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.

SD Circuit Court Rules Health Providers Can Be Sued Over Credentialing

According to a report by the Washington Times, a circuit court judge in South Dakota has ruled that hospitals and health providers can face lawsuits for "negligent credentialing," joining South Dakota with more than 30 other states who allow such lawsuits.

For the full story, click here.

Court Rules in Favor of Hospital's Right to Shield Medical Documents

According to a story from News 4 Jacksonville, the 1st District Court of Appeals in Florida ruled in favor of a Jacksonville hospital's right to not turn over certain medical documents in a malpractice case. Citing federal protections in the Patient Safety and Quality Improvement Act of 2005, the Court asserted that federal law took precedence over a 2004 constitutional amendment in Florida which"sought to ensure broad access to records held by hospitals and other health providers about 'adverse' medical incidents." For the full story, please click here.

HFAP Acquired by AAAHC

In a statement posted to their website, the Healthcare Facilities Accreditation Program (HFAP) announced that they are being acquired by the Accreditation Association for Ambulatory Health Care (AAAHC) effective immediately. The statement notes, "Beginning October 14, 2015, the management and operations of HFAP will be placed under the direction of the AAAHC's hospital accrediting arm, the Accreditation Association for Hospitals and Health Systems (AAHHS)." For the full statement, please click here.

Developing Issue UPDATE: CMS and Temporary Privileges

As discussed in the August 12 posting to the NAMSS Blog, CMS implied during a NAMSS webinar that the hospital governing body is the only body authorized to grant temporary privileges to practitioners. This interpretation is not standard practice and conflicts with the standards and processes put forth by the Joint Commission, Healthcare Facilities Accreditation Program (HFAP), and other CMS-approved accrediting bodies that have long been viewed as being compliant with CMS’ Conditions of Participation (CoP). In response, NAMSS provided comments to CMS urging a reconsideration of this recent interpretation and the continuation of the current national practice of granting temporary privileges in order to ensure that healthcare entities are able to provide timely patient care (click here for the letter). CMS has provided a response to NAMSS, stating they will be “evaluating methods to address how hospitals can meet their need to grant privileges between regularly scheduled governing body meetings, and, at the same time, continue to comply with the Medicare hospital CoP” (click here for the letter). Stay tuned to the NAMSS Blog for updates as we learn more from CMS.

ABIM Reverses Policy on MOC Enrollment and Certification Status

Last month, after receiving feedback from multiple industry stakeholders and medical societies, the American Board of Internal Medicine (ABIM) released a statement reversing changes made to its Maintenance of Certification (MOC) program. In the statement, Dr. Richard Baron - President and CEO of ABIM - asserted:

"Effective immediately, diplomates who are meeting all other programmatic requirements will not lose certification simply for failure to enroll in MOC.

What does this mean for diplomates?

Diplomates who lost certification solely on the basis of failure to enroll in MOC or to pay MOC fees have now had their certification status updated to “Certified.” There is no further action they need to take.

Diplomates who wish to be reported as “Participating in MOC” must be enrolled in the MOC program, be current with their payments and be meeting ongoing program requirements.

Diplomates who earned initial certification since 2013 or renewed certification since 2014 who no longer wish to be enrolled in MOC this year as a result of this policy change may be eligible for a refund of their 2015 MOC enrollment fee(s). Please note that if ABIM provides a refund, MOC enrollment will be canceled, the physician’s status will be reported on abim.org and to the American Board of Medical Specialties (ABMS) as “Certified, Not Participating in MOC”, and the physician will no longer have access to ABIM activities or their MOC Status Report, which gives them their specific requirements and deadlines.

Diplomates must still meet 5 and 10 year MOC program milestones to maintain their certification."

For the full statement from Dr. Baron, please click here.

Developing Issue: CMS and Temporary Privileges

Recently, during a NAMSS hosted webinar, CMS officials specified that in compliance with CMS’ Conditions of Participation, only the hospital governing body can grant privileges and that the process for granting temporary privileges must be the same as the process for credentialing and granting of full hospital privileges. This is in contrast to standards put forth by The Joint Commission (TJC), Healthcare Facilities Accreditation Program (HFAP), and other accrediting bodies.

