Discouraged

During my presentations to medical staff service professionals (MSSPs) around the country I always remind the audience of the need to speak up and educate people about the important contribution our profession makes to the safety of the huge, complex, machine of US healthcare. 

I include this thought:

We verify the credentials, training and experience of the nation’s health care providers. We work with administrative and medical leadership to protect the public from fraudulent, incompetent, unskilled or impaired practitioners.

We are medical staff service professionals, and we are vital to the safety of the nation’s healthcare system.

I really believe that; I do my best to live it.  Speaking about it to others reminds me to be excited about the work we do. 

But every now and then I find myself disheartened over how difficult it is to educate leaders who prefer to believe that it’s nothing more than unimportant, bureaucratic paperwork.  Just smoke and mirrors.

Swimming upstream is hard work.

California Physician Wins 24 Million in Wrongful Termination Suit

A Yuba County California jury has awarded a former Fremont-Rideout Medical Group doctor a total of $24 million in compensatory and punitive damages for his dismissal from the staff of 113 bed Rideout Memorial Hospital in 2003, according to a report in The Marysville, California Appeal-Democrat.

Dr. Richman was dismissed from the hospital after pleading no contest to a misdemeanor drug charge. He claimed, however, that the dismissal was in retaliation for speaking out on patient care at the hospital.

"The jury appreciated Richman’s candor about his flaws during the trial" said Larry Brazil, jury foreman.

Thomas P. Hayes, the Health Group’s chief executive officer stated "We are obviously very upset by this outrageous verdict and are considering our options for appeal.”

Read full story in the Appeal-Democrat:
http://www.appeal-democrat.com/articles/2006/06/22/news/local_news/news2.txt

Via Kevin, M.D.

CMS Requests Second Submission from TUVHS in Deemed Status Application

There is no answer yet as to whether the Joint Commission and the American Osteopathic Association are about to get a major new hospital survey competitor. 

As you may know TUVHS, which is headquartered in Cincinnati, OH, has applied to CMS for deeming authority.  Deemed status by CMS means that organizations accredited by those agencies are “deemed” to be in compliance with government healthcare regulations and can therefore submit bills to the Medicare and Medicaid programs without being surveyed directly by CMS.

In a June 19th press release, TÜV Healthcare Specialists (TÜVHS) announced that the Centers for Medicare Services (CMS) has requested a second submission from them before a decision of whether to grant TUVHS hospital deeming authority can be made. TUVHS expects to make the re-submission by late July.

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The TUVHS press release further states:

TÜVHS is pioneering a significantly new approach to hospital accreditation. The program, called NIAHO (National Integrated Accreditation for Healthcare Organizations), combines ISO 9001 quality management with the conditions of Medicare participation that allow hospitals to receive Medicare and Medicaid reimbursement.

“We are very close, and are grateful for the guidance CMS has provided to make sure our new accreditation process is precisely aligned with their highest expectations,” says Rebecca Wise, CEO of TÜVHS. ”

“Given the magnitude of what we’re doing, I would have been surprised if CMS didn’t want some changes,” says Stefan Butz, President and CEO of TÜV America, the parent company and majority shareholder in TÜVHS. “We are a leading quality company, taking critical feedback and turning it into systemic improvement is what we do.

Upon approval of deeming status, TÜVHS will become the first new hospital accreditation program in over 40 years, and the only program to integrate ISO 9001 quality management with Medicare accreditation.

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For more information about the company visit: www.TUVHS.com

Change of Shift 1.1 – The call of nursing

Kim, our intrepid Emergency Department nurse blogger, has started a new bi-weekly blog carnival called Change of Shift.  It features posts about nurses and nursing.  Kim is an equal opportunity host, bloggers don’t have to be nurses (or wear white caps) in order to contribute.

I rarely hear doctors or other medical professionals speak of their roles as a calling, but I often hear that phrase from nurses.  We need doctors; they oversee and direct our care; but we need nurses to provide the capable, compassionate application of that care.

Modern hospitals are all about "patient satisfaction."  The myriad of surveys and reports they produce on the topic is proof. I absolutely believe that nurses, more than any other single component, determine a hospital’s patient satisfaction score.

Not an easy job caring for people who are in pain, frightened, and generally not at their best.  Perhaps even more challenging is coping with angry, impatient, scared-out-of-their-minds, family members.  Nurses do that.  Bless them!

Then there are the physicial requirements. 

