Transcript The Hospital Perspective on Assuring Ongoing Physician Competency

Julie L. Seitz
Associate Counsel Provider Operations
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Disclaimer
The views expressed are those of the speaker and
not necessarily those of Catholic Health Initiatives.
This presentation is for educational purposes only
and is not intended as legal advice.
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Bio
• 1995 JD from Emory School of Law (Atlanta, GA);
• 1995-2001: Health care litigator for large law firm;
• 2001-present: Associate Counsel Provider Operations
for Catholic Health Initiatives.
• Catholic Health Initiatives is a national nonprofit
health organization with headquarters
in Denver. We are a faith-based system that
includes 77 hospitals; 40 long-term care, assistedand residential-living facilities; and two community
health-services organizations in 20 states
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Goals
• Identify factors affecting hospitals’ efforts to assure
ongoing physician competency;
• Identify hospital challenges to assuring ongoing
physician competency;
• Identify current practices in hospitals’ efforts to
assure ongoing physician competency;
• Discuss the link between hospital efforts and states’
lack of or future implementation of MOL
requirements.
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Current Environment for Hospitals’ Assurance of
Ongoing Competency
• February 2008 FSMB Draft Report on MOL
identifies factors in Section II, