Medkinetics Blog

Throw-Back Thursday for Healthcare!

Melissa Outlaw — Thu, 05 Mar 2015 23:16:00 GMT

In honor of the recent social media craze "Throw-Back Thursday" #TBT - here's a top 10 list for credentialing, privileging, and quality!

Remember when…

10. You got a new IBM Selectric!

9. Duplicate meant using carbon paper not a copier!

8. Everything was stored in file folders? We mean the paper kind, not the ones on your computer!

7. Automation was introduced to the Medical Office and you spent countless hours manually keying information into a system - not to mention the scanning and uploading of the entire, 100+ page paper file!

6. All verification letters for state licensure, peer references, hospital affiliations etc. had to be sent via snail mail? At only 18 cents a letter?

5. Forms and letters were completed by pen to paper - one at a time? Better yet, when you ran out of payor forms and had to request that they send you a batch of forms (again with the snail mail)!

4. Onion skin paper was the 'paper of choice' - do I see a tear?

3. Being an MD meant you could do any procedure or see any patient in your hospital?

2. Peer Review was used only when a provider did something wrong?

1. A provider's quality 'score' was determined on the golf course?

Ha Ha…on a more serious note, it is important to look to the past to truly appreciate how far healthcare delivery and evaluation has come in the last few years. Medical Staff, Providers and Healthcare Organization have done a great job working together to elevate not only the level of care patients receive, but the way they measure themselves and their performance. Imagine what a #TBT list will look like in 2025….I am sure we will look back with just as much astonishment and appreciation of the struggles and accomplishments of yester year.

About the Author

Melissa Outlaw

Melissa Outlaw is a Senior Vice President with Medkinetics, LLC and a Founding Partner of SEERhealth. Melissa supports clients in benchmarking current internal practices, identifying potential efficiencies then driving the integration of technology with process improvement to reduce time of service and operating expenses.

Blurred Lines: Mastering Payor Enrollment

Donna Goestenkors — Wed, 04 Mar 2015 14:10:00 GMT

The specialty lines within the Medical Staff Services industry are changing. The boundaries of work functions primarily found in Medical Staff Services Departments (MSSD), Credentials Verification Organizations (CVO), and Managed Care Organizations (MCO) were quite clear. Not any more! In fact, they are mostly blurred lines of distinction.

The projects a Medical Services Professional (MSP) would historically perform would be dependent upon the environment in which they work. As healthcare continues to shift to a performance-based, outcome driven, budget conscious business – yes, I said business – all healthcare workers are being expected to perform at a higher level, demonstrate competence in broader areas, exhibit innovation in managing their departments and, frankly, do more with less than ever before! Many of my colleagues are being expected, not asked, to consolidate their departments or integrate other revenue generating service lines.

One of the leading specialty areas that is proving critical to an organization’s bottom line is expediting the insurance or payor enrollment of their practitioners. Payor enrollment is now being performed in MSSDs, CVOs, and physician practice groups (just to name a few). There are a growing number of experienced credentialers moving into the specialty of payor enrollment. These MSPs are joining their enrollment specialist colleagues (those that have been performing this work for many years) to get practitioners/providers enrolled into the various payor plans as quickly as possible, all while navigating the complex world of Federal and State regulations and varying insurance requirements. With eyes focused on this specialty and the increasing employment shifts happening for Medical Services Professionals there was a stark realization that resources were no where to be found.

As a result, symplr (formerly Medkinetics), Team Med Global HealthCare Consulting and the Texas Society of Medical Service Specialists collaborated to host, produce and present the ONLY global, NAMSS-approved webinar series targeting this very important topic of payor enrollment. The “Mastering of Payor Enrollment” webinar series is a four-part program serving to introduce experienced and new to the field enrollment specialists, Medical Services Professionals and administrators on enrollment theory, design, challenges and solutions.

The next session will be held on Wednesday, March 11 at Noon – 1:00 p.m. CST and will address the top 10 payor enrollment challenges and the strategies on how to avoid them. Click here to register!

Don’t miss this educational opportunity! You will learn about payor enrollment, how this new information may give you that innovative edge at your organization and how your enhanced competence will increase your career marketability.

About the Author

Donna Goestenkors

President of Team Med Global Consulting and full-time healthcare consultant, speaker, author and educator. With more than 30 years of healthcare experience, her consulting work encompasses the entirety of provider management and her passion is driving the value and professionalism of Medical Staff Services Professionals (MSP’s). Donna served as President of the National Association of Medical Staff Services (NAMSS) in 2005 and continues her work with NAMSS as a Certification Instructor and speaker today. We place high value in her healthcare knowledge, professionalism and most importantly her dedication as a mentor to MPS’s. Click here to learn more about Donna and Team Med Global Consulting http://teammedglobal.com

Waiting for ICD-11

Kristine Tannert — Thu, 19 Feb 2015 16:50:00 GMT

The ICD-10 deadline is just months away. Meanwhile, ICD-11 is fast on its heels. It’s tempting to consider skipping over ICD-10 and just waiting for ICD-11. I get that. With as much change and increase in complexity as the transition from ICD-9 to ICD-10 means and the impact it has on your practice (coding, billing, quality management, training, infrastructure, more staff, more products) I can only assume there’ll be at least an equal amount of change and increased complexity when moving to ICD-11. There’s a part of me that whispers, "Why do it all now just to do it all again in a few years?"

But the reality is, constant change, increasing complexity, and the need for more information are just part of the package when it comes to healthcare. Trying to float along and wait for the next big wave of change is going to leave you drowning.

According to the American Medical Association, there are compelling reasons to switch to ICD-10

First, ICD-9 is outdated. It offers only 13,000 codes. Compared to ICD-10’s 68,000+ codes and sub-codes, it’s clear that continuing to use ICD-9 limits your practice’s ability to improve the quality of care. ICD-10, on the other hand, is a faster and more efficient way to keep everyone at your organization on the same page.

Next, implementing ICD-10 will build layers of knowledge and experience that will flatten the learning curve when implementing ICD-11. So, it won’t be like starting over from scratch when it’s time to adopt ICD-11.

Also, while it’s a valid statement that ICD-10 requires an investment of time and money to implement, it’s also a fair assumption that you’ll get less pushback from payers (fewer requests for additional information or “attachments”), since they have vastly more information at their fingertips.

The American Health Information Management Association warns that glossing over ICD-10 and waiting it out for ICD-11 is a risky move. Transitioning directly from 9 to 11 would be “much more complicated and disruptive.” Furthermore, they estimate that ICD-11 likely won’t be able to implement in the US for another ten years. In my opinion, that’s a decade too long to hang on to an obsolete data structure that will only erode your ability to improve healthcare quality.

The bottom line is - adopting ICD 10 is a necessity in a world that demands data, speed, and continuous improvement. (in addition to the obvious…ICD-10 adoption is a CMS mandate and in order to get paid, your organization has to switch).

The Role of Legal in Preventing Negligent Credentialing Claims

Kesha Boykin-Mclean — Tue, 27 Jan 2015 23:28:00 GMT

From initial appointment to establishing requirements for credentialing decisions, Legal should be, and almost always is, closely involved. In fact, the credentialing processes begins with establishing by-laws to govern the processes your medical staff and quality/risk professionals adhere to.

