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December 2014


 

A Word from the President

Welcome to the December issue of NAMSS Gateway. This past year has presented a breadth of content that shows the vitality of the healthcare industry. This month, we focus on accountability and transparency. One featured article details how more accountability of physicians can be met through various efforts, such as 360-degree performance reviews for all clinical workers and National Patient Safety Board, which would be would be run by leaders in the patient safety movement. Other articles demonstrate the importance of sharing information, whether that information pertains to their facility’s credentialing practices or standards after a merger or acquisition.

As 2014 concludes, I would like to thank everyone that has taken the opportunity to commit to the association's success this year! Your support has allowed NAMSS to continue to enhance the professional development of medical staff professionals and increase recognition of the credentialing services field.

It has been a pleasure serving as this year’s NAMSS President and I look forward to seeing additional growth and exciting developments in the years ahead.

John Pastrano, BBA, CPCS, CPMSM
NAMSS President

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Headlines


News From NAMSS
Late Recertification Applications Still Accepted
The NAMSS Certification Exam Applications Have Moved Online
Attention State Association Leaders!
Remember to Renew Your Dues for 2015!
2014 Comparison of Accreditation Standards
Have You Connected with NAMSS on LinkedIn?

Industry News
"National Patient Safety Board Necessary to Prevent Patient Deaths"
"Insurers’ Listings of In-Network Doctors Often Out of Date"
"Federation of State Medical Boards Receives Certification from NCQA"
"Board Gets Crash Course in Physician Credentialing for Hospitals"
"Setting Physician Pay After a Merger"
"Efforts to Improve Patient Safety Result in 1.3 Million Fewer Patient Harms, 50,000 Lives Saved and $12 Billion in Health Spending Avoided"
"Hospitals See Significant Rise in Quality of Care Measures"
"Costly Care at Hospital Practices"


News From NAMSS


Late Recertification Applications Still Accepted

If you are due for recertification in 2014 but missed the December 1st deadline, it’s not too late! Late applications will be accepted at the NAMSS Executive Office with an additional $50 late fee until December 31, 2014. Click here to download a copy of the recertification application as well as a listing of all individuals due to recertify in 2014.
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The NAMSS Certification Exam Applications Have Moved Online

We’ve gone digital! CPCS and CPMSM exam applications are now available electronically on the NAMSS website. To access the online applications, please visit the appropriate link:

CPCS
CPMSM


Paper applications will be accepted through the spring 2015 testing window only.

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Attention State Association Leaders!

As the 2014 calendar year comes to a close, we would like to take this opportunity to remind you to contact the Executive Office with any leadership changes that are slated to take effect in 2015, as well as your local conference dates for 2015. Please refer to this page on the NAMSS website to double check who we have on file as your President and President-Elect. Any and all changes should be by email to Andrew Miller at amiller@namss.org.
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Remember to Renew Your Dues for 2015!

NAMSS Members – It’s that time of the year again! Renew your NAMSS dues by logging into your account on the NAMSS Website and selecting “Renew your NAMSS Membership.” Maintain your membership in a network of over 5,000 MSPs across the country and, for renewing, you will also receive a special giveaway! If you require a paper renewal invoice to submit a personal or facility check, you can move through the renewal process online and select the “pay by check” option at checkout.
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2014 Comparison of Accreditation Standards

Don’t refer to outdated standards—visit the NAMSS store to purchase the newly-updated fall 2014 Comparison of Accreditation Standards. This electronic document (revised September 2014) serves as a one-stop resource to help you clearly understand the credentials verification requirements of multiple agencies. Standards change frequently, only the most recent version of the NAMSS Comparison of Accreditation Standards includes the latest updates from:
  • Aspect
  • The Joint Commission
  • NCQA
  • DNV
  • URAC
  • The Accreditation Association for Ambulatory Health Care
  • Medicare Conditions of Participation
The 2014 Comparison of Accreditation Standards creates a side by side comparison of the requirements for each agency. Visit the NAMSS store today to purchase the 2014 Comparison of Accreditation Standards.
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Have You Connected with NAMSS on LinkedIn?

