content is there on a regular basis will help doctors stay ahead of a potential crisis. It's also a good way to see what positive things are being said about you, which you may be able to build on.

Steven Wyer, managing director of Reputation Advocate Inc. and author of the book Violated Online, said physicians should set up alerts on Google and Yahoo. These alerts work by registering keywords, such as a name, that the search engines will use to comb the Internet looking for any new mention of those keywords on blogs, websites, online forums and other sites. When it finds a new mention, it will send an email detailing where the keywords were mentioned, what was said and a link to the website.

The mistake many physicians make, however, is to not include all reasonable variations of their name in an alert, Wyer said. For example, John Smith, MD, could have several variations, including Dr. John Smith, Dr. John C. Smith, Dr. John Smith, MD, etc. Alerts for a handful of those variations should be set up.

Two: Correct mistakes and false information
The easiest places to start are websites that show up high in Google searches. Those sites are likely to be physician finder or rating sites or health plan physician finders. The sites often include wrong or outdated contact information and incomplete biographical and educational history.

Many of these sites give doctors the opportunity to edit their own profiles, which they should do by bolstering the information that is presented and highlighting positive aspects. Experts say physicians should complete their CVs by adding professional achievements such as awards and published articles. They also can use the forum to talk about their style of practice and what patients can expect from them.

The overwhelming majority of online physician reviews are positive. Dealing with false or inflammatory content can be trickier, Olsen said. How physicians handle false or misleading information on a site could make a situation worse, depending on how it's handled. They should do what they can to correct the information without being too aggressive, he said. One suggestion is to acknowledge the problem and then ask the author of the content to take things offline to find a resolution.

"Respond in public, but ... definitely don't play it out in the open," Olsen said.

Wyer said most websites have posted terms and conditions. If content on the site clearly violates those terms, a request can be made to the website's site administrator to have the information removed. The same request can be made of content that violates privacy laws or Health Insurance Portability and Accountability Act regulations. Insults are generally not violations, but Web posts that contain personal identifiable information would be considered violations.

Three: Create your own content
The best way physicians can steer conversations in the direction they want, or help hide the conversation they hope no one sees, is to start the conversation themselves. Experts say doctors can do this on many online venues: personal blogs, websites and personal social media pages, which all tend to rank high in search engine results.

If you already have done a search on yourself, you would know which sites are ranked high and need to stay high, and which sites you may want to push down in the results. Posting information on sites that generally rank high in Google searches, such as physician finder sites and LinkedIn profiles, will help push other content down in the search results. The farther down the better, as 90% of people won't go past the first page of search results and 99% won't go past page 2, said Noah Lang, director of business development for Reputation.com.

Wyer said it's important for physicians to own their own name online, starting with claiming their profiles on finder and review sites. On most physician profile sites, a link asks if you are the doctor being profiled. If you are, you can register with the site to take ownership of that listing and edit it as you see fit.

Owning your name could include buying website domains under the physician or practice name, creating social media pages and creating blogs in your name.

A misconception, Wyer said, is that all of these sites must be managed daily. If a physician wants to establish him or herself as a blogger, the goals and strategies are different. But simply populating the sites with basic information such as the doctor's bio, contact information and a link to a website, combined with the appropriate keywords and elements to ensure good placement in Google searches, doesn't require daily or even weekly maintenance.

Four: Embrace constructive criticism
Studies have found that an overwhelming majority of online reviews of physicians are positive. But even if a doctor does not achieve unanimous positive reviews, that's all right, experts said.

Sobel says having only simple and positive reviews will raise red flags. "You want to look for good but balanced comments. There will always be someone unhappy," he said. But it's important for patients to use reputable sites that rate doctors fairly.

Physicians should find a handful of rating sites they trust and direct patients to them. They can do so by having staff verbally tell patients about the sites, hang signs in the waiting room that list the Web addresses, and hand out fliers at the check-out desk.

Five: Address actionable items
Sobel said many of the things patients complain about online are things physicians can work to change immediately and publicize online.

Knowing what the "hot button issues" are among patients -- long waits, lack of response or slow responses, and leaving a message for the doctor and having someone else call them back -- and addressing those things in practice and online will go a long way toward improving your reputation. Part of managing your online reputation is managing how you come across online addressing those issues.

Lang said physicians should broadcast online when changes have been made due to complaints.

Sobel said a physician's website not only can be a source of the positive information they want patients to find but also can serve as a way to respond to negativity in a positive way.