I work in a hospital as a "paper-pusher."  I sincerely believe that the paper I push is important to the bottom line success of my institution and the safe, quality care of patients, otherwise I’d look for another line of work.  That having been said, under physical requirements my job description says "must be able to lift 15 pounds."  My job is unlikely to give me back strain, unless it’s from sitting too long.  (Eye-strain from staring at a computer screen yes, but probably not back strain.)

Nurses work hard, both physically and emotionally.  They really look forward to change of shift.  Now the rest of us can too.

Stop by Emergiblog and peruse the offerings at Change of Shift 1.1.  They’ll make you smile, bring a tear to your eye, and make you glad that good people receive "the call" of nursing.

Changeofshift

       

Grand Rounds 2.39

Grand Rounds 2.39, this week’s best of the medical blogosphere is up at Dr. Deborah Serani’s Psychological Perspectives.

Find out more about Deborah Serani, Ph.D., in Nicholas Genes’ article in MedScape’s Pre-Rounds.  For example, find out Dr. Serani’s views on managed care, discover what actor she’s related to (although never met), which movie star "encouraged" her to go into blogging, and the television show for which she serves as technical consultant. 

Grand_rounds

No Winners in ‘Reverse Credentialing’ Battle

 In a case that has been dubbed as “reverse credentialing” a 62 member physician group practice in Rock Hill New York has pulled out of 174 bed Catskill Regional Medical Center, citing a litany of complaints about the facility and its leadership. The group represented about one quarter of the hospital’s medical staff. Catskill Regional is located in Harris, NY about 90 miles from New York City.

The battle between Sullivan County’s sole hospital and it’s largest physician group practice has torn this rural community apart. As angry words and accusations are exchanged on both sides, residents are not sure who to believe.

On June 2, 2006 the Times-Herald Record Online reported that Crystal Run Healthcare left Catskill Regional Medical Center on June 1st “with guns blazing.”

In a news conference Crystal Run managing partner Dr. Hal Teitelbaum laid out his complaints against the hospital and called for the state to intervene.

“It was the end of two years of Crystal Run trying to change the hospital from the inside,” Teitelbaum said.

In a 16-page, single-spaced document, Teitelbaum detailed his staff’s worries in several areas. He also pointed to financial relationships between several doctors and the hospital that he says represent conflicts of interest.

These complaints have all been filed with the state Department of Health, which is investigating.

On June 15, 2006, in an opinion piece also printed by the Times-Herald Record Online entitled Crystal Run doctors rejected the hospital’s rules, Joseph Lauterstein, M.D., a recently retired cardiologist who served as chief of cardiology at Catskill Regional Medical Center (CRMC) for 34 years, defended the hospital.

Dr. Lauterstein stated that Dr. Teitelbaum’s complaints began shortly after the group applied for staff privileges at CRMC. He felt that the medical board office was not processing the Crystal Run applications quickly enough, and he did not like the medical staff constitution, bylaws or rules and regulations. According to Lauterstein, these disagreements led to “the present state of affairs, which is not about quality but about power or the lack of it.”

On June 16, 2006 the Times-Herald reported that Catskill Regional’s CEO Art Brien announced the immediate lay off of 53 employees, an event he states is directly tied to Crystal Run’s departure.

References:

6/16/06 Times-Herald – Catskill Regional in Critical Condition

6/15/06 Times-Herald – Crystal Run doctors rejected the hospital’s rules

6/2/06 – New York Times – Medical Group, Citing Poor Care, Breaks With Catskill Hospital

5/25/06 – Times-Herald – Care at Catskill Regional Medical Center is excellent

5/13/06 – Times_Herald – Scrutiny of Catskill hospital

Hat tip to Nena from SoftMed for sending this tip.

Doctors By the Score

An ode to the credentialer…  composed a number of years ago on a day when I could barely see over the stack of physician applications on my desk…  I know, it’s a rather odd way of dealing with stress, but somehow it made me feel better.  Enjoy.

Doctors By The Score

We love all of the doctors
Who enter through our doors
We like them best of all
When indignantly they roar

Surely you can see
My need is very clear
Give me what I want
Or the CEO will hear!

I need temporary privileges
For an AHP or two
And I can’t believe before they start
I have to come to you

When I first joined this staff
Getting a credentials file
Was a matter of a signature
A handshake, and a smile

You want license and insurance
DEA and Tax ID?
UPIN numbers, Mantoux tests
An application fee!

Do you know who I am?
I started up this place
And all these silly rules you’ve made
Are an absolute disgrace!

Ah yes we love the challenge
Of doctors by the score
Oh no, is that a contract group
I see heading for my door? Rita Schwab  September, 1998