NAMSS has launched a LinkedIn Company page to keep you and your colleagues up-to-date with industry news and events that can impact you and your career. We share shifts in the regulatory landscape, industry innovations that can improve efficiencies, and of course, the latest educational opportunities and events from NAMSS. Start following NAMSS today and be sure to share our page with your MSS colleagues. For more in-depth peer-to-peer conversations, you can still access the NAMSS Group on LinkedIn. Just look for the link on our company page!
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Industry News


National Patient Safety Board Necessary to Prevent Patient Deaths
Fierce Healthcare (12/04/2014) Small, Leslie

Patient safety advocate Dr. John T. James says preventing hospital deaths involves improving the accessibility of medical records, increasing accountability for clinicians, and creating a National Patient Safety Board. The former chief toxicologist for a federal agency attributes the loss of his son to preventable medical errors. A recent government report found that hospital-acquired conditions have dropped 17 percent between 2011 and 2013, resulting in 50,000 fewer deaths and saving the industry $12 billion. James says the most important measure to reduce patient harm is to institute 360-degree performance reviews for all clinical workers. He suggests that healthcare workers would be the sole recipients of patients' anonymous reviews for a period of two years, giving the workers time to address their faults, and then the reviews would be publicly available. James indeed advocates for the creation of a National Patient Safety Board, which would follow the model of other regulatory agencies like the Consumer Product Safety Commission.
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Insurers’ Listings of In-Network Doctors Often Out of Date
Wall Street Journal (11/25/14) Beck, Melinda

Many insurers are offering smaller networks of doctors in their Medicare Advantage and commercial health plans this year. But physicians and regulators say those networks could be even narrower than they seem because the lists often include names and addresses that are erroneous or out-of-date. Surveys show that in some cases, the doctors shown have moved, retired, or died. Others are listed under the wrong specialty, work in hospitals full time, or don't accept the plan being offered. But insurance companies say doctors are contractually obligated to keep them informed when they change locations or stop participating in plans. Some insurers have cut provider networks to help manage costs, forcing some members to switch plans to keep seeing their doctors. "Health plans say its really hard to keep these lists up to date, but I just don't buy it," said dermatologist Jack Resneck, the study's lead author. "When I submit a claim, within a nanosecond, the plan's computer knows if I'm in the network or not."
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Federation of State Medical Boards Receives Certification from NCQA
Newswise (12/02/14)

The Federation of State Medical Boards (FSMB) recently announced that it has been certified for the second time by the National Committee for Quality Assurance (NCQA). The FSMB is certified under NCQA's Credentials Verification Organization Certification Program for the following credential elements: Education and Training, Ongoing Monitoring and Sanctions, Medicare/Medicaid Sanctions, and Medical Board Sanctions. "The FSMB is very please to again receive this prestigious certification from the NCQA," said Humayun Chaudhry, president and CEO of the FSMB. "This certification represents FSMB's commitment to improving quality by promoting high standards for performance to greater meet the changing health care needs in service to our member boards in their protection of the public."
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Board Gets Crash Course in Physician Credentialing for Hospitals
muskokaregion.com (12/03/14) Brownlee, Alison

Dr. Jan Goossens, chief of staff for the Bracebridge and Huntsville hospitals in Ontario, told Muskoka Algonquin Healthcare board members that there is a long and thorough process that takes place whenever a physician's hospital privileges are considered in a region. Goossens presented the information last month as part of an annual overview of the physician credentialing process at Muskoka Algonquin Healthcare and discussed granting privileges to physicians. He said new doctors are rigorously vetted through reams of paperwork, multiple reference checks on their qualifications and personality, their physical and mental health, acceptance of the organization's bylaws and policies, a criminal background check, valid college license, and area of expertise. He said the names of candidates that meet all of those requirements are sent to the hospital board for final approval. Additionally, a one-year probation period is required before full privileges are granted.
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Setting Physician Pay After a Merger
Healthcare Finance News (11/25/14) Ullman, Kurt