When a physician's reputation has taken a beating, Sobel said, ignoring it and hoping it goes away is not a sound option. Besides their knowledge of medicine, physicians' reputations are their highest commodity, he said.


ADDITIONAL INFORMATION:
Think twice before taking legal action for something online
Things read online might be blatantly false and even harmful to a physician's reputation. But in most cases, taking legal action may make the situation worse.

When opinions and reviews include false information that would constitute libel or defamation, legal action might be warranted, said Craig Newman, a New York-based attorney. But he warns clients to think long and hard before filing a lawsuit or drafting a cease-and-desist letter.

Because of the many exceptions, libel and defamation are very hard to prove in a court of law. Therefore, physicians take a risk when filing a suit, bringing more attention to the matter, and not being able to prove their case.

Noah Lang, senior director of business development at Reputation.com, said it's generally better just to let things live and die. A physician could send a cease-and-desist letter, but then a blogger could post that online, only exacerbating the issue.

However, experts said legal action might be warranted -- including a call to law enforcement -- if a physician sees something threatening to family or staff members as well as the physician.

Here's what to look for in a reputation management firm
Not all reputation management firms are created equal. If a reputation management company doesn't handle things correctly, a bad situation could be made worse.

First, experts say, a good reputation management firm will have a good understanding of the physician's business. If it specializes in services for physicians specifically, the better.

Scott Sobel, president of Washington-based Media & Communications Strategies, said a good firm will have a relationship with a reputable lawyer or law firm and have some knowledge of public relations. The firm also should be familiar with First Amendment and copyright laws.

While a good firm should never talk about specifics of a prior case, it should be able to talk in general terms about the techniques it will use, such as search engine optimization, Sobel said. A firm that talks about committing some of the same actions it should be protecting clients from, such as verbal attacks, libel or defamation, also should be avoided.


http://www.ama-assn.org/amednews/2011/09/12/bisa0912.htm#top

HRSA: HIPDB to Merge with NPDB

The Division of Practitioner Data Banks (DPDB) is anticipating the merge of the Healthcare Integrity and Protection Data Bank (HIPDB) into the National Practitioner Data Bank (NPDB). The merger is planned for 2012.

Please see the following links for more information:

http://www.gpo.gov/fdsys/pkg/FR-2011-09-23/pdf/2011-24403.pdf
http://www.npdb-hipdb.hrsa.gov/resources/section1921.jsp
http://www.npdb-hipdb.hrsa.gov/resources/brochures/NewInfoNPDBUnderSection1921.pdf

HFAP Manual Updates Posted

HFAP updates standards relating to telemedicine credentialing and privileging.

ACUTE CARE
________________________________________
01.00.06 Governing Body Responsibilities – Revision of Standard
Effective Immediately

03.00.07 Telemedicine Privileging Provisions – New Standard
Effective Immediately

03.00.08 Telemedicine Privileging Provisions Through Distant Site – New Standard
Effective Immediately

03.01.09 Bylaws – Granting of Privileges – Revision of Standard
Effective Immediately


CRITICAL ACCESS
________________________________________
01.00.08 CEO Appointment – Standard Revision
Effective Immediately

05.00.14 Telemedicine Privileging Provisions Through Distant Site Hospital Agreement – New Standard
Effective Immediately

05.00.15 Telemedicine Privileging Provisions Through Distant Site Entity Agreement – New Standard
Effective Immediately

12.00.24 Diagnosis & Treatment Review – New Standard
Effective Immediately

For more information, visit HFAP's website:
http://www.hfap.org/manualupdates.aspx

NYT: Withdrawal of Database on Doctors Is Protested

DUFF WILSON -- September 15, 2011

Three journalism organizations on Thursday protested a decision by the Obama administration to remove a database of physician discipline and malpractice actions from the Web.

The National Practitioner Data Bank, created in 1986, is used by state medical boards, insurers and hospitals. The “public use file” of the data bank, with physician names and addresses deleted, has provided valuable information for many years to researchers and reporters investigating oversight of doctors, trends in disciplinary actions and malpractice awards.

On Sept. 1, responding to a complaint from Dr. Robert T. Tenny, a neurosurgeon in Kansas, the Health Resources and Services Administration, an agency of the Department of Health and Human Services, removed the public use file from its Web site, said an agency spokesman, Martin A. Kramer. The agency also wrote a reporter a letter to warn he could be liable for $11,000 or more in civil fines for violating a confidentiality provision of the federal law. Both actions outraged journalism groups.