The legal department is trained to recognize issues that may expose hospitals to negligent credentialing liability and are equipped to defend potential claims. With more and more plaintiff’s lawyers targeting negligence in credentialing as grounds for suit, it’s imperative to review the information considered when onboarding a provider. Moreover, the increase in litigation blaming the failure to review provider performance is creating the need for healthcare organizations to re-engage legal in the onboarding processes. What can your organization do to better protect itself?

Consult with a legal team to validate your credentialing and re-credentialing processes appropriately cover:

Conducting a thorough background check including license, sanctions, malpractice and NPDB searches. If needed, consult with a professional background screening company to conduct, at a minimum, the following public record searches: criminal, sex offender, bankruptcy, and civil searches.
Validating whether the license to practice contains pending investigations or complaints and require an unrestricted license to practice for all applicants.
Credentialing committee review should include peer review and performance review assessments.
Reviewing of quality metrics such as:

Procedures performed
Privilege to Procedures
Re-admission Rate
Benchmark Statistics
Mortality Rates
CMI

5. Engaging other providers who have worked with the physician to complete a Peer Review evaluation.

Accompanying the need to mitigate risk is the desire to provide the best care possible! Reviewing your processes and procedures regularly, with legal, will ensure your organization is reducing liability and striving to create an environment of true patient safety!

About the Author

Kesha Boykin-Mclean

As Chief Compliance Officer, Kesha Boykin-Mclean brings over 20 years of experience in healthcare. Prior to joining VCS, Boykin-Mclean held a number of senior-level compliance roles, including managing and developing the compliance program for St. Francis Hospital in Connecticut. She was also the Division Ethics and Compliance Officer for the Hospital Corporation of America’s Gulf Coast Division where she was responsible for oversight of compliance programs for all hospitals within the division. Most recently, she served as an independent healthcare consultant, assisting hospitals with the planning and implementation of compliance programs.

To request an online demo of the Medkinetics Electronic Physician Record® (EPR®), click here. Our platform consists of four robust modules: Credentialing, Privileging, Quality, and Event Reporting. Each module is designed to work individually or together to create an innovative, web-based solution that is much more than just technology!

An Introduction to Payor Enrollment

Donna Goestenkors — Tue, 20 Jan 2015 16:57:00 GMT

If you build it, they will come! That’s exactly what the Texas Society for Medical Services Professionals (TSMSS), symplr and Team Med Global Consulting did. Their collaboration led them to the first-of-its-kind educational webinar series focused on payor enrollment and the specialists in the field. The first session, of three, Introduction to Enrollment was held on Wednesday, January 14th with more than 200 participants. Over the years, these professionals have been working with minimal guidance, little to no resources and having to do what many Medical Staff Service Professionals (MSP) colleagues have done – learn from the school of hard knocks! We all understand the challenges this practice creates (i.e. errors, inconsistently applied practices, inefficiencies, non-compliance and slow or no reimbursement). We want to help you change this!

There’s a critical need for education, resources, consulting and guidance in payor enrollment. The confusion begins with the name itself, credentialing at the hospital vs credentialing with payors or payor enrollment, and continues with whom the work is performed for as well as the information necessary to complete the tasks. Credentialing and payor enrollment have unique requirements, forms and regulations creating disparately different disciplines. That said, when these two areas collaborate and work together to onboard providers – it can avoid enrollment delays for both groups. There is a direct correlation between increased revenue when enrollment occurs in tandem with the credentialing process. The quicker physicians and practitioners are granted privileges, enrolled in the various health plans and oriented to that organization’s culture and requirements, the faster and often times, the greater their reimbursement.

In today’s “credentialing world",there’s an inherent need for those working with, aggregating and using the same medical staff data to work collegiately. Some MSPs are already performing payor enrollment work, many have expressed an interest in expanding into enrollment while those specializing in enrollment desire growth of their roles and responsibilities as well. Throughout this process, we will work to lead the industry, push for change and provide education and resources to those who wish to take advantage of it.

To learn more about payor enrollment, click here to register for Session 2, “Enrollment 101” to be held on Wednesday, February 11th and Session 3, “Enrollment 201” to be held on Wednesday, March 11th. Help us be a part of the change!

About the Author

Donna Goestenkors

To request an online demo of the Medkinetics Electronic Physician Record® (EPR®), click here. Our platform consists of four robust modules: Credentialing, Privileging, Quality, and Event Reporting. Each module is designed to work individually or together to create an innovative, web-based solution that is much more than just technology!

Shared Services For Healthcare Organizations Is More Than HR & IT

Melissa Outlaw — Mon, 12 Jan 2015 15:42:00 GMT

A shared service is not a new idea, but a spreading concept in healthcare, which provides benefits across the entire organization. The theory behind a shared service is identifying those functions or departments that are repeated at multiple facilities and consolidating them into one central location. It is commonplace for Information Technology (IT) and Human Resources (HR) to be centralized, not only because of the benefits, because it is acknowledged as the most effective way to execute these areas of service.

The Benefits of Shared Services in Healthcare Organizations

Healthcare organizations are experiencing the benefits of this centralization, especially with the ever-increasing number of multi-facility organizations. One driving factor of this shift is the emphasis on ACOs. It is now the norm for an organization to encompass a mixture of hospitals, surgery centers, physician practices, and long-term facilities. As a result of this environment, we are also seeing a fundamental shift in how these organizations collaborate to manage the credentialing of providers.

Medical Staff Services Benefits of Shares Services

In order to prevent redundancies across organizations, Medical Staff Services are being consolidated, too. Verifying providers' credential information in a central location has immense and immeasurable benefits, such as:

Allowing large organizations greater efficiency through volume-based processing
Leading to greater sharing of information
Higher visibility of key data and statistics
Establishing an office within healthcare that propels best practices throughout the organization
Increased provider satisfaction due to eliminating redundant processes and forms

Provider Satisfaction of Shared Services

Provider satisfaction is significantly increasing as centralized credentialing offices becomes more prevalent. Prior to the onset of centralized credentialing, a provider who worked in three facilities went through credentialing three times. This means the provider would have to review and update his or her information and provide copies of all updated information three separate times to three separate medical staff personnel.

Consolidating this work and establishing one point of contact for the provider eliminates excessive paperwork and the provider is now free to do what he or she does best - treat patients. Both the provider and organization reap the benefits!

Facilities Benefiting from Shared Services

The adoption of this centralized model does not mean that facilities are no longer supported. On the contrary, it is both common and recommended that some staff, depending on the organization size, be retained on site to help facilitate facility-specific tasks, such as privileging and quality measuring and reporting.

Shared Services Provides Shared Benefits

Organizations and providers alike enjoy the benefits of the shared services model for healthcare. The adoption of this model eliminates redundancies, ensures accuracy, and liberates providers to focus on quality of practice.

It is imperative, however, to implement and execute this method with accuracy. If you do not have staff who are experienced in large organizational change initiatives and have knowledge of diverse considerations needed to create this solution, we recommend that you look outside your organization and consider outsourcing to help oversee this effort.

