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June 2014

A Word from the President

Welcome to the June issue of NAMSS Gateway, your portal to the top stories for MSPs nationwide.

Many of us are facing the new challenges presented by hospital-employed physicians. In this issue, we feature an article from The Atlantic that explores this relatively new phenomenon and poses the question: Should Doctors Work for Hospitals? While many of us may have individual opinions on the matter, the fact is that “According to data from the American Hospital Association, the number of physicians employed by hospitals grew by 34 percent between 2000 and 2010.” As MSPs, we must learn how to manage the complexities of working in a facility that employs its physicians. This new change of encountering various issues from processing the applications, identifying processes for any disciplinary actions, and onboarding these physicians has provided me another opportunity for professional growth and development. Employed physicians have become another component of credentialing for medical staff professionals. To quote Maya Angelou, "If you don't like something, change it. If you can't change it, change your attitude." We can all continue to grow professionally, and as your professional organization, NAMSS is here to help guide the way—several sessions at the 38th Educational Conference & Exhibition address this very issue, including “Peer Review and the Hospital-Employed Physician” and “Navigating the Rough Waters of Credentialing, Hiring, and Terminating Employed Physicians.” Check out the Conference program online for full descriptions of these and many other timely sessions.

As always, if you have feedback about NAMSS Gateway, please reach out to the staff at Enjoy!

John Pastrano, BBA, CPCS, CPMSM
NAMSS President
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News From NAMSS
CMS Issues Final Rules on Hospital Medical Staff Conditions of Participation
NAMSS Call for Committee Volunteers
Free Webcasts Now Available Through the AMA

Industry News
"In a Shift, Hospitals Added New Jobs Last Month"
"Oklahoma Medical Board Streamlines Physician Licensure Process"
"New York Doctors' Group Wants Law to Require Displaying Specific Medical Credentials"
"All ACOs Are Not The Same, Which Type is Yours?"
"Hospital Charges to Continue on Slow Growth Path, Fitch Predicts"
"UCLA Program Helps Foreign Doctors Practice in U.S."
"CMS Opens Physician Registration for Sunshine Act"
"3 Risk Management Tips For Hospitals in the New Healthcare Environment"
"States Take Steps to Increase Use of Prescription Drug Monitoring"
"Should Doctors Work for Hospitals?"

News From NAMSS

CMS Issues Final Rules on Hospital Medical Staff Conditions of Participation

In early May, CMS issued a final rule on several Conditions of Participation that affect NAMSS members: dietitian privileging, hospital medical staff membership composition, hospital governing body representation, medical staffs within multi-hospital systems, and outpatient hospital orders.  To help understand this final rule, we highlight CMS’s 2013 proposals to the above topics, NAMSS’ comments on these proposals, CMS’s final rules, and key takeaways in the following article, “CMS Issues Final Rules on Hospital Medical Staff Conditions of Participation.”
NAMSS Call for Committee Volunteers

Mark your calendars! The NAMSS Call for Committee Volunteers will open on June 30th, 2014. Are you looking to expand your industry knowledge and expertise? Perhaps you want to broaden your professional network, or maybe you want to give back to the organization that has enriched your career. The reason doesn’t matter. We all share the same goal when we make the commitment to volunteer for NAMSS… to elevate the status of our professional organization.

Free Webcasts Now Available Through the AMA

Free webcasts are now available to members through the American Medical Association Organized Medical Staff Section (OMSS). Access webcasts 24 hours a day, seven days a week, and earn valuable AMA PRA Category 1 Credit™. These activities are designed for medical staff leaders (e.g., chiefs of staffs, medical staff presidents, medical directors and medical staff members), physicians interested in leadership issues, medical staff service professionals and medical staff legal counsel.

Download the brochure here!