“Reporters across the country have used the public use file to write stories that have exposed serious lapses in the oversight of doctors that have put patients at risk,” Charles Ornstein, president of the Association of Health Care Journalists and a reporter for ProPublica, an investigative newsroom, said in an interview. “Their stories have led to new legislation, additional levels of transparency in various states, and kept medical boards focused on issues of patient safety.”

Two other national journalism organizations, Investigative Reporters and Editors and the Society of Professional Journalists, joined the health reporters’ group in a letter to Mary K. Wakefield, administrator of the federal office. “If anything, the agency erred on the side of physician privacy,” they wrote.

Mr. Kramer said the agency, contacted by a doctor, had become concerned that a Kansas City reporter obtained information from the full data bank, not just its public use file.

“We have in the past sent letters like this, but it is the first time in our knowledge one has gone to a journalist,” Mr. Kramer said.

That concern and the letter, though, were made moot when the reporter explained that he had been getting information from the public use file, Mr. Kramer said. “That’s the end of that,” he said.

Nonetheless the agency is reviewing the public use file and may change it to further assure confidentiality before placing it back on the Web, he said, adding that he hoped it would be public again within six months.

“We are going to do everything we can to get the data back up in a public use file as quickly as we possibly can,” Mr. Kramer said. “We want to make sure the public, researchers and reporters have access to all the information that we can legally make available.”

Mr. Kramer said he could not speculate about how the public use file would be changed. He said the agency was still reviewing complaints made by the journalist organizations.

The Kansas City Star, despite the letter to its reporter, published its article on Sept. 3, titled, “Doctors With Histories of Alleged Malpractice Often Go Undisciplined.”

“To see whether other doctors with long malpractice payment histories are practicing in Kansas and Missouri, The Star analyzed thousands of records in the National Practitioner Data Bank,” the article said. It found 21 doctors had at least 10 malpractice payments but had never been disciplined by the states.

Mr. Ornstein said the Star reporter, Alan Bavley, like many others across the country, had performed broad research of courts, state agencies and hospital actions, “allowing them to connect the dots” to individual doctors. But he said the federal database itself did not reveal identities.

Other recent notable articles based partly on the database have appeared in The Duluth News Tribune in Minnesota and The St. Louis Post-Dispatch, which published a series last year titled, “Who Protects the Patients?”

American-Statesman: New state law bans anonymous complaints against physicians

Karen M. Cheung – September 20, 2011

Following the fallout of two Winkler County whistle-blowing nurses who lost their jobs, a new Texas law that goes into effect this month bars the Texas Medical Board from considering anonymous complaints against physicians.

Adjusting the complaint process, House Bill 680 requires the Medical Board know the identity of those persons filing complaints, including pharmaceutical companies and insurers, while keeping those identities confidential, reports the American-Statesman.

The Texas rule follows the case of two Winkler County Memorial Hospital nurses Anne Mitchell and Vickilyn Galle, who in 2009 sent an anonymous ethics complaint about physician Rolando Arafiles Jr. to the Texas Medical Board, accusing him of dangerous practices. Winkler County Sheriff Robert L. Roberts Jr. and friend to Dr. Arafiles identified the two nurses, which resulted in the nurses losing their jobs and indictment. Charges were dropped against Galle before trial, and Mitchell was found not guilty. The Medical Board put the physician on probation, and the Sheriff was found guilty of retaliation.

"Though I do not know if the Winkler County nurses would have filed their complaints if they had to attach their names, the new law would keep their names confidential," said State Rep. Donna Howard (D-Austin) in the article.

Supporters and critics of the legislation argue how widespread its effects could be. Anonymous complaints make up 4 percent of the 6,849 complaints the Texas Medical Board received last year, according to the article. Patient safety advocates say that maintaining anonymity ensures protection from retaliation, while provider supporters say banning anonymous sources ensures valid complaints.

For full article:
http://www.statesman.com/news/texas-politics/new-law-bans-anonymous-complaints-about-doctors-1865789.html

Medscape Medical News: Top Performing Hospitals Listed in Joint Commission Report

Mark Crane, September 15, 2011

Small and rural hospitals headed the list of top performing hospitals in using evidence-based processes closely linked to positive patient outcomes, according to the Joint Commission's annual report on quality and safety, Improving America's Hospitals.