About the Author

Melissa Outlaw

Medkinetics and VCS: Simplifying Your Complex World

Kristine Tannert — Mon, 22 Dec 2014 16:22:00 GMT

Depending on which part of the hospital you work in, credentialing means different things. When you talk to the Medical Staff Services department, they’ll tell you it’s all about primary source verification and committee approvals for provider appointments. When you talk to Revenue Cycle Managers, they’ll tell you it means enrolling providers with payors. Talking to the Supply Chain, they’ll tell you it refers to screening a potential sales rep. But the basic definition is still the same: credentialing is verifying someone’s qualifications, background, and achievements in order to determine if they are suitable for something.

One Complete Credentialing Solution

These different ideas of healthcare credentialing recently came together when Medkinetics and Payor Enrollment Services merged with Vendor Credentialing Service (VCS) to form the new company, symplr.

VCS has its origins in credentialing medical sales reps. However, it has recently expanded to credentialing other healthcare populations, including traveling nurses, medical and nursing students, non-medical staff, volunteers, and contractors.

There are a couple other differences between the Medkinetics and VCS products:

VCS is tailored to handle the lighter credentialing needs of non-providers. It doesn’t contain the features that Medkinetics offers to manage committees, grant privileges, and conduct peer reviews. Instead, its solutions focus more on managing compliance and access.
VCS offers a CVO-like service along with its software. The VCS Credentialing Team verifies all submitted credentials (such as immunization records and background check) using industry best practices.

Despite some differences, Medkinetics, Payor Enrollment Services, and VCS (now known as symplr!) are focused on making your complex world in the areas of credentialing, quality, risk, and compliance, well, simpler.

Here is a short video to learn more about the credentialing products from VCS:

About the Author

Kristine Tannert

Kristine is the Senior Product Manager for Medkinetics and Payor Enrollment Services. She formerly served Vendor Credentialing Services (VCS) as a Product Manager and a Business Analyst. She has experience in process improvement, quality assurance, training, and technical writing.

Is Your Facility Prepared for the Ebola Panic?

Kristine Tannert — Tue, 09 Dec 2014 20:06:00 GMT

I recently read an article talking about how healthcare facilities should expect an onslaught of patients needing reassurance that they don’t have the Ebola virus. The author reasoned that with flu season reaching its peak, symptoms will likely be mistaken for Ebola. As such, this could cause an increase in visits to emergency rooms and hospitals, even with no other reason to suspect the deadly virus.

While I was reading the article, I reflected on how Ebola has been handled both in the news and on my own recent experience.

Panic – A New “Disease”

It seems like you can hardly turn on the TV or read the news without hearing about Ebola. I confess, I’ve been guilty of buying into the panic (in my defense, I’m a first-time mother of an infant, so every little sneeze makes me jump out of my skin). When my little angel had fever and vomiting last week, I called the pediatrician. The first thing the staff asked me was if she’d been to West Africa or had related exposure. What I should have thought was, “This baby only travels within a ten mile radius from our home – there’s nothing to worry about!” But instead, I freaked out a little bit, thinking, “Oh no! I just knew that the new teacher at her daycare had a funny accent! What if…” and you can guess the rest. As it turns out, she had a sinus infection… and the funny accent was Australian!

It is clear, however, that I am not the only person who has responded this way. The media hype has certainly created a mood of panic. I can only imagine the battle that healthcare facilities are fighting every day. In addition to the fear and urgency created in the news, flu season is now in full swing, and, unfortunately, influenza and Ebola have some similar symptoms. There could likely be some hectic months ahead. The panic seems to have taken on a life of its own, an epidemic almost equal to the virus itself!

The Cure

So, how do you treat panic? The article I read suggested that training and information are the cures. I completely agree. The better prepared you feel to handle the problem, the smaller and more manageable the problem seems. It’s like my husband always says, “Control what you can control.”

You can’t control the message that the public is getting in the news, and you can’t control the fact that the panic has coincided with flu season. However, you can control the message that you project and the tone you set.

To create a calm, rational environment at your facility, you need to reassure and empower your staff and clinicians. Beyond educating them to understand symptoms, you should address their fears and build their confidence.

Teach them best practices for working in an Ebola-contaminated environment. Go through actual drills and practice sessions of working around and disposing of hazardous materials. Train, practice, and rehearse until your staff feels comfortable with the process.

They may still have concerns, but at least you can stop the momentum of panic and shift from a reactive to a proactive environment. Then, your trained and empowered staff will not only be prepared to handle the threat of Ebola, but they will be prepared to handle the more likely threat of frightened patients. In short, they’ll be equipped to soothe patients’ fears because you’ve helped them address their own.

About the Author

Kristine Tannert

Kristine is Medkinetics’ Senior Product Manager. She formerly served Vendor Credentialing Services (VCS) as a Product Manager and a Business Analyst. She has experience in process improvement, quality assurance, training, and technical writing.

Ebola: New Policies for Staff and Patient Safety

Kesha Boykin-Mclean — Mon, 24 Nov 2014 22:53:00 GMT

While hundreds of U.S. hospitals are implementing Ebola training requirements and new patient screening protocols, some are going a step further. One facility recently announced that it will place any employee on paid leave who has “in the last month returned to the U.S. from Guinea, Liberia, Sierra Leone, Nigeria and Senegal.” Other facilities are requesting its vendors refrain from sending representatives for 21 days if they traveled to the regions of West Africa within the last month.

With the increase in policies aimed toward protecting patients and employees from the risk of Ebola, new legal questions are raised. How much can employers infringe upon personal liberties in the interest of public safety?

Screening

Concern over Ebola has also impacted the screening of applicants and new hires at medical facilities nationwide. One Texas hospital has included questions about travel to Africa as part of its applicant screening. In addition to asking whether an applicant has the requisite years of experience in a particular field, hospitals want to know whether the applicant has recently traveled specifically to West Africa. Industries outside healthcare are also responding to the threat of Ebola by implementing conservative travel policies. A recent article in Forbes states that US companies with operations in West Africa including IBM and Shell Oil have implemented restrictions on non-essential travel to affected areas.

Many more hospitals will likely develop an array of policies and procedures to address the growing concern over the spread of Ebola. The Center for Disease Control (CDC) has issued guidelines for preventing transmission of Ebola, however there is currently not a process for monitoring whether they are properly implemented.

In order for you and your organization to prepare for cases such as this, it is important to not only document the process, but to test the process frequently and randomly. Be sure to include the screening of employees and vendors in your processes to ensure complete compliance.

About the Author

Kesha Boykin-Mclean

Profiting from a Privileging Software Solution

Julie Costa-Bickmore — Wed, 19 Nov 2014 23:17:00 GMT

The Problem

Hospitals have an obligation to administer superior care to patients that can only be achieved with qualified physicians who are properly privileged. This can be quite complex in a hospital-system environment, as privileges do not necessarily carry across the entire system; creating an overwhelming and staggering load for staff.

Attempting to manage this process by hand is outdated and comes with a deluge of challenges, yet many hospitals still have their privileges in paper form. Not only is this manual process labor intensive, it is also prone to error. Perhaps the largest concern, however, is the fact that documentation becomes outdated quickly and circumstances change with time gaps in notification creating a huge area of liability for hospitals and physicians alike.

