The focused professional practice evaluation (FPPE) process is designed to establish a systematic process to ensure there is sufficient information provided to confirm the current competency of practitioners initially granted privileges and current members who have been granted new privileges. One of the ways health care facilities are implementing this process involves the assignment of proctors. This responsibility could reside with a section chief, department chair, or chair of the credentials committee. My guess is that in most cases it will be the responsibility of the department chair.

That being the assumption, how will the department chair manage the assignment of proctors and what incentives will be offered to proctors to accept responsibilities of being a proctor. For example, the criteria for being proctor may be that he/she must be a member in good standing and must have unrestricted privileges to perform procedures similar to those of the physician to be proctored. The first step is to define the type of proctoring required for the new physician (direct observation, concurrent observation, or retrospective chart review).

The proctor must further agree to complete necessary paperwork (evaluation forms) for the number of cases designated for determining competency in each privilege area. One of the major concerns will be how much time will the proctor need to spend in the proctor role and how much time will that take away from his/her private practice.

The Joint Commission has admitted that this will be a resource intensive effort for practically all our facilities and especially difficult for those without the infrastructure to collect, monitor and compile data for the department chair's review.

How will you solve this problem at your facility? Your experience and comments are most welcomed!

Carole La Pine, MSA, CPMSM, CPCS

Washington Post reporter Ellen Nakashima recently wrote an article on healthcare databases being used to develop a "health credit report". It appears that insurance companies to help improve health care and reduce costs can use prescription drug databases containing over 200 million records. 

Instead of using physician medical records, drug profiles are considered more accurate, less expensive, and quicker to obtain. This practice demonstrates the use of electronic data obtained for one purpose, then used and marketed for quite another. Is such a practice protected by the federal health privacy rules? Does it border on accepted – non-accepted practice? 

Here's what is occurring: companies Ingenix and Milliman construct patient profiles using prescription drug databases to retrieve prescription drug histories. Insurance companies may then make an on-line query on a patient. The database is searched and returns aggregated data going back as far as t years and includes information such as dosages, dates filled, therapeutic class and prescribing physician. This data is massaged to produce a "pharmacy risk score." High scores suggest higher medical costs. 

According to report Nakashima, such profiles cost about $15/search. One company gets approximately 1 million queries from insurers each year. Sounds like a very lucrative business! 

Questions for MSPs to consider: How will this affect a hospital's pharmacy? How does this affect the confidentiality of patient health information? 

Carole La Pine, MSA, CPMSM, CPCS

Michigan's Governor Janet Granholm was informed on August 6 that there was a breach of the confidentiality of her medical record.  The breach was discovered during a routine audit to ensure compliance with federal health record privacy protection laws.  As a result of this audit it was discovered that employees of Sparrow Hospital had attempted to access the computerized medical information when the Governor was admitted for abdominal surgery on April 29.  Disciplinary action resulted in some employees getting fired and others were "disciplined" (details not available). 

This is not an isolated incident.  It has been reported that medical breaches are increasing as more medical records become computerized.  Over 120 workers at a Los Angeles hospital looked at celebrities' medical records and other personal information (Britney Spears, Farrah Fawcett, and Maria Shriver) between January 2004 and June 2006.  Some of these employees were fired, others were disciplined. 

This may be a good time to remind employees that the confidentiality of health records is serious business.

Carole  La Pine, MSA, CPMSM, CPCS

In a few short weeks I will be making a major change in my working world. I'm leaving a position I've held with an organization for over 18 years! Why the change? New challenges, pay increase, and an opportunity to share my knowledge with a wider audience. The decision to change jobs wasn't easy; in fact, it was extremely stressful. Once decided, however, I am now moving on, wrapping things up at one end and gearing up at the other.

If you are thinking about your current position and wondering if it as good fit for you, consider what I learned from my experience.

There is no "perfect" job. The hours may be different, the drive to and from work may be longer, and the salary may be higher but it is the excitement and satisfaction of job performance that makes it fulfilling.

What drives MSPs to perform is the knowledge that our efforts add value to the organization and that we are appreciated and respected by bosses and peers.

MSPs don't have to be "managers" to make things happen; we see the goal and stay focused on reaching it.

MSPs look for a place where we can demonstrate leadership, and a place where we can make a difference.

Once we find that place, we'll have a job we love!


Carole La Pine, MSA, CPMSM, CPCS

Here in the United States MSPs have been hearing about a serial killer named Michael Swango. Author James Stewart reported the Swango case in his book, Blind Eye. This week I learned about another notorious serial killer, Harold Shipman, an English general practitioner who happens to be the only British doctor to be found guilty of murdering his patients. He was convicted January 31, 2000 for 15 murders and sentenced to life imprisonment. Following the trial, an investigation discovered enough evidence to link Shipman to the murders of over 215 people, 80 percent of them females.

As a result of these horrific crimes, a plan to require annual competency evaluations is being implemented and will affect over 150,000 physicians from India who are practicing in the United Kingdom. The details of the plan are explained in Medical Revalidation: Principles and Next Steps by Sir Liam Donaldson, Britain's Chief Medical Officers. Senior physicians appointed to identify poor performers based on patient questionnaires and comments from colleagues will conduct these assessments. These assessments will include physician communication skills, prescribing habits, personal problems (alcohol or drug abuse) and inclusion of patients in decisions regarding their treatment.

Who came up with this idea? According to information from the references listed below, the proposals were developed by the General Medical Council and the Academy of Medical Royal Colleges. The rationale is the scandals over medical incompetence and in particular the case of Dr. Shipman. The focus of this plan is to raise standards, not as a means for disciplinary action for a small number of physicians.

It will be interesting to see how this plan rolls out, how it is perceived by the public, and what impact it may have on the practice of medicine. Think the United States government will be watching?