The 405 hospitals identified as attaining excellence in accountability measure performance for 2010 represent approximately 14% of Joint Commission–accredited hospitals. The top performers were the most diligent in following best-practice protocols, such as giving aspirin to a person who is having a heart attack on arrival at the hospital, or the use of corticosteroids in children admitted with asthma, said the report, which was issued this week.

The nation's most highly regarded hospitals (the Mayo Clinic in Rochester, Minnesota; Johns Hopkins in Baltimore, Maryland; Massachusetts General Hospital in Boston; and the Cleveland Clinic in Ohio) were not included among the top performers. The list also did not include a single hospital in New York City or the most prominent facilities in Chicago and Houston.

Hospital performance nationwide continued to improve in using evidence-based treatments related to 22 accountability measures for heart attack, heart failure, pneumonia, surgical care, and children's asthma care.

In 2002, hospitals achieved 81.8% composite performance to perform care processes related to accountability measures. In 2010, hospitals achieved 96.6% composite performance, a 9-year improvement of almost 15 percentage points, the report found. More than 9 in 10 hospitals had scores of at least 90%, which is more than 4 times the figure of 9 years ago. The top performing hospitals all had scores of 95% or better.

"While the data across the annual report show impressive gains in hospital quality..., further improvements can still be made," Joint Commission President Mark R. Chassin, MD, MPH, said in a news release. "By following evidence-based care processes, hospitals can improve the quality of care they provide and meet national mandates regarding performance."

Hospitals had relatively low performance on providing fibrinolytic therapy within 30 minutes of arrival to patients having heart attacks (only 60.5% of hospitals achieved 90% compliance or better), and on providing antibiotics to immunocompetent intensive care unit patients with pneumonia (only 77.2% of hospitals achieved 90% compliance or better).

The list of top performers included a disproportionate share of small and rural hospitals, as well as 20 Veterans Affairs Medical Centers. "It is certainly true that larger hospitals, particularly if they are reporting on more measures than smaller hospitals, have a lot more work to do," Dr. Chassin told reporters during a conference call yesterday. "But on the other hand, they have more resources than small hospitals to do that. It may be a question of priority setting.

"I hope [the list] is both a wake-up call to the larger hospitals to put more resources into these types of programs, and a recognition that a small, rural hospital can do an excellent job," he said.

Starting in January, Joint Commission–accredited hospitals will be required to meet an 85% composite compliance target rate for performance on accountability measures. Some 121 hospitals would not pass that mark based on their 2010 scores.

"They know who they are," Dr. Chassin said. "We'll see if they have heeded the warning."

HealthLeaders Media: Overhaul of Physician Education System Recommended

Cheryl Clark, September 12, 2011


The nation's system for training physicians is in dramatic need of a complete overhaul to adequately provide future patient care, says a report from the Josiah Macy Jr. Foundation, which issued 14 recommendations to make that happen.

"Although notable changes have occurred in graduate medical education (GME) over the past decade, including the introduction of a competency-based framework and limitations on duty hours, many people feel that much broader reforms are needed to keep pace," says the 39-member panel that authored the report.

The panel, consisting of physicians and surgeons as well as medical school deans and faculty members, said the nation will be short more than 100,000 doctors by the middle of the next decade, in part because of the current system's entrenched ways of educating and assuring the quality of the physician workforce.

"Unless we in academic medicine are self-critical and show a willingness to change, the political and public support for graduate medical education will disappear," warns Macy President George Thibault, MD, in a statement. "This is a huge enterprise built on tradition, but the system has to change to be more responsive to public needs."

One of panel’s key recommendations is that medical education should shift from gauging competency by months and years of training to actual measurements of individual physicians' readiness for independent practice. This is because medical school residents "vary significantly in how quickly they achieve competency, yet the current system of training all residents for a fixed duration fails to recognize or accommodate this reality."


The panel also prioritizes its recommendation to diversify training sites from traditional teaching hospitals to federally qualified and school-based health centers "and to expand content related to professionalism, population medicine, and team-based practice.”

A third key recommendation is for educational institutions to eliminate historic boundaries so that other health provider professions can learn with their physician colleagues. "This will require revising regulations that now prevent supervision across specialties or professions," the group says.

The panel also wants to require a period of "monitored independence" during GME to confirm each physician's readiness for independent practice. "Program directors and teaching faculty express widespread concern that residents are not given sufficient opportunity to act independently within the present teaching environment and are consequently less well prepared for practice," the statement says.