The Solution

Adopting a robust software solution builds a foundation for a smooth and precise privileging processes. A comprehensive software solution should consist of a complete privilege library, researched extensively by experts. As new medical procedures and devices are introduced, those expert researchers work directly with the necessary sources, such as device manufacturers, to provide your organization the recommended minimum standards to possess such privileges.

With an introduction of new procedures and technologies almost daily, utilization of a software solution allows experts to handle the research for you and ensures that hospitals are utilizing the most updated best practices when privileging providers. This should be handled in real-time to assure privileging is done using the most current standards and documentation possible. This, in turn, liberates your medical office staff to focus on supporting the departments in adopting and delineating these privileges.

The Profit

When all medical staff has access to provider privileging data that is streamlined and automated, they are able to schedule for procedures quickly and error free. No longer do you have to worry that the floor staff is not updated regarding a provider’s suspended or revoked privileges - a robust software should do it for you!

Additionally, having a comprehensive library of delineated privileges tied directly to ICD and CPT codes is an effective tool for managing procedures in your facility. It affords you the opportunity to reconcile your billing system with actual granted privileges; streamlining re-credentialing and reporting for quality metrics such as OPPE and FPPE.

Maintaining current and accurate hospital privileging data is an important function within any healthcare organization. A software solution ensuring proper processes and documentation mitigates risk and assures the most appropriate clinical execution.

About the Author

Julie Costa-Bickmore

Julie Costa-Bickmore is a senior member of Medkinetics, LLC and a Certified Provider Credentialing Specialist (CPCS). Julie’s focus is the creation, development and maintenance of competency-based privilege criteria for all medical specialties. Julie directs a team in working with device manufacturers, training programs, the ACGME, the AOA, ABMS, expert providers, and other healthcare leaders to determine the necessary training, experience and certifications each applicant should demonstrate to be granted competency-based privileges.

TeleMedicine – Is Your Hospital CMS Compliant?

Richard Curtis — Tue, 11 Nov 2014 22:05:00 GMT

TeleMedicine? What's That?

Advances in technology have fundamentally changed how healthcare is delivered. Hospitals now have access to clinicians that provide high-quality care by remote locations. Twenty years ago, the idea of a physician in New York treating a patient in Montana via live computer feed was a pipe dream. Today, it’s common practice – and it’s called telemedicine.

As telemedicine has grown, so has the degree of regulatory oversight by the Centers for Medicare and Medicaid Services (CMS) . According to CMS, “telemedicine means the provision of clinical services to patients by physicians and practitioners from a distance via electronic communications.” Services can be provided either simultaneously, such as real-time interaction in an ICU, or non-simultaneously such as teleradiology services.

CMS Regulations Requirements

CMS has several regulations that address the provision of telemedicine services. For example, a hospital’s governing body must ensure, through a written agreement with a telemedicine entity, that all of the following provisions are met:

The telemedicine entity’s medical staff credentialing and privileging process must at least meet the CMS Conditions of Participation at §482.12(a)(1) through (a)(7) and §482.22(a)(1) through (a)(2).
The individual physician or practitioner must be privileged at the entity providing the telemedicine services.
The telemedicine entity must provide a hospital with a current list of the physician’s or practitioner’s privileges at the telemedicine entity.
The individual physician or practitioner must hold a license issued or recognized by the state in which the hospital whose patients are receiving such telemedicine services is located.

There are a great number of benefits to hospitals and patients when technology is harnessed to deliver the highest level of care available. Understanding your hospitals requirements and ensuring your compliance remains within the guidelines of CMS is as crucial as the care you provide.

Want to learn more?

Tune into CIHQ's Audio Conference on Nov 21st to understand all the Telemedicine regulation requirements. This conference will be brought to you by Richard Curtis, RN, MS, HACP, the Executive Director for CIHQ.

This informative audio conference will discuss:
•   What is telemedicine and what it is not
•   Key requirements by CMS governing the use of telemedicine services
•   Common compliance issues among hospitals
•   And much more…

Please join us by registering below!

Richard Curtis RN, MS, HACP

Rick Curtis is Chief Executive Officer for CIHQ – the nation’s newest CMS approved accreditor for acute care hospitals.. Rick is nationally recognized as an expert on accreditation standards and the certification survey process. Rick's clinical background is in critical care nursing with a focus in cardiovascular service lines. He has held both clinical and executive management level positions in Quality, Risk, Education, Infection Control, and Regulatory Compliance. Rick is nationally certified in healthcare accreditation, and serves as the Chair of the Board of Examiners for the Healthcare Accreditation Certification Program (HACP). Rick received his Nursing Degree from the University of Hawaii and has a Master of Science Degree in Health Services Administration. Rick is a resident of Round Rock, TX.

From a Doctor’s Mouth to an MSP's Ears

Donna Goestenkors — Thu, 06 Nov 2014 16:29:00 GMT

The following is a summary of a conversation I had with a newly credentialed physician processed by a CVO and then recently appointed to a hospital’s Medical Staff.

Dr. Jennings, Invasive Cardiologist, and I were speaking on a flight to Atlanta. After he and I established our career positions, we began to talk about his experience in the application process. His exact words, “Credentialing? Yes, I just went through a long and involved process and came to the conclusion that this is not the time to make waves and that I better just do what I’m asked to do.” He continued, “Honestly though, there has to be a better way!”

What were my immediate thoughts?

“Dr. Jennings gets it!” It was refreshing to speak with a clinician who understood that the gathering and evaluating of his credentials must occur in order to validate that he indeed has the ability to provide quality patient care. In addition, I thought how lucky I was that I was having a real conversation about my industry business with a doctor, one who was also a new graduate, who joined a large cardiology group and who was rich in experience, since he had been approved by the Board of Directors just one month before. Lastly, as I was constructing this month’s article I also realized that this conversation with Dr. Jennings was another branding connection about the valuable role that MSPs have in their organizations.

Improving Provider Relations

Improving systems and processes to make our offices more efficient, safe, and risk averse will always be at the core of our business practices. And, in this case, it truly brought to light the importance of working with our providers to support their efforts. If we can reduce their paperwork burden, we free them up to focus on what they do best – provide quality care to our patients.

I had a captive audience in Dr. Jennings! So, I took this opportunity to ask him how our industry might improve the credentialing experience for practitioners. His suggestions, although they may appear simple to many MSPs, can be used not only as a point of reference to measure your credentialing and privileging practices but also as a springboard to ferreting out opinions from some of your practitioners. How can we all work together to improve the credentialing experience for the practitioner and the MSP? Let’s start the dialogue!

Top Five Examples on How Credentialing and Privileging Can Be Improved

1. The Medical Staff Application was too long.

ACTION: Review your application to be sure it includes compliant and only necessary information. Some states and organizations dictate the content of an application. So be it. However, MSPs can make certain that associated inclusions to an application are current, relevant and meaningful. When was the last time you really updated your application and/or application packet?

2. The Payor Enrollment Application includes much of the same information being requested on the Medical Staff Application.

ACTION: Work with your Recruitment Department, Payor Enrollment Department, etc. and all key stakeholders to consolidate needed information to one application. Have you started your outreach?

3. Once I submitted my application, no one notified me that it had been received or kept me informed about its status. I was only contacted when someone needed me to do something.

