JCAHO Physician Engagement Advisory Group Formed

Are there any openings left?  I want to nominate Aggravated DocSurg, Medpundit, and Bard Parker…  

The Joint Commission on Accreditation of Healthcare Organizations has announced the establishment of an 18-member Physician Engagement Advisory Group. The group will advise the Joint Commission in its efforts to expand physician participation in the accreditation process and to broaden physician engagement in quality of care and patient safety initiatives.


Georgia M.D. Loses License

The license of Totada R. Shanthaveerappa, M.D., the 70 year old Georgia doctor charged with injecting cancer patients with weedkiller and defrauding insurance companies, was suspended last week.

The Georgia Medical Board of Examiners, after an emergency meeting, voted 9-0 to recommend the suspension of Shanthaveerappa's license on December 23rd.

A Chance to Cut is A Chance to Cure outlines some of the details of this strange case, as does the Atlanta Journal Constitution (free registration required).

Dr. Shanthaveerappa maintains a web site at http://www.wehealcancer.com/


I get regular e-mail from the RealAge folks. One of this week’s topics was the health benefits of friendship.

Spending time with good friends may protect health by helping lower blood pressure, decreasing levels of stress hormones, and boosting emotional well-being.

Research suggests that close relationships with family members can help protect health, too. In addition to spending time with family and friends, practicing stress reduction techniques may also protect your emotional health.

“Walking with a friend in the dark is better than walking alone in the light.” ~ Helen Keller

Truth and Consequences

If you were terminally ill, would you want to know? Would you be one to ask, “How much time have I got left Doctor?” I suspect that most of us would answer yes. We would feel the need to make plans, arrangements, and help prepare loved ones. But is complete disclosure always the right answer? Probably not.

The New York Times reports on the Doctors’ Delicate Balance in Keeping Hope Alive. In a poignant article, author Jan Hoffman writes about the difficult balancing act between hope and despair that doctors face when dealing with the seriously ill.

Assessing his 23 year old AIDS patient, Dr. Sacco knew her medical options amounted to a question of the lesser of two evils: either the more aggressive ventilator, on which she would probably die, or the more passive morphine, from which she would probably slip into death. But there was also a slender chance that either treatment might help her rally.

He also knew that how he presented her options would affect her decision, the feather that would tip the balance of her hope scale.

I know a family who lost a member to terminal cancer a number of years ago. I saw first-hand the damage that can be done by false positives and cheerful platitudes. When the patient died his family felt angry and betrayed by his physician, who had just days before told them how good his test results were, an indication that he was responding well to chemo. I doubt that the doctor actually said the patient was getting better, but that is understandably what the family heard.

After the patient’s death the doctor steadfastly avoided family members and their questions.  They were left feeling that they simply no longer mattered.

I suspect that it was more that the doctor used avoidance to distance herself from grief. Part of me is sympathetic, doctors are human too.

The power of a doctor’s pronouncements is profound. When a doctor takes a blunt-is-best approach, enumerating side effects and dim statistics, in essence offering a hopeless prognosis, patients experience despair.

Efforts are being made across the medical community to grapple with the language and ethics of hope.

It’s an important discussion. I hope it continues.

JCAHO – The Borg?

Aggravated DocSurg is living up to his name today – he’s really quite aggravated. The target of his wrath is the Joint Commission on Accreditation of Healthcare Organizations. He labels them The Death Star of American Medicine.  Medpundit and Bard Parker have joined in the fray.

As a veteran of many encounters with JCAHO surveyors over the years, I feel I must take issue with some of the statements made by my aggrieved fellow-blogger.

Watching hospital administrators lose bowel and bladder control the minute a JCAHO inspection is brought up has always reminded me of Vader’s underlings wilting in his presence..What is most galling to me, however, is that hospitals must fork over a hefty sum for these frequent torture sessions, and the inspections are done not by practicing physicians or nurses, but by folks who long ago gave up the difficulties of actually caring for patients for the safety of a clipboard to hide behind.

We agree; the Joint Commission is powerful. Accreditation is voluntary, but pity the reputation and finances of the poor institution that fares badly on a survey. However, while many surveyors have retired from active practice, a number have not. For those who have, I doubt they’ve forgotten all ‘the difficulties of caring for patients.’

A hospital that wishes to bill federal programs may choose to be inspected by the government, in the form of CMS surveyors, instead of JCAHO. Can’t say I’ve had that pleasure, but some of my colleagues have reported that a JCAHO survey is far less painful.  There’s also a potential new player on the horizon in the form of TÜV Healthcare Specialists.