The report lists four trends that make a major shift in medical training necessary:

1. New approaches to physician practice are necessary to meet the needs of an aging population, as the number of people 65 and older will double by 2020. This population will live longer with more chronic, cognitive, and functional issues and will be more racially and culturally diverse.

2. Care continues to move outside the hospital to the home, clinics, and other community settings, and care providers are assuming new roles to meet these needs. The Affordable Care Act's directives will accelerate this trend, giving 32 million more people health coverage. This influx will require trainees to be "prepared to work in different organizations and sites of care, and in teams of health professionals."


3. Trainees must enter practice trained to use new healthcare technologies safely and efficiently. "Advances in medical diagnostics, therapeutics, and information technology can significantly improve health outcomes. However, we have fallen short in consistently using technology optimally to improve the quality and efficiency of healthcare," the panel writes.

4. The next generation of physicians must help lower costs and be more efficient. "Physicians in training must understand the financial implications of their patient management decisions, and their training must include new and efficient models of care so that they will be prepared to practice cost-effective medicine and be responsible stewards of resources while providing high-quality patient care," the report says.

However, to change the graduate medical system, medical educators face many obstacles, including the growing tension between work-hour restrictions and competition for curricular time and non-educational tasks. Another important obstacle is the difficulty in persuading sufficient numbers of medical students to choose primary care.

"In the past decade, the number of residents in subspecialty training has risen five times faster than the number of residents in the core specialties (those representing primary board certification). The number of residents expected to practice primary care has declined by more than 10%," the report notes.

The panel was chaired by Debra Weinstein, MD, Massachusetts General Hospital, and Vice President for Graduate Medical Education for Partners Healthcare System, Inc.

From Samueli Institute's 2010 Complementary and Alternative Medicine Survey of Hospitals

More hospitals (42 percent) offered complementary and alternative medicine (CAM) last year than in 2007 (37 percent), according to a survey by Health Forum and the Samueli Institute. Hospitals cited patient demand (78 percent), evidence of effectiveness (74 percent), and practitioner availability (58 percent) as reasons for offering CAM services. Report (.pdf)


http://www.siib.org/news/2468-SIIB/version/default/part/AttachmentData/data/CAM%20Survey%20FINAL.pdf

Medscape.com: Board Certification Varies With Demographics, Education

Specific demographic and educational factors are associated with board certification of physicians. These include race and education debt, according to a study published in the September 7 issue of JAMA.

Certification by an American Board of Medical Specialties member board is an important credential, and it is becoming increasingly common. Previous studies have shown better outcomes in patients who are in the care of board-certified physicians, and health maintenance organizations, hospitals, and insurance plans use board certification as an evaluation tool for physicians.

Donna B. Jeffe, PhD, and Dorothy A. Andriole, MD, both from Washington University School of Medicine, St Louis, Missouri, investigated how demographic, medical school, and graduate medical education were associated with American Board of Medical Specialties board certification. They conducted a retrospective study of a national cohort of 42,440 medical students who graduated from US medical schools between 1997 and 2000. Participants were followed up through March 2, 2009.

Of the participants, 37,054 (87.3%) were board certified. The researchers found that board certification was associated with first-attempt passing scores in the highest percentile (compared with those who failed on the first attempt) on US Medical Licensing Examination Step 2 Clinical Knowledge. This trend held true in all physician categories. The lowest adjusted odds ratio (AOR) was found in emergency medicine (87.4% vs 73.6%; AOR, 1.82; 95% confidence interval [CI], 1.03 - 3.20). The highest was found for radiology (98.1% vs 74.9%; AOR, 13.19; 95% CI, 5.55 - 31.32).

Participants who self-identified as underrepresented racial/ethnic minorities had a lower likelihood of being board-certified — a trend that held for every physician category except family medicine. The percentage in pediatrics was 83.5% (vs 95.6% of whites; AOR, 0.44; 95% CI, 0.33 - 0.58). In other nongeneralist specialties, the percentage was 71.5% (vs 83.7% in whites; AOR, 0.79; 95% CI, 0.64 - 0.96).

Increased debt also had an effect. Among obstetrics/gynecology specialists, every $50,000 stepped increase in debt was associated with a lower likelihood of board certification (AOR, 0.89; 95% CI, 0.83 - 0.96) compared with those who had no debt. The reverse was true among family medicine specialists (ie, family practitioners with higher educational debt were more likely to be board certified; AOR, 1.13; 95% CI, 1.01 - 1.26).

