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November 2014


A Word from the President

Thanks for reading the November issue of NAMSS Gateway, providing you the latest and most relevant healthcare news.

You’ll find that patient safety is a strong theme in this issue—especially the importance of a patient-centric system. One article focuses on the publication of the Joint Commission’s publication of the 2015 Comprehensive Accreditation Manual for Hospitals that educates and informs hospital leaders on the importance of a patient-centered safety system, while another article reports that the actions — or inaction — of patients should be considered in programs designed to improve care and outcomes. Find another interesting read on how switching from a non-for-profit hospital to for-profit status can effect quality of care.

If you are interested in learning more about the Joint Commission and how your facility can provide safe and effective care of the highest quality and value, join NAMSS for a live webinar on the top five scored standards in the medical staff chapter from the 2014 Joint Commission Standards.

As always, I hope you enjoy this month’s articles. Continue reading for the latest industry news.

John Pastrano, BBA, CPMSM, CPCS
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News From NAMSS

Upcoming Webinars
Remember to Renew Your Dues for 2015!
NAMSS 38th Education Conference Recordings are Now Available
Update to the Certification Examinations and Recertification Information

Industry News
"Botched-Surgery Claims Might Tip S.D. Law"
"Healthcare Employment Bouncing Back, Latest Report Shows"
"New Hospital Accreditation Chapter Puts Heightened Focus on Safety"
"Health-Care Boards More Responsible for Compliance"
"Medical Liability Claims Flat, But Loss Rates Rising"
"Hospital Oversight Groups Are Pressing for Improved Antibiotic Stewardship"
"New Fed Loans to Promote Rural ACOs"
"Hospitals That Switch to For-Profit Status Do Not Harm Patient Care"
"Pioneer ACOs Performance is Mixed in First Two Years, CMS Data Shows"

News From NAMSS

Upcoming Webinars

The Joint Commission Medical Staff Update 2014
November 21, 1:00 pm – 2:30 pm EST
Laurel McCourt, MD
Consultant, Joint Commission Resources
1.5 CE Credits

This presentation will cover the top five scored standards in the medical staff chapter from the January - June 2014 Joint Commission Standards and the compliance tips for these standards. In addition, participants will learn about the new Conditions of Participation (effective September 29, 2014) and the standards that are now in place to reflect the Conditions of Participation. Participants will also hear about what to expect in 2015.

Physician Assistants: Rules, Regulations and Realities”
November 25, 2:00 pm - 3:30 pm EST
Tricia Marriott, PA-C, MPAS, DFAAPA
Director, Regulatory and Professional Advisory Services
American Academy of Physician Assistants
1.5 CE Credits

Physician assistants (PAs) have been shown to provide quality, cost effective care and have become integral members of the provider workforce.  However, the rules and regulations as they apply to the PA profession are often misunderstood.  This session will dispel the myths and urban legends by providing detailed information on PA scope of practice, credentialing, certification maintenance requirements and competency assessment, payer enrollment concerns, and resources available for the Medical Staff Professional.

“How to Privilege for New Privileges and New Technology”
December 10, 2:00 pm – 3:00 pm EST
Jon Burroughs, MD, MBA, FACHE, FACPE
President and CEO, the Burroughs Healthcare Consulting Network, Inc.
1.0 CE Credits

With the proliferation of medical innovation and new technology, it is important for healthcare organizations to balance patient safety, organizational mission, and support for physicians with a standardized process to vet, develop, approve, and implement these initiatives in an evidence based way. Many organizations rush to market with innovations only to inadvertently harm patients, undermine the community’s trust and place both the organization and physicians at risk. This one hour webinar shares ‘best practices’ utilized by top performing healthcare systems that will enable you to introduce new privileges and new technology in a manner that benefits key stakeholders and protects patients from potential harm.
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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. NAMSS will also be mailing invoices later this year.
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NAMSS 38th Education Conference Recordings are Now Available

NAMSS presents two new ways to gain valuable education from the 2014 Annual Conference and earn cost-effective CE. Check out our two new conference bundles, offering you access to some of the highest-rated sessions from the NAMSS 38th Educational Conference at a fraction of the price. Each package consists of three session recordings and quizzes worth 4.5 CE Credits.
  • Package 1: Credentialing and Privileging Package
    • Peer Review and the Hospital Employed Physician
      Catherine Ballard, JD & Jeremy Morris, JD
    • The Impact of Pay for Value Reimbursement on Credentialing and Privileging
      Jon Burroughs, MD, MBA, FACHE, FACPE
    • This Is What We Live For: Protect the Patient, Facilitate Clinical Practice, Support Organizational Goals
      Hugh Greeley
  • Package 2: Executive Leadership/Legal Package
    • Difficult Decisions: A Rising Tide of Ethical Challenges for Hospital Medical Staffs
      Todd Sagin, MD, JD
    • Legal Update: 50 State Review of New and Significant Cases
      Lowell Brown, JD & Erin Muellenberg, JD
    • Navigating the Stormy Waters: Strategies for Medical Staff Professionals to Ensure Smoother Sailing
      Heather Fields, JD & Sarah Coyne, JD
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Update to the Certification Examinations and Recertification Information

Effective fall 2014, all CPCS and CPMSM examinations administered will contain multiple choice questions with three possible answer options, a decrease from the present format of four. For more information regarding the 2014 CPCS and CPMSM examination content outlines, please visit our Candidate Handbook.