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Industry News

In a Shift, Hospitals Added New Jobs Last Month (06/09/14) Shinkman, Ron

According to the U.S. Bureau of Labor Statistics (BLS), hospitals added more than 6,900 new jobs to their payrolls during May after a period of stagnation. As of the end of the month, the total number of workers employed by hospitals nationwide stood at 4.803 million versus 4.79 million in May 2013 -- a gain of 11,000 jobs. For the entire healthcare sector, the number of jobs created between May 2013 and May of this year rose to a seasonally adjusted 218,600. Nursing care facilities were the only category polled by BLS researchers that did not add jobs on a seasonally adjusted basis. The overall healthcare sector has now added jobs to the U.S. economy for 131 consecutive months. The last time it shed any jobs was in July 2003. Experts credit the relatively sluggish job growth as of late to two factors -- reimbursements cuts in the Medicare program and a refocus to try and make healthcare delivery more cost-effective.

Oklahoma Medical Board Streamlines Physician Licensure Process
Newswise (06/04/14)

The Oklahoma Board of Medical Licensure and Supervision (OSBMLS) has launched the Uniform Application for Physician State Licensure to streamline the licensure process for physicians in the state. It not only eliminates the need for physicians to re-enter data multiple times, it makes it easier for them to apply for licensure in multiple states. Among the benefits the Uniform Application offers Oklahoma physicians: one, it auto-populates key data, saving physicians time by eliminating the need to re-enter information multiple times; two, it auto-populates credentialing data for users of the Federation Credentials Verification Service (or FCVS); and, three, all data provided by physicians is stored in a permanent data repository. Lyle Kelsey, executive director the Oklahoma Board of Medical Licensure and Supervision, remarks, "Many physicians practice in multiple states, and the old process could be very tedious and cumbersome. Now it's a much simpler, faster process."

New York Doctors' Group Wants Law to Require Displaying Specific Medical Credentials
Columbus Republic (IN) (05/21/14)

A group representing New York physicians has called on their state Legislature to require medical practitioners to display their specific licenses and credentials. They contend that a number of their colleagues advertise being "board certified" when it doesn't actually apply to their current specialty. According to the Medical Society of the State of New York and its approximately 25,000 physician members, pending bills would help end widespread patient confusion such as believing an optometrist is a physician. Specifically, the legislation would require medical professionals to conspicuously post and put on nametags the type of license they hold. In addition, it would prohibit misleading information in advertisements.

All ACOs Are Not The Same, Which Type is Yours?
Becker's Hospital Review (06/04/14) Ellison, Ayla

A new Leavitt Partners report has identified a half-dozen types of ACOs based on three factors -- their organizational structure, ownership, and patient care focus. Researchers used data from over 40 surveys and more than 100 interviews with ACO leaders as well as a database of 627 ACOs to analyze characteristics of ACOs and develop the six classifications. The first one listed is Full Spectrum Integrated ACOs, which directly provide all aspects of healthcare to their patients. Two, Independent Physician Group ACOs have a single physician group owner and do not contract with other providers to offer additional services. Third, Physician Group Alliance ACOs may have multiple physician group owners, but they do not contract with other providers to offer additional services. Fourth, Expanded Physician Group ACOs only directly provide outpatient services, but will contract with other providers to offer hospital or subspecialty services. Fifth, Independent Hospital ACOs have a single owner that directly provides inpatient services but not subspecialty care. Finally, Hospital Alliance ACOs have multiple owners with at least one directly providing inpatient services.

Hospital Charges to Continue on Slow Growth Path, Fitch Predicts
Modern Healthcare (06/10/14) Landen, Rachel

A recent analysis from Fitch Ratings forecasts that growth in hospital charges will continue to be historically low, pressured by two factors -- sequestration cuts affecting Medicare and declining reimbursement rates. In recent years, the Consumer Price Index for hospital and related services has been sluggish. The index recorded 4.8 percent growth from 2011 to 2012, before falling to 4.4 percent from 2012 to last year. The trend appears to be continuing in the first half of the current year. Fitch expects the sequestration cuts that became effective last spring will continue to place downward pressure on hospital charges, with an annualized effect of nearly $11 billion across healthcare providers. Meanwhile, healthcare providers that have a high exposure to Medicare and Medicaid will have limited capacity to use charge increases to offset reimbursement pressures from government payers.