The authors noted that the observational nature of the study makes it impossible to assign causal associations, and longer follow-up times may increase the rates of board certification. The results also cannot be applied to osteopathic physicians or students at international medical schools.

"Nevertheless, our findings can inform an understanding of factors contributing to US medical school graduates' advancement along the medical education continuum to board certification, an outcome of interest for medical school graduates, their patients, and the relevant professional organizations involved in undergraduate medical education, [graduate medical education], and board certification," the authors write.

The study was supported by the National Institutes of Health National Institute of General Medical Sciences. The authors received travel funds from the National Institutes of Health for meeting attendance. One author received an honorarium and travel reimbursement from the University of Cincinnati supporting a lecture on MD-PhD programs and their graduates.

JAMA. 2011;306:961-970.

Jim Kling, September 6, 2011

http://www.medscape.com/viewarticle/749172?sssdmh=dm1.716474&src=nldne

Alert: NIMS Guideline for the Credentialing of Personnel

The purpose of this NIMS Alert is to announce the availability of the NIMS Guideline for the Credentialing of Personnel.

The NIMS Guideline for the Credentialing of Personnel (Guideline) is now final and available for use. The Guideline provides guidance on credentialing for Federal, State, Tribal and Local Personnel, as well as for persons affiliated with Critical Infrastructure and Key Resources, voluntary and not-for-profit response organizations. This Guideline was developed with the participation of stakeholders from key sectors of our society, and builds on the doctrine established in NIMS Guide 0002 NATIONAL CREDENTIALING DEFINITION AND CRITERIA dated March 27, 2007. The Guideline addresses the full range of responders who may be called upon and need to establish their legitimacy through proof of Identity, Qualification/Affiliation and Authorization to deploy.

The Guideline and the NIMS Guide 0002 can be found at the NIMS Resource Center at the following URLs:

The Guideline - http://www.fema.gov/emergency/nims/ResourceMngmnt.shtm#item3

The NIMS Guide 0002 - http://www.fema.gov/pdf/emergency/nims/ng_0002.pdf

For more information on NIMS visit: www.fema.gov/emergency/nims

All questions can be directed to the NIC via e-mail: FEMA-NIMS@dhs.gov or via telephone: 202.646.3850.
• NIMS Alert 02-11 Guidelines for the Credentialing of Personnel.pdf

IDFPR: State Revokes Licenses of Health Care Workers Convicted of Sex Crimes or Crimes against Patients

CHICAGO – Earlier today, the Illinois Department of Financial and Professional Regulation (IDFPR) revoked the licenses of 11 health care workers who have been convicted of sex offenses or violent crimes against their patients. These revocations are required by a new law signed by Governor Quinn last month. HB 1271 (Public Act 97-0156) provides that the professional license of any health care worker who has been convicted of a sex offense or of a violent crime against their patients is permanently revoked without a hearing and further provides that sex offenders cannot be licensed as health care workers in Illinois.

“The State takes its responsibilities to protect our residents seriously,” said Brent E. Adams, Secretary of Financial and Professional Regulation. “This new law establishes tough outcomes that are intended to shield Illinois patients from health care workers who have been convicted of sex offenses and certain violent crimes.”

While many health care workers are covered by the new law, regulations will be proposed to specifically list all the types of health care workers that are covered by the law. The law also lists most of the crimes requiring permanent revocation, but regulations will be proposed to make clear all the crimes that trigger permanent revocation. These proposed regulations will be filed later this year.

Each health care worker whose license was revoked today appears below, along with the city at which he/she was licensed, and the crime that triggered the permanent revocation.

For Missouri Members: Upcoming Change in State Law

DIFP: New state law allows consumers to learn more about their physicians

Also gives state regulators more tools against dangerous doctors

Jefferson City, Mo. - Under a new state law, Missouri consumers can now learn more about the educational history of their doctors. House Bill 265, signed by Gov. Jay Nixon, took effect yesterday and allows the State Board of Registration for the Healing Arts to release extensive information about licensed doctors for the first time. The board's website now allows consumers to learn about medical and professional schools attended by physicians, as well as any specialties or board certifications.

In addition, more information will soon be available to the public: Under the law, any future information submitted to the board may be released if it pertains to discipline by another government agency or court-ordered limitations on a doctor's practice.

"This law is a significant step toward better transparency for patients in Missouri," said John M. Huff, director of the Missouri Department of Insurance, Financial Institutions and Professional Registration. "We always encourage consumers to learn as much as they can about the professionals they're doing business with, and that's especially important in a doctor-patient relationship."