All candidates due to recertify in 2014 must submit their recertification application by December 1, 2014. For more information, view the NAMSS Recertification page and/or the 2014 Recertification Policies & Guidelines.

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Has your facility gotten on board with NAMSS PASS™ yet? Over 325 facilities have joined NAMSS PASS™, and the database contains more than 157,850 practitioners and 275,850 affiliations. Creating an account and uploading your data is FREE and participation does not require any additional agreements or releases from the practitioners you credential – saving you valuable time! Don’t be left out – join NAMSS PASS™ today!
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Industry News

Botched-Surgery Claims Might Tip S.D. Law
Argus Leader (11/09/14) Ellis, Jonathan

A spine surgeon who has been accused of botching nearly three dozen surgeries that ended up maiming and even killing some patients could spark a change in medical malpractice lawsuits in South Dakota. Indeed, the avalanche of cases against Dr. Allen Sossan threatens to undermine the notion that doctors are blameless when a patient is injured or loses his/her life. Sossan already had one jury verdict go against him in 2013 for performing unnecessary surgeries on a patient who died. He is currently on trial again, with over 30 other cases pending. The Iranian-born Sossan has fled the country, and it remains uncertain if he'll return. While those seeking claims against Sossan will likely never recover any damages from the doctor, their lawsuits do include the facilities -- Avera Sacred Heart and Lewis & Clark Specialty Hospital -- where Sossan performed his surgeries. They allege that both places were negligent for credentialing Sossan to perform surgeries in their facilities. Members of Avera's medical executive committee say they were coerced by hospital administrators into granting Sossan credentials, despite the fact that he had lost privileges at a Nebraska hospital. "Negligent credentialing" is a legal concept that has been recognized by judges in at least 30 other states, but not in South Dakota.
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Healthcare Employment Bouncing Back, Latest Report Shows
Modern Healthcare (11/07/14)

The latest numbers from the U.S. Bureau of Labor Statistics show that healthcare hiring continues to recover from a slump that slowed, but never quite halted, job growth. The sector added approximately 24,500 jobs during October and almost 257,000 jobs over the previous 12 months. While new hiring in healthcare decreased in 2013 and remained weak throughout much of this year, it has gained some steam in the past few months. According to the latest federal employment data, the healthcare sector employed 14.8 million workers as of Oct. 31. Economists with the Altarum Institute are now looking into whether employment gains were strongest in states with broader expansion of health insurance under the Patient Protection and Affordable Care Act.
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New Hospital Accreditation Chapter Puts Heightened Focus on Safety
Healthcare Finance News (10/21/14)

The Joint Commission's 2015 Comprehensive Accreditation Manual for Hospitals features a new "Patient Safety Systems" chapter to educate facility leaders on the importance of an integrated patient-centered system in enhancing patient safety and care quality. The standards are taken from existing chapters on Leadership, Rights and Responsibilities of the Patient, Performance Improvement, Medication Management and Environment of Care, so there are no new requirements for hospitals. The Joint Commission is posting the standards chapter on its website to ensure all who are interested can access it, marking the first time the organization has done so. "For leaders, our hope is they will study this chapter and use it as a tool to build or improve their safety culture program," says Dr. Ana Pujols McKee, chief medical officer at The Joint Commission. "Developing a culture of safety starts at the top of the chain of command and then works its way through the layers of management and employees to build trust, which is an essential ingredient for improvement. In order for improvement to take root and spread, leaders need to be engaged and know the current state of the culture in their organization."
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Health-Care Boards More Responsible for Compliance
Wall Street Journal (10/17/14) Ensign, Rachel Louise

Recent health-care settlements are upping the ante for health-care boards by requiring them to be more involved in compliance oversight matters. For instance, a recent $38 million accord between the federal government and Extendicare Health Services Inc. over Medicare and Medicaid billing requires members of the nursing home company's board to establish a compliance committee whose members will individually sign resolutions tied to a compliance overhaul. Extendicare Health Services has also been ordered to create a compliance officer position that reports to the board. While corporate directors have long been considered responsible for compliance, a 2011 guide from Health and Human Services and the American Health Lawyers Association provided more details on this responsibility, describing it as "a continued focus of attention and enforcement."
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Medical Liability Claims Flat, But Loss Rates Rising
Business Insurance (10/28/14) Greenwald, Judy