My experience with JCAHO accreditation is based primarily on hospital compliance with Medical Staff and Leadership standards. Understanding and implementing those standards is a challenge; many of them are inconvenient and expensive. It is for that very reason that healthcare needs accrediting bodies. Hospital leaders aren’t overly fond of inconvenient and expensive standards. If no one was “looking over their shoulders” some standards would simply be ignored.

Case in point. Several years ago I did consulting for a number of different hospitals. The first day at one of them an administrator I met told me to work on temporary privileges for a surgeon who was at that very moment, in the OR. No records, no verification of credentials, no screening, but in the OR performing surgery nonetheless. Turns out this was not an isolated occurrence. When I vigorously argued about this practice, the administrator’s response was that it was his job to bring in money to help keep the hospital financially solvent, it was my job to worry about credentials.

Thanks to a team of Joint Commission surveyors, that practice came to an abrupt end, thank you very much.

Joint Commission accreditation is a far from perfect process. My biggest complaint over the years has been that survey focus is often surveyor dependent. Some surveyors have “pet” standards which they focus on to the exclusion of others. That seems to be less of a concern with the recent change to tracer methodology, where patients are “traced” through the facility.

So my Aggravated friend, there is another side to this story. Resistance may not be futile, but sometimes it’s just not healthy.

The JCAHO mantra can really be translated as “Resistance is futile. You will be assimilated!” As a result, I suppose JCAHO is really The Borg.

Technorati tag: JCAHO

National Provider ID Program Begins in 2007

BizJournals.com reports that most HIPAA-covered entities must obtain and use National Provider Identifiers to identify themselves and process standard transactions by the following dates:

May 23, 2007 for Medicare, Medicaid, and covered entities, except small health plans.
May 23, 2008 for small health plans (receipts of $5 million or less).

Health care providers include physicians, dentists and pharmacists, as well as organizations such as hospitals, nursing homes, health maintenance organizations, pharmacies and group practices.

Every health care provider, including individual health care professionals who transmit health information electronically in connection with any of the standard transactions, is required to obtain identifiers, even if they use business associates, such as billing agencies, to prepare transactions.

Go to BizJournals.com for the full article: New fed rule assigns health providers single ID number

Procedural Credentialing as a Defense

Dermatology Times contains an article by David Goldberg, M.D., J.D., Credentialing: Can hospital be liable for docs?

Dr. Jonas was sued for alleged negligence…  In his defense, he pointed to the fact that he had hospital privileges to do such peels, had been evaluated by the local hospital in this approval process and therefore was "procedurally credentialed" by the hospital.

Once this defense was supplied to the plaintiff’s legal counsel, they amended their initial complaint to include vicarious negligence on behalf of the hospital for its negligence in credentialing Dr. Jonas.


Interview – Ruth Jackson, CPMSM, CPHQ, CPCS

Welcome to the second installment in the MSSPNexus Interview Series.  This interview features Ruth Jackson, CPMSM, CPHQ, CPCS, Director of Professional Staff Services at Children’s Hospital of The King’s Daughters Health System in Norfolk, VA.

Ruth came to my attention when I found out that she joined the National Association Medical Staff Services (NAMSS) in 1983, just five years after the association was founded.  Truly, she is the voice of experience in the medical staff services profession.  She is also well known for her willingness to share her knowledge and experience with other MSSPs.    

MSSPNexus: How long have you been working in the field of medical staff services?
Since March 1, 1982.

MSSPNexus:  You’re a long-time member of NAMSS, what do you consider the best benefit(s) you’ve received over the years?
One of the greatest benefits is the ability to network with my peers – people who are doing the same thing and who understand all the ins/outs/problems and offers of help so we all don’t have to "re-invent the wheel"

MSSPNexus: What advice do you have for people who may be new to the profession?
Remember that your life and family are important – take time for them.

MSSPNexus:  Why do you feel that the work you do as a medical staff service professional is important? 
I am in a PEDIATRIC HOSPITAL – and those babies and little children need someone to make sure that the people "touching them" are trained, qualified and competent – and understand that children are not just "little adults".  I am proud to play a part in that.

MSSPNexus: Any closing comments? 
This is a great profession – very demanding, often under appreciated, but the pride we can take in what we do is wonderful!!!

MSSPNexus: Thanks Ruth – we appreciate you!