NAMSS is working to attain clarification on this significant change in CMS’ interpretation of the Conditions of Participation and will be working with our industry partners to address this change. As NAMSS obtains additional information, we will update our members via the NAMSS Blog so please stay tuned.

Health Care Consolidation Continues as Anthem Looks to Merge with Cigna

Following the merger of Aetna and Humana earlier in the month, Anthem announced in late July that it would acquire Cigna. This constitutes one of the largest health insurance mergers and will have ramifications across the health care industry. As reported by the New York Times, "Together, Anthem, which runs Blue Cross plans in 14 states, and Cigna, which offers insurance plans through employers, would have around $115 billion in revenue. Cigna also has 24 million behavioral health customers, nearly 14 million dental care members, eight million pharmacy benefit plan members and 1.5 million Medicare Part D pharmacy customers." (Click here for the full New York Times article)

Insurance companies have cited the need to cut costs and increase access to broad networks as the reasons behind such mergers. However, the Anthem-Cigna merger, coming so close on the heels of other major health insurance industry mergers, faces potential regulatory challenges. For a full description of these potential hurdles, please click here for another helpful article from the New York Times.

Iowa Joins 9 Other States in Enacting the FSMB Interstate Medical Licensure Compact

Following Alabama, Idaho, Minnesota, Montana, Nevada, South Dakota, Utah, West Virginia, and Wyoming, Iowa enacted the Interstate Medical Licensure Compact earlier this month. The legislation was signed into law by Governor Terry Branstad and received endorsements from the Iowa Board of Medicine, the Iowa Academy of Family Physicians, the Iowa Hospital Association, the Iowa Medical Society, and others.

According to a press release by the FSMB, "The final model Interstate Medical Licensure Compact legislation was released in September 2014. Since then, 19 state legislatures have introduced the Compact legislation and nearly 30 state medical and osteopathic boards have publicly expressed support for the Compact. The Compact has been endorsed by a broad coalition of health care stakeholders, including the American Medical Association (AMA)."

For the full release, please click here.

Doctors Coming Back after a Break from Practice

From a Report by Anna Gorman in Kaiser Health News:

"Like many professionals, physicians take time off to raise children, care for sick family members or to recover from their own illnesses. Some want to return from retirement or switch from non-clinical jobs back to seeing patients. But picking up where they left off is more difficult in medicine than in most careers.

In medicine, change occurs quickly. Drugs, devices and surgical techniques that were standard a decade ago may now be obsolete. Or a returning doctor’s skills may simply be rusty...

After extended leaves, doctors must convince medical boards to reissue their licenses, hospitals to grant admitting privileges and malpractice insurers to provide coverage. Only a handful of programs around the country are set up to help physicians brush up on their skills, and they can cost doctors thousands of dollars."

For the full story, click here.

Register Today for NAMSS' 39th Educational Conference and Exhibition

Join NAMSS in Seattle, Washington for the 39th Educational Conference and Exhibition, October 3 to 7, 2015. This year’s educational conference will feature more than 30 sessions, giving you the freedom to choose your own educational pathway.

This year, we are excited to offer four unique tracks centered around Embracing Change: A Journey of Leadership, allowing you to pick sessions that are most important to you! This year’s tracks include:

• Professional Development
• Credentialing and Privileging
• Executive Leadership
• Legal

Arriving to Seattle before the official start to the conference? Attend one of our Pre-Conference Workshops and take advantage of this great way to help you prepare for your upcoming CPCS or CPMSM exam. Along with the educational offerings, network with your peers and create new relationships with other members in the industry. While interacting with your peers, be sure to meet with innovative and leading exhibitors who will showcase the latest technology and services within the field.

Register on or before Friday, July 24 for early bird savings on your conference registration! Not a NAMSS member? Join now to receive additional savings of up to $150!

The Sheraton Seattle Hotel is the headquarters hotel for the NAMSS 39th Educational Conference & Exhibition. NAMSS has secured a discounted rate of $199 per night for a single or double room. Both the Washington State Convention Center (where all conference events will be convening) and the Sheraton Seattle Hotel are a short walk away from a variety of shops as well as the famous Pike Place Market. The hotel reservation cut-off date is September 10, 2015.