House Bill 265 also gives more authority to the board to discipline doctors who violate the law. The board can now:

More effectively seek an immediate suspension of a physician's license when the board believes the doctor is a danger to patients;
Streamline the process for discipline of doctors;
Move cases more quickly through the state Administrative Hearing Commission, which conducts hearings related to the discipline of doctors; and
Discipline doctors for alcohol dependency, being on a sex offender registry or failing to cooperate with board investigations.
Consumers who would like to learn more about their physicians can use the licensee search feature on the board's website at pr.mo.gov, or they can contact the board by phone at 573-751-0098.

About the Missouri Department of Insurance, Financial Institutions & Professional Registration

The Missouri Department of Insurance, Financial Institutions and Professional Registration (DIFP) is responsible for consumer protection through the regulation of financial industries and professionals. The department's seven divisions work to enforce state regulations both efficiently and effectively while encouraging a competitive environment for industries and professions to ensure consumers have access to quality products.

August 29, 2011

H&HN: Mobile Apps That Bring Patients to Your Door

Mobile medical applications may get all the attention, but apps that effectively market your hospital to patients may be equally important

The explosion of mobile applications has been one of the biggest health IT stories of 2011, and with good reason: Mobile apps can offer hospitals and doctors portable versions of medical devices and instant access to stores of medical research. And at a time when cost pressures are forcing providers to envision a care delivery process that can serve patients with fewer inpatient interactions, mobile apps also offer a way to reach those ends.

Lately, though, I've been coming across an increasing number of examples of how hospitals are harnessing the power of mobile applications beyond the clinical setting as a way to connect with potential patients and offer them real-time, valuable information on where to go for their care in a pinch.

For instance, Baptist Health in South Florida now offers patients real-time information on wait times for physicians at its urgent care centers and emergency rooms. For its efforts, Baptist Health received a 2011 Most Wired Innovator Award, and my colleague, H&HN Senior Editor for Data and Research, Suzanna Hoppszallern, recently talked to Baptist Health's Petter Melau, the project lead for the mobile app initiative. Melau said the service has been extremely popular; within two days of the app launching, 1,000 users signed up. Melau added that the application also has helped users clarify the difference between services offered by Baptist Health's urgent care facilities and its emergency rooms, a critical distinction in an era of overcrowded EDs.

And industry momentum for mobile apps is definitely quickening. Earlier this week, Carolinas Health System, a 30-hospital system based in Charlotte announced the rollout of a new, free mobile app that allows patients to find locations, check wait times or even search for physicians via their location and specialty.

Beyond the advantages these types of mobile apps offer patients, many IT experts are convinced that if current usage trends continue, it won't be long before smart phones will supplant web-based browsers as the chief access point for online information. For H&HN Daily, for instance, roughly 20 percent of our daily readers access the publication via their phone and not a traditional browser. And on a personal level, I'm a huge fan of the mobile sites in Chicago that allow me to check train and bus times on the go. In other words, in a few years time patients will view mobile apps with real-time information not as an added amenity but as an expected service.

By Haydn Bush August 31, 2011

Medscape Medical News: Hospitals Begin to Reopen in the Aftermath of Irene

Woes Left in Hurricane's Wake Are Enormous

East Coast hospitals that had evacuated their patients before Hurricane Irene struck during the weekend have begun to admit them again as diminished winds continue to blow northward in the form of Tropical Storm Irene.

In New York City, for example, Staten Island University Hospital reopened its doors last night, as did Palisades Medical Center in North Bergen, New Jersey. However, nobody has given the all-clear sign just yet. St. Clare's Hospital in Sussex, New Jersey, is discharging or transferring 14 patients today because of a malfunctioning emergency generator, said a hospital spokesperson.

Although Irene has been downgraded from a hurricane to a tropical storm, the woes it left behind are enormous. An estimated 4.2 million homes and businesses along the Eastern seaboard lacked power as of Sunday night. Meanwhile, storm-swollen rivers continue to flood inland cities and threaten to contaminate drinking water.

Irene has been a troublemaker with a wide reach. A healthcare research company called Stratasan estimated through computer mapping technology that more than 60 million people, 135,000 physicians, and 459 hospitals lay within the storm's path.

Well Prepared

Irene did not wreak the havoc that Hurricane Katrina did in 2005, but nevertheless it caused the deaths of at least 16 individuals in 6 states, according to news accounts.

