Grand Rounds 2.23

Grand Rounds 2.23, this week’s best of the medical blogosphere, is up at A Chance to Cut is a Chance to Cure. 

This week’s edition is accompanied by the artwork of the late surgeon/painter Joseph Wilder, M.D., a 1942 Dartmouth College graduate who earned his M.D. at Columbia. Before his retirement, he was chief of surgery at New York’s Hospital for Joint Diseases and a professor of surgery at Mt. Sinai Medical School. 

Nice job Dr. Parker!

Read more about ‘Bard Parker’ on Medcape, Blogging Surgeon Cuts to the Heart of Medicine, by Nicholas Genes, M.D. (Free registration required.)

Badge Bureaucracy

Nick Jacobs, President of Windber Medical Center in Windber PA shares an email thread he recently received from an employee.  Sometimes we’d be better off just picking up the phone…

This is one of the 231 e-mails I receive every day. The names have been changed slightly to protect the guilty. This may be why we haven’t put anyone on Mars yet. It is priceless.

Dear Employee Number 2:
Could you please create a new ID badge for employee number 3 with the attached photo? His title is BLANK Assistant. Thank you.
Employee Number 1

Dear Employee Number 1:
Did he lose his badge? We charge $5.00 for replacement badges.
Employee Number 2

Dear Employee Number 2:
I requested him to have a new photo and updated badge. Unfortunately, I think we are going to have more coming through. We are making some changes that will mean requiring updated information on Id’s.
Employee Number 1

Keep reading to the big finish…

Board Certification and Credentialing Discussed in JAMA

When it comes to ensuring that pediatricians who are granted privileges are board certified, neither hospitals nor health plans appear to be up to snuff, according to two studies undertaken for an American Board of Pediatrics advisory committee. Gary Freed, M.D., of the University of Michigan reported his findings in the Feb 22 issue of the Journal of the American Medical Association.

Christine Cassel, M.D., president of the American Board of Internal Medicine, added "It would be valuable to have this study reproduced in several other major specialties or perhaps across physician groups involved in hospitals or health plans."

A few years from now, they wrote, studies such as those of Freed and colleagues might well show a more rigorous approach to monitoring.


Surgeon02 This study could hardly be considered non-partisan as it was conducted at the behest of the American Board of Pediatrics, however, it does revisit long-standing questions.  The issue of whether to require board certification has been (hotly) debated over the years by many a Credentials Committee.

1.  Should board certification and recertification be required for hospital privileges and health plan credentialing? 

2. Are there excellent, highly-qualified physicians who are not board certified? 

3. In the US should the claim of Board Certification status be limited to those who acquire and maintain certification from an ABMS (American Board of Medical Specialties) or AOA (American Osteopathic Association) Board? 

4. If you answer No, board certification should not be required and Yes, there are excellent physicians who are not boarded, what benchmark should be used to determine who qualifies?   In the world of credentialing we often use the phrase ‘or equivalent training and experience’.  Who determines equivalency?

These are difficult questions.  I suspect the trend in US hospitals is toward not requiring ongoing certification, partially because enforcing the requirement can become so onerous and even litigious.

Would you be willing to see a non-board certified physician? 

Read full text of the article Lapses Found in Pediatrician Credentialing in MedPage Today:

A Valuable Life

It isn’t often that attending a professional conference alters your perspective completely, but that’s what happened to me a few years ago. It was an Ohio Association Medical Staff Services session that dealt with physician impairment.

What made this session noteworthy? In addition to the educational speakers from OPEP, several recovering physicians bravely faced an audience of medical staff credentialers (and we, as you may know, tend to be a cynical and suspicious lot; it’s a job hazard) and told their stories. Each was at that moment ‘clean and sober’, some for a few months, others for many years, but each had a compelling, poignant, exceedingly human, story to tell.

I walked out of that room with far more understanding and compassion than I went in with.

My paradigm shift?  It remains our responsibility to protect patients, but it is accompanied by an equal responsibility to extend help and care to afflicted practitioners. Not all will accept it, but evidence shows that a significant percentage will.

Consider this account. A resident was called in late one night to care for a patient because the attending had shown up at the hospital drunk. Concerned for the attending physician, the next day the resident approached a senior member of the medical staff and asked what could be done to help him.

“Don’t worry about him,” was the reply. “As soon as we get one more documented instance we’re getting rid of him.”

Of course, that documentation soon followed and the physician was dismissed from staff. Several months later he died from an alcohol overdose.

A valuable life carelessly tossed away.

About 15% of physicians will suffer from some form of addiction during their lives. However, those who receive treatment also have a phenomenal rate of recovery; they are intelligent, educated, and highly motivated.  With treatment between 80 and 90 percent recover and learn to live sober.

As a conservative estimate at least 4% of your professional staff members are currently abusing alcohol, drugs, or both. Get educated. Find out how to help those who will accept help, and how to protect your patients from those who won’t.