NAMSS 2015 Payer Credentialing Standards Roundtable A Success

On May 7, 2015, the National Association Medical Staff Services (NAMSS) held the 2015 Payer Credentialing Standards Roundtable at the Gaylord National Resort in National Harbor, MD. NAMSS brought together thought leaders from across the health care industry to discuss essential common practices for practitioner credentialing with payer organizations. These practices can be utilized to improve both credentialing efficiency and patient safety.

Credentialing is the gateway to patient safety. Preventable adverse events in healthcare kill 200,000 to 400,000 Americans annually, making them the third leading cause of death in the United States. Some of these deaths could be avoided if the healthcare system could better identify unqualified healthcare practitioners through the credentialing process. Industry collaboration is essential to realize a credentialing system that reduces costs, streamlines the process, and – ultimately – protects patients. That is why NAMSS convened this important Roundtable discussion.

In May 2014, NAMSS also assembled the Ideal Credentialing Standards (ICS) Roundtable to discuss essential common practices for provider credentialing at medical facilities. By working collaboratively with participants from both the 2014 and 2015 Roundtables, NAMSS hopes to create a better, more efficient credentialing system that best serves patients.

Physician Credentialing and Technological Advancement

As Health Leaders Media reports, a commentary recently published in the Journal of the American Medical Association (JAMA) highlights the ever-evolving relationship between physician credentialing and technology. In the words of one of the University of Michigan researchers who co-authored the JAMA commentary, "As surgical innovations continue to emerge, and as pressures from patients and hospital administrators to be on the cutting edge of technology continue to increase, strengthening hospitals' credentialing and privileging for new procedures should be a high-yield target for improving patient safety." For the full report from HLM, please click here.

House Bill to Repeal SGR Physician Payment Formula Also Addresses Telehealth

The nearly $200 billion Medicare legislation to repeal the Sustainable Growth Rate (SGR) physician payment formula includes several other significant provisions, among them three that address telehealth. The House of Representatives passed the bill on March 26 by an overwhelming majority and sent it to the Senate, where it will be addressed following Congress's return from their spring recess on Monday, April 13. To learn more about the telehealth provisions in this bill, please click here for a summary in the National Law Review.

NCQA Seeks Public Comments on Changes to Its Health Plan Accreditation by APRIL 8

NCQA is asking for interested parties to submit comments regarding proposed changes to its Health Plan Accreditation (HPA) by 5:00 PM EST on Wednesday, April 8, 2015.

From NCQA:

"NCQA is releasing proposed changes to Health Plan Accreditation for public comment, including:

• Developing a more comprehensive assessment of network adequacy and provider directory accuracy by updating existing requirements and adding new requirements in a new category of standards: Network Management. 
• Including new requirements to strengthen NCQA’s ability to detect systematic issues related to Utilization Management. 
• Simplifying scoring for file review elements in HPA and other accreditation/certification products that contain these elements. 

In addition to HPA standards updates, NCQA proposes policy changes to the following programs:

• Managed Behavioral Healthcare Organization Accreditation (MBHO) 
• Wellness and Health Promotion Accreditation (WHP) 
• Credentials Verification Organization Certification (CVO) 
• Health Information Products Certification (HIP) 
• Utilization Management and Credentialing Certification (UM/CR)" 

Please click HERE for more information on the proposed changes and instructions for submitting comments.

CAQH Announces Updates: UPD to CAQH ProView™ Transition

From CAQH:

CAQH ProView, the next generation of the Universal Provider Datasource® (UPD), recently launched on March 2, 2015. Several resources are available to help you in the transition:

The CAQH ProView User Guides are now available
The links below provide access to each document:

1. Providers - CAQH ProView Provider User Guide
2. Practice Managers - CAQH ProView Practice Manager Module User Guide
3. Participating Organizations - CAQH Proview Participating Organization User Guide

Save the Date for CAQH ProView Training
CAQH will provide online training via webinars for participating organizations throughout March. Click here to view the available dates and to register for a session.

A complete list of action items, including information for you to communicate to your providers and IT department is available on the CAQH website.

Request Roster Validation Tool and View Sample Roster Files
CAQH has developed a roster validation tool for your organization to confirm that your new roster file format meets the CAQH ProView required changes. Sample CAQH roster file now available: Please email upd@caqh.org to request the tool and to access the sample roster files.

