Happy New Year from NAMSS!

As we close out another year, NAMSS has much to celebrate and even more to look forward to in 2017!

In 2016, we...

Celebrated the 40th Educational Conference & Exhibition in Boston, MA - where with 1,700+ attendees we enjoyed record attendance.

Instituted the Leadership Certificate Program, in which 36 veteran Medical Services Professionals (MSPs) were recognized in our inaugural class, and Virtual Executive Roundtable.

Welcomed 100+ new members to the NAMSS community.

Released the first-of-its-kind State of the Medical Services Profession Report.

Received 900 Certified Provider Credentialing Specialist (CPCS) and Certified Professional Medical Services Management (CPMSM) applications.

Launched a Twitter profile and quickly grew to 150+ followers.

Partnered with the AHA, ACGME, and OPDA to release the Verification of Graduate Medical Education Training Form.

We wish you a Happy New Year from everyone at NAMSS and look forward to building on all of this wonderful success in 2017!

Becker's: 7 Steps to an Efficient, Centralized Credentialing Department

In an article for Becker's Hospital Review, Sarah Pelletier - advisory consultant and chief credentialing officer at the Greeley Company - outlined the seven essential steps to achieving an efficient and effective centralized credentialing department. These seven steps are as follows:

1. Standardize and consolidate: "This means physicians shouldn't have to fill out the same application for multiple hospitals within the same system or send in the same document multiple times."
2. Eliminate duplication: "Every department involved with physician recruitment should be on the same page in terms of what is required of a hire."
3. Establish a single source of truth: "This 'single source of truth' should be one systemwide integrated web-based credentialing software system that facilitates timely communication between recruitment, credentialing and enrollment staff."
4. Create an onboarding team: "Systems need to break down the walls between various functions involved with hiring medical staff and create one onboarding team that meets regularly."
5. Streamline application processes: "Applications, document requests and contracts should be sent in a single envelope to the physician and returned in a single envelope."
6. Use a knowledgeable physician liaison: "This point person can help the physician through the process and can help reduce the number of incomplete applications."
7. Integrate credentialing with provider enrollment: "To get ahead of the game, begin enrolling providers with the system's various public and private payers as early as possible during the credentialing process and seek out delegated credentialing agreements with payers."

For the full article from Becker's, please click here.

UPDATE: Verification of Graduate Medical Education Training Form

The National Association Medical Staff Services (NAMSS), in partnership with the American Hospital Association, the Accreditation Council for Graduate Medical Education, and the Organization of Program Director Associations, released a new Verification of Graduate Medical Education Training Form in April 2016. This form, developed over the past several years, seeks to standardize the process for the verification of a practitioner’s internship, residency and fellowship experience in compliance with healthcare accreditation organizations’ standards. Over time, each hospital, managed care organization and other healthcare entities developed their own unique forms for obtaining verification of training. This created an inefficient system in which training programs received multiple variations on requests for the same information, slowing the credentialing and onboarding of practitioners and creating extra work for all involved. This new verification form eliminates these inefficiencies through standardization. Since its release, the form has already been downloaded over 6,000 times and is being implemented in hospitals and other healthcare organizations across the country.

The Verification of Graduate Medical Education Training Form is available for download HERE.

11 of Nation's Largest Payers Advocate for Expansion of Medicare Telemedicine

In a letter to the Congressional Budget Office (CBO) last week, eleven of the nation's largest health insurance carriers offered to make available data on the value of telemedicine as Congress considers expanded coverage under Medicare for telemedicine services.The letter states, "We view telemedicine as an important tool in increasing consumer access to high quality, affordable healthcare, improving patient satisfaction and reducing costs," and, "We believe our experience in the commercial market can inform estimates of the impact of policy changes in Medicare."

For the full story from HealthLeaders Media, please click here. For the full text of the letter, please click here.

UPDATE: MSPs & the Standard Occupational Classification System

Please click here to access the comments submitted by NAMSS urging the inclusion of Medical Services Professionals (MSPs) in the 2018 Standard Occupational Classification (SOC) system. As previously reported in this blog, MSPs were not included as a new detailed occupational classification.

As MSPs play a unique, distinct and integral role in health care - leading the credentialing, privileging, and onboarding of medical staff applicants and thus serving as the gatekeepers of patient safety – NAMSS will continue to work toward recognition of the MSP profession in the SOC system. Again, we will provide additional updates as they become available.

MSPs & the Standard Occupational Classification System

The Bureau of Labor Statistics (BLS) released new updates to the 2018 Standard Occupational Classification (SOC) system in July. Medical Service Professionals (MSPs) were not included as a new occupational category, despite NAMSS' submission of official comments in 2014 urging their inclusion. BLS is accepting additional public comments before finalization and NAMSS will be submitting remarks advocating for recognition of MSPs as a detailed occupational category.  

According to the BLS website, the SOC system "is used by Federal statistical agencies to classify workers into occupational categories for the purpose of collecting, calculating, or disseminating data." Inclusion in this system increases recognition of a profession both in the public and private sectors, as well as allows for the generation of a wealth of information regarding the profession and those who practice it.