With hospitals continuing to acquire physician practices, healthcare finance executives must consider how to compensate physicians, taking into account the interests of the physicians and the hospital as well as legal requirements, including the Stark Law. Experts note that physician compensation cannot be based on how many patients or how much money they bring to the hospital. Rob Crigler, a partner at WithumSmith+Brown, says, "Hospitals can build compensation and incentives around things like the level of relative value units a physician produces." Ted Matthews, CFO of Banner Medical Group in Phoenix, says hospitals can show that direct compensation is appropriate when the compensation is consistent with the earnings of a private practitioner in the same market and a community need can be established. "In this instance, you can compensate a physician compared to national benchmarks," he says. Crigler adds that, under the Stark Law, hospitals cannot pay physicians based on the number of procedures they perform. So ancillary services generally are part of the buyout of the practice, not direct compensation for the physician. Hospitals can adjust compensation if physicians meet or fail to meet certain metrics in the future, but they must use historical data from the physician's practice when calculating future compensation.
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Efforts to Improve Patient Safety Result in 1.3 Million Fewer Patient Harms, 50,000 Lives Saved and $12 Billion in Health Spending Avoided
HHS News Release (12/02/14)

A reduction in hospital-acquired conditions from 2010 to 2013 has resulted in approximately 50,000 fewer patients deaths in hospitals and $12 billion in health care cost savings, according to a report released by the Department of Health and Human Services (HHS). Coordinated efforts by hospitals to reduce adverse events are due to such factors as Medicare payment incentives and the HHS Partnership for Patients initiative. Preliminary estimates show that hospital patients experienced 1.3 million fewer hospital-acquired conditions from 2010 to 2013, which translates into a 17 percent decline in hospital-acquired conditions over the period.
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Hospitals See Significant Rise in Quality of Care Measures
Health Data Management (11/14) Goedert, Joseph

The Joint Commission reports that 36.9 percent, or 1,224, accredited hospitals reporting accountability measure performance data for 2013 were deemed "Top Performers" in 2014, up 11 percent from 2013. Hospitals of all types and sizes are represented in the top tier, according to the report. The Joint Commission raised the number of selected core measures on which hospitals must submit data from four to six this year, noting that 44 of these Top Performers already reported on five or more of the measures in their 2013 data. Hospitals are consistently achieving performance levels of at least 95 percent on many measures, meaning that "a hospital provided an evidence-based practice 95 times out of every 100 opportunities to provide the practice," the Joint Commission stated. However, the percentage of hospitals reaching composite rates of more than 95 percent declined slightly in 2013 from 2012 due to the addition of the perinatal care accountability measure set, with only 5.6 percent of hospitals achieving composite rates of more than 95 percent on that measure. Under the Top Performers were 718 hospitals that failed to hit the 95 percent mark on just one measure.
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Costly Care at Hospital Practices
MedPage Today (11/23/14) Moore, J. Duncan

A new study in JAMA finds that patients at physician-owned practices have lower total expenditures than patients at hospital-owned and multihospital system-owned practices. University of California-Berkeley economist James C. Robinson and Integrated Healthcare Association analyst Kelly Miller looked at the total medical expenditures over four years of 4.5 million patients in California insured through commercial HMOs. Total expenditures were determined based on what the insurer paid to physician organizations, hospitals, laboratories, and drug makers for professional services, in and outpatient care, diagnostics, and prescription medications. This was then adjusted for patient illness burden, geographic input costs, and organizational characteristics. The researchers found that patients at physician-owned practices had the lowest mean expenditures at $3,066 in 2012. Patients at hospital-owned practices paid $4,312 and patients at multihospital system-owned practices paid $4,776. The researchers were careful not to ascribe causes to the differences in patient expenditures, but Harvard economist David Cutler says potential causes could include better outcomes and better coordination of acute care at physician-owned hospitals. "it's probably because the price is higher, they charged more for care," said Cutler. The study's limited scope should be kept in mind. Its results may not apply nationwide and to other coverage groups.
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