ACTION: Immediately take action to incorporate a strong ongoing feedback component into your credentialing system. Do you at least advise the applicant that their application has been received?

4. The clinical privilege form didn’t reflect current procedures that an invasive cardiologist would be expected to do.

ACTION: It is necessary and required that an organization’s clinical privileges reflect only those that can be performed at that organization as well as ensuring that the contents of the form include current procedure criteria and defined privileges that are relevant to the specialty. What’s the date of your most current revision to your delineation of privileges?

5. Proctoring requirements did not take into consideration the cases/procedures I performed during my education and training programs.

ACTION: Be sure that the training, education, and procedure log of an applicant are matched with your organization’s procedure criteria as well as FPPE and proctoring requirements so unnecessary work is not being done. Do you present this level of competence information to your Departmental Chief and/or Credentials Committee as part of their evaluation process?

Thanks to Dr. Jennings for sharing his insightful comments!

Colleagues, I hope you found this information to be a helpful starting point on action steps you can take to adjust some of your forms and processes to enhance the experience of the practitioner and improve your products and services. It will serve as a win/win experience for all involved.

About the Author

Donna Goestenkors

President of Team Med Global Consulting and full time healthcare consultant, speaker, author and educator. With more than 30 years of healthcare experience, her consulting work encompasses the entirety of provider management and her passion is driving the value and professionalism of Medical Staff Services Professionals (MSP’s). Donna served as President of the National Association of Medical Staff Services (NAMSS) in 2005 and continues her work with NAMSS as a Certification Instructor and speaker today. We place high value in her healthcare knowledge, professionalism and most importantly her dedication as a mentor to MPS’s. Click here to learn more about Donna and Team Med Global Consulting http://teammedglobal.com

Does Your Credentialing Process Feel Like "Murder Castle"?

Kalli Sutton — Thu, 30 Oct 2014 14:04:00 GMT

When credentialing is not executed well it can feel a bit like a haunted maze with rules, loopholes, and doors that lead to brick walls.

Murder Castle!

Have you ever heard the legend of “Murder Castle”? It was built in the 1890s in Chicago by H.H. Holmes who is suspected of being our nation’s first serial killer. The story can make one's skin crawl.

Holmes was the owner of a three-story building at 63^rd and Wallace Street, where the 2^nd floor and basement earned the building’s reputation. Holmes was said to be the only person to know the layout of the maze he created on the 2^nd floor. He would hire different contractors to construct different parts of the floor, fire them, and hire another to complete a separate part.

There were doors that would only open from the outside, doorways that would lead to brick walls, staircases that lead nowhere, hinged walls and blind passageways. Today, we are still unclear of how many people Holmes murdered in the Murder Castle; estimates range from twenty to a couple hundred.

Are You Running a Maze?

We are aware that the credentialing process can often feel pieced together and like bad guys are lurking around the corners. It doesn't have to be this way! Medkinetics can ease this weight and ensure successful onboarding. Credentialing for your facility is imperative. If an outbreak should ever occur, proper credentialing ensures the ability to account for everyone in your facility.

Don't let your facility feel like a modern day version of Murder Castle; check out our many simple and easy credentialing solutions today!

About the Author

Kalli Sutton

Kalli Sutton is the Marketing Analyst at Vendor Credentialing Services (VCS) and part of the marketing departments for Medkinetics and Payor Enrollment Services. She brings to the table a focus on marketing across all media outlets, digital marketing, content creation and marketing implementation practices. She received her bachelor’s degree in Marketing and Communications.

Responsibilities When Delegating Credentials to a CVO

Melissa Outlaw — Thu, 23 Oct 2014 15:00:00 GMT

Delegating Credentials

There are many benefits to delegating credentialing to a qualified Credentials Verification Organization (CVO). However, this does not remove all responsibility from the delegating organization. There are many questions to be asked, issues to be resolved, and processes to be documented prior to delegating credentialing. When the following issues are resolved properly, the delegating organization will be confident they are onboarding providers that meet or exceed state and federal requirements.

Role Definition

One of the first considerations is Role Definition. The following points may seem apparent but unless they are documented and agreed to by both parties, it can lead to serious misunderstandings that may ultimately, be paid for by the delegating company. Therefore, the delegator must establish a policy and procedures manual including the following points:

Detailed list of responsibilities of each party
Description of delegated activities
Semi-annual or better reporting requirements
Delineated valuation process
Procedures for remediation or revocation of contract
Terms are mutually agreeable

Having these policies and procedure documented will avoid misconceptions and give clear definition of the agreed upon role of each party.

Know Where Responsibility Lies

While the delegating entity may give a delegate the authority to act on its behalf it still remains responsible and accountable for the performance of that activity.

Whether the functions are performed by a delegated CVO or in-house, the delegating company is ultimately accountable for all functions performed within its domain. The delegating organization must exhibit the ability to monitor the activities of its subcontractors as well as ensure that processes are performed according to standards, such as NCQA (National Committee for Quality Assurance).

The delegating organization should perform regular audits and share the results with the CVO. They should then work alongside one another to create a Corrective Action Plan (CAP) to remedy each issue revealed in the audits. All documentation should be saved and readily available for reference and audits.

Protected Health Information

It is critical to document if any protected health information (PHI) will be provided to the CVO. If this information is transferred, NCQA standards require the following provisions in the documentation:

List of allowed uses
Description of safeguards that will prevent misuse by the delegate
Delineation of any transfer to sub-delegates
Assurance that the delegate will afford individuals access to their PHI information
Established notification system if there is a breach in security or protocol when dealing with PHI
Agreement that all PHI will be returned or destroyed at the delegators request at the end of the contract

When the delegating organization properly handles these essential obligations, they can move forward with ease and peace of mind.

About the Author

Melissa Outlaw

Quality Data Matters

Jim Leonard — Fri, 17 Oct 2014 15:58:00 GMT

There must have been a sigh of relief for many healthcare providers, payors, clearing houses and billing services when the Center for Medicaid & Medicare services (CMS) announced the delay of the ICD 10, again. The new date of October 1, 2015, is exactly one year from the previous deadline.

You may be wondering why such a long delay? Well, going from 18,000 codes to more than 140,000 codes requires a lot of planning, communication, testing and comprehensive training. The implementation, and results, are all about quality.

The success of healthcare providers isn’t just measured by patient satisfaction of quality of care and experience, it’s also based on maintaining positive provider relations. Fostering the success of these relationships requires actionable and equitable quality data and an MEC (medical executive committee) with the ability to analyze data effectively.

Quality Data Matters

Two providers have largely different readmission rates on the same surgical procedure. After careful review of their data, they discover that one surgeon prescribed a different post-op antibiotic compared to the other provider hence a significantly high readmission rate. Problem solved.

That is an example of the benefits of quality data. Quality data not only provides insights into what providers are doing but it also improves disease management and patient safety.

Quality data also helps in fraud detection and reduction by eliminating gray areas.