UCLA Program Helps Foreign Doctors Practice in U.S.
San Bernardino County Sun (CA) (06/02/14) Steinberg, Jim; Abram, Susan

Drs. Michelle Bholat and Patrick Dowling developed the UCLA International Medical Graduate Program to help bilingual, bicultural physicians from Latin American countries complete exams and residency in family medicine for free. In return, the doctors must then practice in underserved communities. Bholat remarks, "We need doctors who know the language, the culture, and who understand their patients from the cradle to the grave." The UCLA program is highly competitive. Those who apply must be recent graduates from a medical school recognized by the Medical Board of California. In addition, the candidate must be bilingual in English and Spanish and has preferably lived in a Latin American country. The program also accepts recently graduated doctors who have been out of medical school for no more than five years. Finally, the program only accepts U.S. citizens or permanent residents, and it does not assist applicants in acquiring the visa status needed for eligibility. To date, 81 students have been placed in residencies in Riverside County and across Southern California.

CMS Opens Physician Registration for Sunshine Act
Health Leaders Media (06/02/2014) Commins, John

The Centers for Medicare and Medicaid Services (CMS) has opened the first stage of a process that will allow doctors and teaching hospitals to review and potentially dispute payments and gifts given to them by pharmaceutical companies and medical device makers. The initial stage involves physicians and teaching hospitals registering using CMS's Enterprise Portal, which will allow them to access the information about payments and gifts that drug companies and medical device makers are required to report under the Physician Payments Sunshine Act. The second stage begins in July, when doctors and teaching hospitals will be allowed to register in the Open Payments system so they can review and dispute data about payments and gifts. Any disputed data that is not corrected by drug and medical device makers will be released by CMS on Sept. 30 and marked as "under dispute." The American Medical Association has criticized the launch of the review process by saying that CMS has missed almost every deadline contained in the Sunshine Act and associated regulations. Nevertheless, the organization is calling on doctors to register to participate in the review period to ensure that the data about any payments and gifts they received is accurate.

3 Risk Management Tips For Hospitals in the New Healthcare Environment
Becker's Hospital Review (06/11/14) Ellison, Ayla

There have been a number of changes in the healthcare environment since the Patient Protection and Affordable Care Act (PPACA) was passed, especially with so many new entrants into the market and new models of care evolving. Brad Rosgen, healthcare practice leader at Burns & Wilcox, provides a trio of risk management tips for healthcare organizations in this new environment. First, they should adapt in order to protect against new risks. Since the PPACA's passage, many new models of healthcare have emerged, and there has been a dramatic increase in physician integration where solo practitioners and smaller groups are either banding together or selling to bigger networks. Any new structure will have to be controlled from a risk management perspective. Second, take a step back. In this regard, Rosgen advises healthcare organizations to look for advice from such professionals as insurance agents and consulting firms to ensure they have a "solid, robust risk management plan." Finally, be prepared for data breaches.

States Take Steps to Increase Use of Prescription Drug Monitoring
iHealthBeat (06/02/14)

More healthcare providers will be required to register with Rhode Island's controlled substances database under a law enacted in that state late last month. The statute calls for approximately 6,000 healthcare providers -- including doctors, nurses, and dentists -- to register with the database when they are initially licensed to prescribe drugs or when those licenses are renewed. Less than 20 percent of the 7,300 healthcare providers in Rhode Island who are licensed to prescribe controlled substances are currently registered to use the database. Providers will not be required to check the database for potential signs of drug abuse before writing prescriptions for controlled substances.

Should Doctors Work for Hospitals?
The Atlantic (05/27/14) Gunderman, Richard

The number of doctors employed by hospitals went up 34 percent between 2000 and 2010, according to the American Hospital Association, and the number of physician searches that were performed by hospitals went from 11 percent in 2004 to 63 percent in 2013. Hospitals hire physicians because they can legally refer patients to hospitals, and hospitals can also charge more for procedures than independent physicians. Hospitals that have more physicians can negotiate better rates with health insurance providers and provide more integrated care. However, after a previous boom in the 1990s, it was discovered that doctors who move to hospitals often have lower productivity and morale.

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