At the same time, storm-battered hospitals continued to usher in new lives. Seventeen babies were born during the weekend at New Hanover Regional Medical Center in Wilmington, North Carolina, said Stephanie Strickland, a spokesperson for the North Carolina Hospital Association.

Similar to other facilities up and down the seaboard that suffered power outages, New Hanover Regional kept its monitors and lights on thanks to an emergency generator.

Good preparation translated into good patient care during the weekend, said Donna Leusner, a spokesperson for the New Jersey Department of Health and Senior Services.

"Two weeks before the storm, coastal hospitals, the Department of Health and Senior Services, and county Offices of Emergency Management completed a hurricane exercise that really ensured that the state's plans were up to date and [that] the issues that we found in training were addressed appropriately," Ms. Leusner told Medscape Medical News.

Coping with the storm also required the best of Hippocratic spirits. Some physicians and nurses spent the weekend at East Coast hospitals, not knowing when they might be relieved.

"Many slept in rooms where their patients were housed," said Ms. Leusner.

'Priceless' Experience

At Kings County Hospital Center in Brooklyn, New York, psychiatric resident Kendra Campell, MD, curled up on a bed in a resident on-call room Saturday night.

"I got 4 or 5 hours of sleep," said Dr. Campbell. "It wasn't bad."

Dr. Campbell worked during the weekend in the psychiatric emergency department, where stressed-out patients came for shelter, medications, and a listening ear. Clinicians kept them occupied with games and art exercises. One of the attending physicians strummed an acoustic guitar to brighten the mood.

"I felt an overwhelming sense of teamwork," said Dr. Campbell.

Dr. Campbell was able to go off-duty at 5 pm on Sunday. She Tweeted her sense of relief: "Hours worked at the hospital: 33. Meals eaten out of paper bags: 3. Showers taken: 1. Walking home post-call and post-hurricane: Priceless."


Robert Lowes

American Medical News: Criminal convictions and discipline of Illinois doctors returning online

Profiles were posted on a website for a few years, but a court required the state to remove the information.

Illinois has rejoined the nation's other 49 states in making physician profiles available to the public in some form.

Disciplinary actions, criminal convictions, medical liability payments going back five years and other information on the state's physicians will be provided online by the Illinois Dept. of Financial and Professional Regulation.
A "key to good health is a great doctor, which is why we are ensuring that all of the important information needed to select a physician is online and available 24 hours a day," Illinois Gov. Pat Quinn said after signing the legislation Aug. 9.

Physician profiles went online as part of the state's 2005 comprehensive medical liability reform. But they were removed from the public eye when the Illinois Supreme Court struck down the liability reform in February 2010 because legislation included caps on noneconomic damages.

Under the new law, physicians will have the right to review the information posted about them and will be able to have inaccurate information corrected. Having the opportunity to review and correct information is a positive thing, said Illinois State Medical Society President Wayne V. Polek, MD, an anesthesiologist.

More than 30 states require background checks at licensure for health professionals. "And we encourage patients to confirm information with a physician," he said.

Dr. Polek said physicians are more comfortable with physician profiles than they were five or 10 years ago. But he said one sticking point is putting medical liability claims in the profiles.

"People are sued for a variety of reasons, and they settle for a variety of reasons. For example, an insurance company or employer says you have to [settle]. That information is not necessarily helpful to patients," Dr. Polek said.

ISMS was neutral on the Patient Right to Know Act because it was a stand-alone measure and not part of more comprehensive legislation to extend the state's Medical Practice Act, Dr. Polek said. The act, which governs the practice of medicine in Illinois, is scheduled for sunset repeal on Nov. 30.

The medical society has supported online physician profiles, including those that were part of the 2005 medical liability reform.

With the new Illinois law, all states now make some type of physician profile information available to the public in some form, said the Federation of State Medical Boards.

"We have come a long way," said FSMB President and CEO Humayun J. Chaudhry, DO. "Back in 1996, no boards had physician profiles. State boards recognize the value of physician profiles. We see Illinois as an example of this continuing trend."

How physician profiles are made public varies among states, Dr. Chaudhry said. But the trend is moving toward states making more information publicly available, he said.

Meanwhile, physicians applying for a new medical license in Indiana must pay for and complete a national criminal background check. Under a law that took effect July 1, doctors also must provide fingerprints. More than 30 states require background checks at licensure for health professionals.

Tanya Albert Henry, Posted Aug. 29, 2011.