Technology and Data

Technology equips four basic items required to deliver actionable data and actualize significant improvements in patient safety, satisfaction and a hospital’s bottom line:

Clinical data should be integrated with privileging, credentialing, and peer review data to establish provider benchmarks and produce OPPE (Ongoing Professional Practice Evaluations) Reports
The delineation of each provider’s granted privileges tied to the appropriate ICD/CPT code
Apply a case-mix index with the ability to adjust for patient severity
Organizational and provider buy-in. This requires cooperation from management and the entire medical staff. By-Laws must state and providers must be assured that outcome data is not going to be utilized only as a disciplinary tool but a means by which the entire organization raises the bar on delivering the best care possible to patients

Every person on the MEC and provider relations team play critical roles in demonstrating organizational goals are to improve patient outcomes, identify best practices and foster a team environment. Understanding quality begins with the success of providers is pivotal to the future success of every healthcare organization.

About the Author

Jim Leonard

Jim serves Medkinetics as Managing Director and Consulting Practice Leader. His focus, as a national resource, is working with clients to identify and resolve gaps in performance of current credentialing and privileging platforms. Moreover, working to improve efficiencies in quality and performance improvement to streamline oversight, transparency and heighten insight throughout a single hospital or entire network. In addition to performance enhancements, Jim works with Medkinetics’ clients to ensure compliance with various reporting requirements including FPPE/ OPPE.

Does Your Credentialing Meet Standards?

Melissa Outlaw — Thu, 09 Oct 2014 23:49:00 GMT

Using words like documentation, best practices, and standards can often exude a negative emotion or reaction. They seem to conjure feelings of defeat or mounds of paperwork. However, the weight of meeting requirements doesn't have to become your organizations reality!

The intent of guidelines and standards are to serve the people and organizations that implement them. They should bring consistency, proficiency, and peace of mind. Documenting processes should alleviate the guesswork and stand as a record for future reference. When used properly, documentation can also facilitate an environment of dexterity, poise, and efficiency while mitigating any inconsistent or conflicting outcomes. When there is a firm paper trail for each procedure and action, audits become mundane instead of burdensome and alarming.

What to Document

In the “verification of credentials” process, best practice is to have the following information for each verification, regardless of the type of standard (TJC, DNV, NCQA, etc.) your organization adheres to. And in doing so, random audits will be a natural, welcomed step in your process.

Retain the name and title of the person who verified the information provided. If, for instance, a phone call is made, document the name and title of the employee who made that call. For years to come, their name and title should remain with the record regardless of that employee’s retention. If a phone call is the method used, it should be recorded or followed up with an email or fax so there is documentation of information provided.
There is not a need to document every attempt to obtain the verification. Simply record the date and time the verification was successfully obtained. The date is of utmost importance for items that aren’t static- such as licensure.
It is of utmost importance to note the source of the verification. Given the ample methods available, this source could greatly vary. It could be a person you spoke with, a fax from a human resource manager, or the URL of the website you searched. As previously stated, if it is a person, obtain and document the name and title.
You may run into discrepancies or distinctions between the information from the provider/applicant and what can actually be verified. Should this be the case, document the discrepancy. If discrepancies are found, further action may be in order. Some industries require the applicant certify and/or attest that information provided is accurate and in some cases, discrepancies found may be enough to prevent an applicant from being hired. Also, identified gaps in employment/education may be a red flag that the applicant is hiding information.
Many industries require verification to be attached to the file. This is something your organization should embrace! In the event of a dispute, you have the ability to show attorneys or auditors the information provided, who provided the information, and why decisions were made.

Credentialing software is a technology available to arm those performing the verifications and your organization. Excellent credentialing software will document many of these processes for you and will do so in a way that meets your organization’s requirements. There are some instances that shortcuts can be taken; verification of credentials is not one of them.

About the Author

Melissa Outlaw

Recovering From Mistakes

Donna Goestenkors — Fri, 03 Oct 2014 18:18:00 GMT

Mistakes, we all make them in our personal and business lives. In healthcare, mistakes come in many forms and can be minor or major. A mistake in the operating room can cost someone their life or a provider their career. A mistake in the credentialing or privileging process can put your organization in financial or legal risk. The question is, how does one recover from and move beyond an error? I actually get this question quite often when working with healthcare professionals and my initial response is “Always remember that everyone makes them”. Intellectually, you understand that as fact, but I believe it’s reassuring to hear it directly from someone who has been in your shoes.

While spending some time thinking about it, I discovered that I process mistakes in a systematic way. It’s funny that it wasn’t something I realized until sitting down to write this article.

Get Out of Your Head

It is easy to dwell on the experience, embarrassment, or judgment, but know the longer you go over and over the situation in your head, the more your self-esteem and confidence can be affected.

Identify the Lesson Learned

Identify what caused it, what you learned and what you can do differently next time.

Acknowledge and Accept

When an error is obvious to you and others, it’s vitally important to promptly accept responsibility for it, resolve it and reassure those involved that it won’t happen again.

Fix the Mistake

Review your process; make needed adjustments and work toward ongoing improvement. Ask for tools to help, if needed, or more education and support.

Focus on the Positive

Your accomplishments throughout the day measure all you do well. A mistake is just that and simply a part of what makes us human. The best way to shake it off is to work through it, resolve it and set a goal to not repeat it. Don’t dwell on the error, focus on the positive moving forward.

Walking yourself through a methodical process to identify and resolve mistakes will enhance your ability to get past it and ensure it doesn’t happen again.

About the Author

Donna Goestenkors

Outsourced Credentialing Equals In-House Quality

Melissa Outlaw — Thu, 02 Oct 2014 20:48:00 GMT

Healthcare is changing and every day there are new studies, updated findings, and more requirements that providers are required to know and follow. It’s the Medical Staff Professionals' (MSPs) job to ensure that providers meet those requirements by primary source verifying education, licensure, CMEs, insurance, etc. Additionally, many MSPs are responsible for privileging, peer review, focused and ongoing professional practice evaluations, and determining whether a provider meets the healthcare organization’s requirements for procedures performed and benchmarking.

As a result, many healthcare organizations are beginning to discover the benefits of outsourcing their initial and re-credentialing services to a Credentials Verification Organization (CVO). When utilizing a reliable and accredited CVO, credentialing can maintain the high standards MSPs are accustomed to while allowing them to focus on quality assurance and facility specific responsibilities.

Five Benefits to Outsourcing to a CVO:

CVOs are focused on one thing, primary source verification of provider credentials. Their business depends on knowing and implementing recent changes and trends which greatly reduces their client’s risk.
Outsourcing to a CVO allows MSPs to implement quality assurance steps that ensures credential files are complete without discrepancies or issues.
CVOs have automated processes that many healthcare organizations are still doing manually which generally allow CVOs to process files quicker and more accurately.
Budgeting for outsourcing is clear with the normal fixed cost per file; whereas, credentialing in-house can fluctuate costs.
The use of a CVO can result in collaborative relationships that help eliminate duplicative credentialing for multi-facility organizations with delegated credentialing agreements.

Choosing to outsource credentialing to a CVO can give MSPs the time needed to focus on high level, facility specific quality and performance tasks. Ultimately, organizations are given the peace of mind that providers are meeting and often times exceeding minimum qualifications to ensure what everyone wants – patient safety.