Federation of State Physician Health Programs

A Reason to Smile

I’ve been very good all week, reporting on JCAHO Standards and TUV CMS applications. It’s time to expend a few keystrokes just for fun.

As you may know, I work at Mega Clinic in Northeast Ohio. Really big place – lots of buildings, many of which are linked together by indoor skywalks. Being that it tends to be quite cold and blustery in NE Ohio, being able to walk for blocks inside is a good thing.

This story however, unfolds on a beautiful warm June morning a couple of years ago. It was one of those days that just forces you to be in a good mood, no matter how many Joint Commission standards you know you’re going to have to enforce. I drove to work with the radio turned up loud and the windows down. Arrived at Mega Clinic, jumped out of my car and began the long walk from where I park to where I work. (Mega Clinic is very health conscious on behalf of its employees, I believe that’s why they assign us parking twelve blocks from where we actually work.)

The first person I encountered on my marathon walk smiled at me and said good morning. “Good morning!” I cheerily replied. The next several people I passed also smiled and said good morning. “Good morning” I replied, beginning to wonder suspiciously why everyone was in such a pleasant mood. After all we work in healthcare, which is not always a bastion of good cheer.

After a quick check I was relieved to find that yes, I had indeed put on all my clothes that morning,  therefore not fulfilling that recurring dream I have of showing up for work in my slip…

I finally decided that everyone was simply reacting to the same stimulus I was – a beautiful, balmy morning, so I smiled and greeted all who greeted me.

When I finally reached my destination and spied my reflection in the glass doors I could see, sticking out of the top of my head at a weird angle, a large tuft of hair, stylishly arranged by the twin elements of wind and hair spray. Alfalfa would have fallen for me in a heartbeat. (From Spanky & Our Gang for those of you too young to understand the reference.)

I consoled myself with the thought that I had given no less than a hundred passers-by a reason to smile. There are worse ways to start your day.

TUV seeks CMS deemed status – CMS requests public comment

Is the Joint Commission about to get a major new competitor?  Are hospitals about to get a new accreditation choice that includes CMS deemed status? The answer to those intriguing questions hangs in the balance.

The application of healthcare quality firm TÜV Healthcare Specialists (TÜVHS) to the Centers for Medicare & Medicaid Services (CMS) for deeming authority has been published in the Federal Register and is open for public comment until February 27th.  Download cms2228pn.pdf

TÜVHS, which is headquartered in Cincinnati, OH, completed its formal application for deeming authority in December. Posting in the Federal Register moves the process into the public domain as a way to inform and involve healthcare leaders and the general public.

TÜV Healthcare Specialists offers the National Integrated Accreditation for Healthcare Organizations (NIAHOSM) program as an alternative to current hospital accreditation programs. NIAHOSM integrates the internationally recognized ISO 9001 Quality Management System standard with Medicare’s Hospital Conditions of Participation.

If granted deeming authority, TÜVHS will become the first new option for CMS hospital accreditation in 40 years, and the only service to integrate the ISO 9001 Quality Management System into the accreditation process.  Currently only the Joint Commission on Accreditation of Healthcare Organizations and the American Osteopahtic Association have deemed accreditation status with CMS.

TUVHS Press Release

Technorati tags:  JCAHO TUVHS TUV Federal Register

Are Annual Evaluations A Requirement of JCAHO LD.3.70?

Are you trying to understand whether Joint Commission standards require an annual evaluation for practitioners credentialed under LD.3.70?

Pat Sudds from Hillsdale Community Health Center in Hillsdale, Michigan submitted a question to the JCAHO Standards Interpretation Group regarding the LD.3.70 requirement for annual evaluations.  You will find her question and the response she received below:  (Reprinted with permission – Thanks Pat.)

Here is the original submitted question:

"LD.3.70 – Currently, we credential/privileges the following allied health professionals:

PA’s – physician employees
CRNA’s – contracted service employees
FNP – physician employees & hospital employees
CNM – physician employee
PT – contracted service employees
Counselors (CSW, PhD) – hospital employees & contracted service employees
(mental health)

All are reappointed every 2 years and follow the same process as our medical staff. Do any of these individuals require an annual evaluation?

Thank you for your response.

Here is the answer provided by the JCAHO SIG group:

If your HR process requires annual evaluations then you would need to do an evaluation for any direct or contract employee including physicians.

Also under the new requirement EP 4 at standard LD.3.70 you would need to do annual evaluations for anyone brought into the organization by an LIP (excluding PAs and APRNs who are under EP 2).

In your list EP 2 applies to :

PA’s – physician employees
CRNA’s – contracted service employees
FNP – physician employees & hospital employees
CNM – physician employee

In addition if they are direct or contract employees of the organization then all HR standards apply.

The HR standards which apply to all direct and contract emplloyees would apply to :

PT – contracted service employees
Counselors (CSW, PhD) – hospital employees & contracted service employees
(mental health)

John Herringer
Associate Director