Need More Information? 
CAQH ProView - Frequently Asked Questions is the place to find updated answers to questions about how to prepare for the launch of CAQH ProView and information about the solution's features. If you do not see an answer to your question, please email upd@caqh.org.

All Healthcare Industry Eyes on the Supreme Court This Week

Beginning on March 4, the U.S. Supreme Court will hear the first oral arguments in King v. Burwell, the case that will determine the validity of federal subsidies assisting millions of American patients afford health insurance under the Affordable Care Act. Should the Court strike down these subsidies, the effects will be felt across the entire healthcare industry. Here are "5 Things to Know About the Supreme Court Case Challenging the Health Law," a report by Kaiser Health News.

NAMSS Offering Live Education in Atlanta

The National Association Medical Staff Services is hosting its annual Regional Education Summit, providing MSPs with three live learning opportunities in Atlanta, GA on March 13-14. Whether you are preparing for a NAMSS Certification Exam, are new to the industry, or have new staff that need critical introductory education, the NAMSS Regional Education Summit provides an unparalleled opportunity to learn and network. Join NAMSS at the Westin Peachtree Plaza and connect with fellow industry professionals at one of the following three courses:

• The two-day NAMSS Credentialing Specialist (CPCS) Certification Preparation Course helps those preparing to take the CPCS certification exam gain a sense of what topics the exam focuses on and develop a personalized study strategy. REGISTER NOW
• The two-day NAMSS Medical Services Management (CPMSM) Certification Preparation Course helps those preparing to take the CPMSM certification exam gain a sense of what topics the exam focuses on and develop a personalized study strategy. REGISTER NOW
• Credentialing 101 is a two-day program that introduces attendees to credentialing and gives examples of how and when to apply accreditation standards. REGISTER NOW

Register Now and Save! Enter the following code during checkout and save 10% off of meeting registration: NAMSS10GA. Questions? Contact the NAMSS Executive Office at education@namss.org.

http://www.namss.org/Education/NAMSSEducationSummit.aspx. 

ABIM President Announces Changes to MOC Program

On February 3, 2015, the American Board of Internal Medicine (ABIM) announced that it would be making significant changes to its Maintenance of Certification (MOC) program via a letter distributed by ABIM President and CEO Richard Baron, MD. Dr. Baron began the letter by stating, " ABIM clearly got it wrong. We launched programs that weren't ready and and we didn't deliver an MOC program that physicians found meaningful. We want to change that." For a full version of the letter, please click here.

NBPAS Provides New Recertification Alternative

According to a report by MedPage Today, the National Board of Physicians and Surgeons (NBPAS) has been established to provide physicians with an alternative path to board recertification. Founded by vocal critics of maintenance of certification, such as Paul Teirstein, MD of the Scripps Clinic in San Diego, CA, the NBPAS presents new competition for the American Board of Medical Specialties (ABMS) in the board recertification process.

From the NBPAS website:

"The National Board of Physicians and Surgeons (NBPAS) is committed to providing certification that ensures physician compliance with national standards and promotes lifelong learning. We require fulfillment of the following criteria for board certification:

•  Candidates must have been previously certified by an American Board of Medical Specialties member board. Initially, NBPAS will only certify physicians in selected specialties.  Other specialties and other boards will follow.
• Candidates must have a valid, unrestricted license to practice medicine in at least one US state.
• Candidates must have completed a minimum of 50 hours of continuing medical education (CME) within the past 24 months, provided by a recognized provider of the Accreditation Council for Continuing Medical Education (ACCME). CME must be related to one or more of the specialties in which the candidate is applying. Re-entry for physicians with lapsed certification requires 100 hours of CME with the past 24 months.
• For some specialties (ie interventional cardiology, electrophysiology, critical care), candidates must have active privileges to practice that specialty in at least one  US hospital licensed by a nationally recognized credentialing organization with deeming authority from CMS (ie JCHAO, HFAP, DNV).
• A candidate who has had their medical staff appointment/membership or clinical privileges in the specialty for which they are seeking certification involuntarily revoked and not reinstated, must have subsequently maintained medical staff appointment/membership or clinical privileges for at least 24 months in another US hospital licensed by a nationally recognized credentialing organization with deeming authority from CMS (ie JCHAO, HFAP, DNV)."

For the full report from MedPage Today, please click here.