Aon Risk Solutions' 2014 Aon/American Society for Healthcare Risk Management (ASHRM) Hospital & Physician Professional Liability Benchmark Analysis reveals that the frequency of professional liability claims is flat and there will be an annual loss rate of $2,870 per occupied bed in 2015. Loss rates are rising at a modest 2.5 percent annual rate, according to the study, due to flat frequency and modest loss cost growth. Hospitals can use business intelligence to bend down the flattening curve of professional liability to reduce costs, said Aon Risk Solutions' Erik Johnson. He also indicated that the hospital sector's strength lies in its history of self-insurance, but it lacks standardization in analyzing claims.
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Hospital Oversight Groups Are Pressing for Improved Antibiotic Stewardship
Hospitals & Health Networks (11/14) Barr, Paul

Accreditation, certification, and standard-setting organizations are pressuring hospitals to reduce the overuse of antibiotics. More specifically, they are urging them to create antibiotic stewardship programs. DNV GL recently launched a new program to certify hospitals as Centers of Excellence in Managing Infection Risk, which includes requirements that are aimed at reducing the overuse of antibiotics. The importance of antimicrobial stewardship has been pushed hard by the CDC and other entities within health care. Now, it's starting to spill out into the public's consciousness. Making it a requirement of the DNV program can only help the cause, especially considering that DNV officials say there's a lot of interest from hospitals in getting certified. Inclusion of the requirement was welcomed by staffers at Sentara Leigh Hospital, one of the first facilities to be certified in infection risk management certification. Sentara now has stewardship committees in place at two hospitals and plans to expand them across the system. The Joint Commission, meanwhile, recently began collaborating with National Quality Forum representatives to come up with a plan of their own to address the issue.
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New Fed Loans to Promote Rural ACOs
Modern Healthcare (11/01/14)

The White House recently announced plans to offer infrastructure loans to small and rural healthcare providers to take part in Medicare's program for accountable care organizations (ACOs). According to Obama administratioin officials, the advances will fund capital investment and hiring at ACOs with fewer than 10,000 patients that want to participate in the Medicare Shared Savings program. All critical-access hospitals will be eligible for the program in addition to physician groups. The Centers for Medicare & Medicaid Services (CMS) will also consider applications from hospitals with up to 100 beds. Dubbed the ACO Investment Model, the new program is administered by the CMS' Center for Medicare & Medicaid Innovation. This policy laboratory was created by the Patient Protection and Affordable Care Act to test new ways to deliver and pay for healthcare.
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Hospitals That Switch to For-Profit Status Do Not Harm Patient Care (10/23/14) Shinkman, Ron

When not-for-profit hospitals switch to for-profit status, their finances often improve. However, the quality of care they deliver remains about the same, concludes new research in the Journal of the American Medical Association. Dr. Karen Joynt and her colleagues at the Harvard School of Public Health focused on 237 not-for-profit hospitals that had struggled under this status and became for-profit institutions, examining Medicare and Medicaid data from between 2002 and 2010. "We did not see that there were higher mortality rates, even for vulnerable populations like the disabled," Joynt stated. "Nor did we find that quality suffered in the ways that we could measure quality." At the same time, the hospitals that switched to for-profit status were able to improve their margins at a much better rate than the 631 institutions that were compared as a control group. Harvard healthcare economist David Cutler cautions that the profit motive tends to bear little relation to actual social utility, such as improving patient care. For-profit hospitals have been criticized for driving up overall healthcare costs, cherry-picking patients, and placing too much emphasis on profitable service lines at the expense of needed services. Addressing such concerns, Connecticut recently passed a law that provides closer monitoring of for-profit facility conversions statewide.
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Pioneer ACOs Performance is Mixed in First Two Years, CMS Data Shows
Medical Economics (10/10/14) Mazzolini, Chris

Data released by the Centers for Medicare and Medicaid Services (CMS) shows that the Pioneer accountable care organization (ACO) program has had a mixed record when it comes to saving providers money. The program began in 2012 with 32 participating providers, half of whom saved money that year while the other half achieved no savings or saw their costs rise, the data shows. On one end of the spectrum was an ACO that saved roughly $23 million, or 7 percent of its expected expenses based on benchmarks in 2012. On the other end was another ACO that lost more than $9.3 million. But average spending in 2012 was roughly $20 less per Medicare beneficiary per month compared to if the ACO was not taking part in the program, according to CMS. As for 2013, 14 of the ACOs that released results for that year said they achieved savings while six said they lost money. These mixed results come as providers are leaving the program, with three withdrawing in September alone. Nineteen providers now participate.
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