As MSPs play a unique, distinct and integral role in health care - leading the credentialing, privileging, and onboarding of medical staff applicants and thus serving as the gatekeepers of patient safety – NAMSS remains committed to working toward recognition of the MSP profession in the SOC system. We will provide further updates as they arise on this issue.

Celebrating 40 Years of NAMSS Conferences in Boston, September 17-21

As the NAMSS 40th Educational Conference & Exhibition quickly approaches, we are excited to highlight some new and fun features for attendees this year. To mark this important milestone, NAMSS is introducing a Memory Wall and a Where is NAMSS Wall where previous conferences will be remembered. These features will be interactive, allowing attendees to indicate which conferences they have attended, where they are from, and share in the memories of 40 successful events.

These are just some of the reasons to be excited about this year's conference in Boston. To learn more about all that this year's event and Bean Town have to offer through a short video and some helpful links, visit the NAMSS website by clicking here. 

Becker's Hospital Review: Improving Credentialing

Becker's Hospital Review interviewed Scott Friesen, CEO of Newport Credentialing Solutions, and Jacqueline Lam, Director of Medical Staff Services at Winthrop University Hospital (Mineola, NY), about ways of improving and streamlining the credentialing process. Here are the 5 suggestions they offered:

1. Utilize an enterprise-wide cloud-based technology platform
2. Ensure data is accurate and current
3. Understand the impact of delayed processing on revenue
4. Streamline operations surrounding enterprise-wide technology
5. Communication is key

For the full article and details on these 5 suggestions, please click here.

The "July Effect"

Every July, hospitals across the country welcome new medical graduates into their ranks. Many studies have been conducted to examine the so-called “July Effect,” the increase in negative outcomes and rates of medical errors for patients often attributed to this influx of inexperienced doctors. However, according to an article in Modern Healthcare, the “July Effect” may require further examination.

While some studies have found that there is an uptick in medical errors and patient morbidity in July, many doctors and hospitals are arguing that the “July Effect” may have little to do with recent medical graduates entering hospitals and staff turnover, and that the effect may vary by institution. One of the major studies on the “July Effect” posited: “Heterogeneity in the existing literature does not permit firm conclusions about the degree of risk posed, how changeover affects morbidity and rates of medical errors, or whether particular models are more or less problematic.”

Hospitals are staying vigilant, though. Through training programs for interns covering “everything from hand hygiene to advanced cardiac life support” and increased attention to quality and safety in orientations, hospitals are trying to combat the “July Effect,” whether real or perceived.

The Accreditation Council for Graduate Medical Education (ACGME) created the Clinical Learning Environment Review program in 2012 to provide feedback to hospitals on patient safety and other areas. "What we are doing as an organization is driving change by providing that information and then coming back two years later to see what's changed," states Dr. Kevin Weiss, the ACGME's senior vice president for institutional accreditation.

NAMSS 2016 Roundtable Report Now Available

The National Association Medical Staff Services (NAMSS) is proud to announce the release of its official report on the 2016 Roundtable: Real Reform through Positive Disruption. This event, the 3^rd annual roundtable discussion convened by NAMSS, was held on Thursday, May 19, 2016 at the Gaylord National Resort in National Harbor, MD. This year’s discussion focused on enacting meaningful, impactful change in the health care provider credentialing and licensure processes. NAMSS recognizes that the time for positive disruption is now, and looks forward to continuing to work with its industry partners into the future to create more streamlined, more efficient processes that preserve patient safety.

NAMSS would again like to thank the following industry partners for participating in this important event: the American Association of Physician Assistants (AAPA), the American Health Lawyers Association (AHLA), the American Hospital Association (AHA), the American Medical Association (AMA), the Council for Affordable Quality Healthcare (CAQH), the Federation of State Medical Boards (FSMB), the Health Resources and Services Administration (HRSA), the Medical Group Management Association (MGMA), the National Committee for Quality Assurance (NCQA), The Joint Commission, Cigna, and DNV.

For a full description of this year’s Roundtable - its background, content and next steps - please click here to access the official report.

NAMSS 2016 Roundtable: Real Reform through Positive Disruption

As part of its ongoing efforts to work with industry leaders on meaningful reforms to the credentialing and licensure processes, the National Association Medical Staff Services (NAMSS) held its 3rd annual roundtable discussion with industry stakeholders on May 19, 2016 at the Gaylord National Resort in National Harbor, MD. This roundtable, titled Real Reform through Positive Disruption, focused on discussing what NAMSS has already accomplished in 2016, as well as beginning to build consensus on additional reforms.

In 2016, NAMSS, along with the American Hospital Association (AHA), Accreditation Council for Graduate Medical Education (ACGME) and Organized Program Directors Association (OPDA), introduced a new Verification of Graduate Medical Education Training Form to alleviate the burden placed on both program directors and Medical Services Professionals (MSPs) in the training verification process. A NAMSS Task Force has also developed a Model Credentialing Application based on best practices from applications across the nation. Roundtable participants were invited to provide feedback on these documents and discuss their implementation.

