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.