About the Author

Melissa Outlaw

MSPs Make a Difference

Donna Goestenkors — Fri, 26 Sep 2014 15:30:00 GMT

True Story

A while back, I boarded a flight out west to work with a client. A young man (about 24 years old) sat next to me. We exchanged greetings, chatted briefly, and he asked what I do for a living. It was in that split second – just before I responded - that I had to decide if I should really describe for him what I do or should I use my old reliable “one liner” that always gets a reaction! I replied, “I’m a healthcare consultant – I’m like the Doctor FBI.”

Like most people I’ve given this response to, his reaction was one of surprise and curiosity! He responded, “I didn’t know there were people who investigate doctors?” And we continued discussing various topics and eventually went about our own business.

About twenty minutes later, he leaned in and asked my name. I responded, “Donna and yours?” We shook hands and he said “My name is Wes and again, I never knew there were people that do what you do, but I’d like to say, thank you. What you do means a lot to me! I have a brother who went through a very difficult situation with a doctor and to learn there are professionals looking out for the public is reassuring.” I thanked him for recognizing our value and shared “My colleagues and I will keep working hard to make a difference.”

What You Do Means a Lot

I was floored that a young man took the time to respectfully introduce himself and after a brief conversation, understood the importance of what MSPs do! To me, this experience validated the importance of what we do, from credentialing to privileging to peer review and beyond, the intelligence required to do it and the absolute value of branding. So, the next time you have the opportunity to tell someone what you do, tell them you’re like the FBI for Doctors ... Go ahead and give it a try!

I wanted to share this real life experience to highlight the important position MSPs hold within their respective organizations because what they do really does make a difference! Sometimes in the hustle of getting the job done, we forget the work required really does touch the lives of the public - often in ways we can’t even imagine.

Please feel free to share my story. The fact that it’s all true makes it that much better!

About the Author

Donna Goestenkors

Uncharted Waters - Integrating Disparate Medical Staffs

Richard Curtis — Wed, 17 Sep 2014 20:26:00 GMT

For years, multi-hospital systems have looked for ways to consolidate medical staffs only to be stymied by an age old Centers for Medicare and Medicaid Services (CMS) requirement that each hospital have its own separate and distinct organized medical staff.

All that changed in July of 2014 when CMS announced revisions for Acute Care and Critical Access hospitals. Under the new guidance, CMS will allow for either a unique medical staff for each hospital or for a unified and integrated medical staff shared by multiple hospitals within a hospital system.

Accrediting organizations have moved quickly to align their standards with CMS. In order for hospital systems to take advantage of the allowance, four requirements must be met:

Members holding privileges at the medical staff of each hospital must vote on whether or not they wish to integrate into a single medical staff. If a medical staff does not wish to integrate, they must be allowed to remain separate and distinct.
For those medical staffs that choose to integrate, they must form a common set of bylaws, rules, and requirements that describe processes for self-governance, appointment, credentialing, privileging, and oversight, as well as its peer review policies and due process rights guarantees.
The integrated medical staff must be established in a manner that takes into account each hospital’s unique circumstances and any significant differences in patient populations and services offered in each hospital.
The integrated medical staff must give due consideration to the needs and concerns of its members regardless of practice or location, and mechanisms must be in place to assure that issues localized to particular hospitals are considered and addressed.

There’s a case to be made for an integrated medical staff. Efforts to adopt evidence-based practices and standardize care processes are more efficient when managed through a single medical staff structure versus the often unwieldy and time consuming process of working with multiple medical staffs. To be sure, the road towards creating a single integrated medical staff will be one full of challenges and unforeseen obstacles. At least, though, hospital systems now finally have the ability to embark on this long awaited journey.

Richard Curtis RN, MS, HACP

Verifying Gaps in Provider Work History?

Melissa Outlaw — Fri, 12 Sep 2014 20:44:00 GMT

It's all too common in healthcare credentialing today for providers to have gaps in their work history. The reasons vary wildly from mission trips to family obligations and long vacations. At the same time, those gaps can represent a serious red flag regarding an incident or event. And, although we'd love to believe everything we hear it's imperative that all gaps in work history are verified and clearly documented by the Medical Staff Professional (MSP).

Three Ways to Verify Gaps

Employment Verification

If the provider stated they were on a mission trip or attending another work related function, you should verify this the same way you would any other employment verification. Contact the church, non-profit organization, or whomever and obtain an employment-like verification.

Professional Reference

A gap in work history where the provider states they were on vacation can be verified by a professional reference. Best practice is to ensure the verifying reference has a close business relationship with the provider. Additionally, you may want to require more than one reference to ensure no stone is left unturned.

Education Verification

If the provider's leave is associated to some form of continuing education, contact the school or association responsible for leading the training and verify the provider's attendance or involvement. Be sure to collect specifics about the days, hours and if needed, you may consider a professional reference in addition to the education verification.

Important Information

Regardless of the verification source, there are some key pieces of information you must collect to accurately document and account for the provider's whereabouts during the gap.

Date Range Verified
Reason for Gap
Name of Source Providing Verification
Relationship to Provider (specific to professional reference)
Title
Signature

The verification should be in written format and signed by the verifying professional. To ensure all pertinent information is given, consider providing the source a form/questionnaire. Generally speaking, the source supplying the verification prefer to receive the questionnaires via email so they can complete it electronically. Additionally, allowing the reference to complete it on their own schedule may provide a quicker turn around resulting in faster onboarding – a win/win for everyone!

Melissa Outlaw

MSPs - A Guide to Success

Donna Goestenkors — Fri, 05 Sep 2014 16:00:00 GMT

The expansion of roles and responsibilities within the Medical Staff Office (MSO) has created a significant opportunity for Medical Staff Professionals (MSPs) to take a leadership role within their organization. More than ever, delivering optimal care for patients is driven by the ability to collaborate with colleagues, providers, and professionals from a growing number of specialties. MSPs play a pivotal role in managing the hub of a constantly evolving environment.

As the role of the MSP evolves, so does the need to become more intimately involved and assertive in driving the success of the organization. There are some specific strategies I’ve found successful in elevating the profile and value of MSPs to the healthcare organizations they support.

Specific Strategies

The first step is putting yourself out there and getting involved so other professionals you work with take notice. Although the first step may seem like a big one, I would invite you to review and incorporate some of these strategies to increase your value to the team, build relationships and take a leadership role within your organization.

Introduce yourself, speak with others at meetings, and get involved in NAMSS or other work-related professional groups
Demonstrate your skills by volunteering to present or lead a team project
Convey that you’re the on-site expert regarding industry issues
Express your opinion on important topics
Practice excellent listening skills
Demonstrate flexibility and the desire to be a team player
Keep commitments to deadlines
Practice the traits of someone who has a practice, characteristic or style you’d like to emulate
Be forthright and kind, sincerity goes a long way
Remember to SMILE, it’s infectious

An investment in Success

Building relationships takes time – that’s a fact! Incorporating just a few of these tips will get you noticed - in a good way! Professionals will seek you out, ask your opinion and want to connect with you. Consider these suggestions as building blocks; an investment in your career success.

About the Author

Donna Goestenkors

Privileging AHPs, What Are You Missing?