Moving forward, NAMSS also proposed reforms to the recredentialing and reappointment cycle, as well as the criminal background check process. Again, roundtable participants discussed these reforms at length to identify the most effective ways to streamline the credentialing and licensure processes and reduce inefficiencies.

NAMSS will continue to work with the roundtable participants and others on an ongoing basis to implement the process improvements so direly needed in the industry. Additional information on the background and outcomes of this year’s roundtable will be available when NAMSS releases its full roundtable report in the near future. Stay tuned!

The following organizations participated in this year’s roundtable: American Association of Physician Assistants (AAPA), American Health Lawyers Association (AHLA), American Hospital Association (AHA), American Medical Association (AMA), Cigna, Council for Affordable Quality Healthcare (CAQH), DNV, Federation of State Medical Boards (FSMB), Health Resources and Services Administration (HRSA), Medical Group Management Association (MGMA), National Committee for Quality Assurance (NCQA), and The Joint Commission.

Efforts Underway in 3 Health Systems to Reduce Surgeries By Inexperienced Doctors

According to Kaiser Health News, Johns Hopkins, Dartmouth-Hitchcock and the University of Michigan "pledged that they will require their surgeons and 20 affiliated hospitals to meet minimum annual thresholds for 10 high-risk procedures."

This is the latest development in the longstanding debate over surgery volume and outcomes.As KHN states, "A groundbreaking 1979 Stanford study found that patients who underwent operations at hospitals that did more... surgeries had significantly lower death rates than those treated at hospitals where they were done infrequently. That finding has since been replicated repeatedly across many specialties and found to apply to surgeons as well as hospitals. Last month, a large study found that the risk of complications was far higher among surgeons who performed only one thyroid removal annually than among those who did 25 or more of the tricky procedures per year."

Groups such as the American College of Surgeons and The Joint Commission have expressed concerns about the implementation of these new standards. Mark Chassin, president of The Joint Commission, states, "Volume should never be used by an accrediting organization as a measure of quality."

For the full story from KHN, click here.

NAMSS, AHA and ACGME Announce New Verification of Graduate Medical Education Training Form

NAMSS, in partnership with the American Hospital Association (AHA), the Accreditation Council for Graduate Medical Education (ACGME), and the Organization of Program Director Associations (OPDA) and others, developed a workgroup that has been meeting over the past year to discuss options to standardize the training verification process and alleviate these burdens placed on hospitals, medical services professionals, and program directors. This group has also been working with the Federation of State Medical Boards (FSMB) to address the needs for licensure within the form and will continue that collaboration into the future.

In an effort to streamline the credentialing process, NAMSS and our partners have collaborated to create a standardized “Verification of Graduate Medical Education Training” (VGMET) form. To access this form, please click here.

The VGMET form consists of three sections:

1. Verification of Graduate Medical Education Training
2. Additional comments as needed
3. Attestation

For 2016 and future graduates:

The form would be completed once by the program director at the time of completion of the internship, residency or fellowship, with a separate form for each training program completed. The signed form would be placed in the trainee’s file.  The form would be photocopied and sent with a standard cover letter to hospitals or other organizations requesting verification of training.

For pre-2016 graduates:

The form would be completed once – if and when a program receives a request for verification of training. The current program director would review the file and complete the form based on information contained therein, sign and date the form and send to the requesting hospital. Thereafter, that form would be used in response to all requests for training verification – a photocopy of the form, and a signed dated cover letter attesting that the form accurately reflects information about the trainee in the file.

NAMSS is proud of this group’s work to create this new form as it is a significant step toward greater efficiency and will ease the burdens placed on Medical Staff and Credentialing Services Professionals, hospitals, program directors, and other stakeholders. It is a prime example of the type of reforms that are possible when those within the industry identify a problem and work together to achieve a creative solution.

AR State Medical Board Policy Changes

From the Arkansas State Medical Board:

Licensure and CCVS Policy Change

In response to requests from the Legislative Branch and other organizations in the state, the Arkansas State Medical Board (ASMB) has approved several changes for licensing and Centralized Credentials Verification Service (CCVS). It is believed these changes may be a factor in helping to reduce the amount of time it takes to license practitioners in this state. These changes are:

- Authorized the use (Not Mandate) of the Federation of State Medical Board’s FCVS credentials program.
- Authorized the utilization (Not Mandate) of the Federation of State Medical Board’s uniform application.
- Reduced the requirement to collect the Work History, including Hospital Privilege History, to only the last 10 years unless circumstances call for the additional information.
- Accept assignments by Locum, Contract or Telemedicine companies for verification of Work History provided by company assignment rather than from collecting verifications from the individual facilities.

*The ASMB/CCVS staff has requested and received approval from NCQA for the use of the FCVS by the CCVS.

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

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

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

For the full story, click here.

NAMSS Payer Credentialing Roundtable Report Now Available

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

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

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

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

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

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

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

CMS/AHIP Release Physician Quality Rating Measures

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

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

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

Key Facts:

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

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

New CMS Regulations Target Health Insurer Provider Directory Inaccuracies

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

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

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

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

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

For more information, access the full WSJ article here.