Carole La Pine, MSA, CPMSM, CPCS



References:
www.business-standard.com/india-Press Trust of India
www.medscape.com - Tim Castle
www.timesonline.co.uk/tol/life and style/health - David Rose
http://en.wikipedia.org/wiki/Harold_Shipman

Many MSPs are familiar with the book Blind Eye by James Stewart about a physician, Michael Swango.  If you have not read this book, you'll want to pick up a copy to learn more about why our jobs are so important to patient safety. 

Mr. Stewart reports the allegations that caused many to believe that Michael Swango may be the most prolific serial killer in American history.  The story is of particular interest to MSPs who investigate applicants for medical staff membership, privileges, and participation in health plans.  Learn how Swango's behavior was not discovered before he committed murder and poisoned coworkers. 

After reading Blind Eye, you'll wonder if you would have uncovered Swango's incompetence, misconduct and criminal behavior. 

Carole  La Pine, MSA, CPMSM, CPCS

I recently learned that The Joint Commission has a Certification Program for Health Care Staffing Services.  The program evaluates the staffing service's ability to provide qualified and competent clinical staff.  To be eligible for this certification a staffing firm must be responsible for placement of clinical staff in other organizations that oversee or provide direct patient care; or placement of clinical staff under the direct supervision of another organization's personnel and have placed at least 10 clinical staff at the time of the evaluation. 

The program also evaluates the staffing service's processes for verifying the credentials and competencies of the clinical staff.  The Health Care Staffing Services Certification Manual standards cover leadership, human resources management, performance measurement and improvement, and information management. 

Two external groups helped The Joint Commission establish the certification program.  One was an Advisory Council comprised of representatives from health care staffing firms and associations and the other was a Standards Task Force composed of industry recipients, providers and other stakeholders.  A Certification of Distinction is awarded to the health care staffing firm that meets the requirements for certification. 

The next time a hospital or ambulatory clinic needs temporary coverage (locum tenens), it might be worth the effort to ask about Health Care Staffing Services certification. 

Carole  La Pine, MSA, CPMSM, CPCS

Physicians who have been reluctant to participate in peer review activities can relax a bit knowing that the Health Care Quality Improvement Act (HCQIA) still stands on solid ground.

In 1998, Presbyterian Hospital of Dallas suspended Dr. Lawrence Poliner’s cardiac catheterization and echocardiography privileges after several physicians questioned his technical competence during peer review activities. Poliner rebutted with a law suit. During the 2003 trial, Poliner convinced the jury that the suspension damaged his career and caused mental anguish. The jury subsequently awarded him $370 million in damages. A trial court later reduced that amount to approximately $33 million.

On July 23, 2008, The U.S. Court of Appeals for the Fifth Circuit overturned the jury and the trial court’s decisions and found in favor of Texas Health System, concluding that the physicians who advocated for Poliner’s suspension are protected under the Health Care Quality Improvement Act. As a result, Poliner will not receive any monetary award for damages.

Read more about the Poliner vs. Texas Health Systems case.

http://www.ca5.uscourts.gov/opinions/pub/06/06-11235-CV0.wpd.pdf

An interesting application crossed my desk this week.

The applicant provided an explanation of a lawsuit that was filed against her.  She explained that one night when she was on call, she was asked by a nurse to come help with a patient who was "out of control".  The patient was wailing his arms, kicking and slapping at the nurse.  The doctor helped to get the patient back to bed all the time being punched and kicked.  The patient then began jumping on the bed. Fearful that the patient would fall off the bed and injure himself, the doctor tried further control over the patient.  The patient continued to kick and punch so the physician "gently" slapped the patient to get his attention.  The nurse reported the physician to administration for patient abuse.

I posed this question to several of my highly respected peers.  Here are some of their thoughts:

Carol (not to be confused with me, Carole):  I think that the physician behaved inappropriately (as did nursing) but the situation was unusual and extreme.  Unless there was a pattern of concern with this physician (previous examples of poor judgment) that this should be an interesting part of this story but have limited impact.

Bonnie:  I would want to verify her story somehow, either through an administrator at the hospital or department chair.  I would also confirm that this behavior was a single incident and not typical of her.  I would push her a little bit to see what evidence there really was to support a lawsuit going forward.  I would probably ask her for a copy of the filing papers.   Did the licensing board take any action or investigate?  Did her hospital take corrective action?

Anne:  There never is a good reason for physical abuse.  I've never heard of a "gentle" slap.  This application requires careful investigation and perhaps an interview with a physician well-being committee.

If you were processing an application, how would you handle this?

Carole La Pine, MSA, CPMSM, CPCS

Physicians who have been reluctant to participate in peer review activities can relax a bit knowing that the Health Care Quality Improvement Act (HCQIA) still stands on solid ground.

In 1998, Presbyterian Hospital of Dallas suspended Dr. Lawrence Poliner’s cardiac catheterization and echocardiography privileges after several physicians questioned his technical competence during peer review activities. Poliner rebutted with a law suit. During the 2003 trial, Poliner convinced the jury that the suspension damaged his career and caused mental anguish. The jury subsequently awarded him $370 million in damages. A trial court later reduced that amount to approximately $33 million.

On July 23, 2008, The U.S. Court of Appeals for the Fifth Circuit overturned the jury and the trial court’s decisions and found in favor of Texas Health System, concluding that the physicians who advocated for Poliner’s suspension are protected under the Health Care Quality Improvement Act. As a result, Poliner will not receive any monetary award for damages.

Read more about the Poliner vs. Texas Health Systems case.

http://www.ca5.uscourts.gov/opinions/pub/06/06-11235-CV0.wpd.pdf