Julie Costa-Bickmore — Thu, 14 Aug 2014 19:33:00 GMT

Did you know Allied Health Professionals (AHPs) make up approximately 60% of the healthcare workforce?¹ That’s over 6 million providers of the 11 million in our healthcare workforce with more than 85 distinct occupations exclusive of physicians and nurses.² AHPs are experts in a multitude of therapeutic, diagnostic and preventative settings that include everything from disease prevention to rehabilitation and they, like physicians, need to be granted privileges to work in a healthcare setting.

Why Privilege AHPs?

While AHPs participate as healthcare team members in patient care under physicians or nurses, they also provide direct patient care as well. Regardless of which side of patient care they’re on, credentialing and privileging AHPs to “touch” a patient is imperative when considering them as members of your healthcare staff.

Privileging Sources

There are many organizations that recommend specific requirements or scope of practice for AHP specialties. For example, in Audiology, The American Board of Audiology and The American Speech-Language-Hearing Association (ASHA) offer the “Certificate of Clinical Competence”. Advanced Registered Nurse Practitioners are guided by The American Academy of Nurse Practitioners-Standards of Practice and the American Nurses Credentialing Center. All organizations offer great resource information when developing privileging criteria.

State Specific Requirements

Last but not least, be sure to check with your respective state(s) in which the AHP will be practicing as there may be a ‘Scope of Practice’ in place regarding how they are licensed that may need consideration. For example, New Jersey has specific requirements for Physician Assistants, Minnesota for Licensed Drug and Alcohol Counselors and Utah, Nebraska, Missouri and Florida all have unique competencies for Advanced Practice Registered Nurses.

Training & Certification for Maintaining Privileges

Many of the organizations recommending requirements for privileging AHPs also provide details on continued training and minimum certifications to maintain privileges. As with physician privilege delineation, continuing education for AHPs should be clearly outlined in your bylaws and reviewed regularly. Medical Staff Professionals (MSPs) should work in collaboration with their AHPs to ensure required training sessions are available and attended.

Re-Privileging AHPs

Re-privileging AHPs should follow the same requirements as providers, every two years. MSPs should verify all licenses are still active, no sanctions have been imposed, and quality statistics are within the organization's documented guidelines.

When it comes to the “patient experience” and overall quality of healthcare provided by your organization, AHPs play a pivotal role. One could argue AHPs spend as much or even more hands on or face time with patients than providers do. And with the future of healthcare being driven by Quality, Performance Improvement and the Continuum of Care - AHPs should be considered as valuable a member of your team as anyone in your organization.

^1- Center for the Health Professionals at the University of California, San Francisco

^2- Health Professionals Network

About the Author

Julie Costa-Bickmore

Are all Accrediting Organizations the same?

Jim Leonard — Thu, 07 Aug 2014 20:00:00 GMT

Like any competitive organization, the what, when and how services are delivered can mean a big difference in how you perform. Every organization carrying the Centers for Medicare & Medicaid Services (CMS) moniker “Approved Accrediting Organization” has worked through a rigorous process to document their rules and regulations will be followed by hospitals they accredit. The question remains, what does that really mean to you and your hospital? Yes, the partner you’ve selected has been approved to perform surveys and work with you to correct any wrongdoings, but how they go about their day to day operations can be disparately different.

As your organization works through the process of choosing a survey partner, or better yet as your organization works through the process to change survey partners, what should you be looking for? After all, this is your opportunity to ask “What will your accrediting organization do to help support us in meeting the Conditions of Participation for Acute Care Hospitals as well as our own internal regulations?”

Other considerations:

What types of surveys are conducted?
Is there a requirement for an annual self-assessment?
Other than a triennial survey, how often are other required surveys conducted?
Are additional fees attached to “complaint” or “follow-up” surveys to clear condition level findings?
Is the Accreditation Outcome simple or complex? Do you get a Pass/ Fail or are there complex rules?
What’s their time frame for submitting a “Plan of Correction” following a survey? If the data has been collected and the survey is complete, you don’t want to wait for a plan, you want to get the plan and strike while the iron’s hot!
Does the Accrediting Organization charge extra for these important components:

Standards interpretation?
On-line access to standards?
Audio conferences to educate staff and leadership?
Resource and reference libraries with tools to aid compliance?

Choosing a partner as your Accrediting Organization can be a challenging task. Colleagues within your healthcare organization may have heard of this one or that one and may simply be comfortable partnering on name alone. Your responsibility in choosing a partner to meet internal and CMS standards is to vet appropriately, thoroughly, ask hard questions and ensure the partner you choose is there to support you and not just provide a shiny plaque to hang on the wall.

Come See What All The Buzz Is About!

About the Author

Jim Leonard

Event Reporting, Are Those Numbers Correct?

Cindy Terry — Tue, 05 Aug 2014 19:00:00 GMT

Reporting and statistics are necessary to ensure we’re achieving our greatest potential personally and professionally. As professionals, we use various tools daily to assess performance, stay on track and make educated decisions about our future. As we discussed in our last post in this series, there are two kinds of reports, those that add value and those that don’t. Once you’ve determined which reports are necessary, trusting the numbers and accuracy of data is imperative!

Have Your Numbers Ever Been Questioned?

In any profession where research plays a pivotal role, it’s important to have the evidence to validate results. Perhaps you’ve been in a meeting with a provider who’s questioned the validity of a report or said the dreaded words – “I don’t think those numbers are accurate!” Providers are trained to think scientifically so it's natural for them to question, critique and question some more; especially when it comes to metrics representing their performance. When presenting event reporting data, it’s imperative to be prepared for questions and confident in the process or system you’re using to share results.

How to Ensure Quality Data?

Even when you’ve worked diligently to ensure accuracy, it can be difficult to defend manual collection metrics. We meet with hospitals every day who are without event reporting software or their current software isn’t robust enough to be of value to the team making outcome and patient care decisions. In either situation, you spend more time than necessary chasing data – only to be questioned about its validity. Having robust Event Reporting Software (ERS) in place can streamline and simplify validating data quality for hospitals and staff.

What to Look for in Event Reporting Software

Event Reporting Software should do several things. It should:

Store events so data can be input once and reused for reporting and analytics
Aggregate data and produce reporting metrics you can trust
Integrate with your organizations provider management software; such as credentialing, privileging, peer review, and focused/ongoing professional practice evaluations (FPPE/OPPE).

Confidently reporting data to providers is, indeed, achievable with the right event reporting software! With it, the risk of errors from manual calculations or missing data will be a thing of the past. With the right ERS, everything can be documented electronically, available for analytics and integrated with other applications in real time. All which remove human error and give you the confidence to respond to questions about the data, especially to those with critical minds!

Medkinetics’ complimentary Event Reporting Software checklist is available to assist in selecting an ERS. Once an ERS is implemented, your organizational goals start becoming reality. You can have more accurate data and spend less time chasing it!

About the Author

Cindy Terry

Cindy is the Director of Quality for Medkinetics following 27 years of hands-on experience in healthcare. Her work with Medkinetics includes leading and directing quality, risk and patient safety initiatives. She assists with ongoing development of our Quality and Performance Improvement system as well as partnering with clients to ensure a seamless implementation that meets standards and allows for the collection and analysis of quality, risk and/or patient safety information. In this role Cindy is also responsible for education and training client leadership, staff and physicians as to the facets of Medkinetics suite of products.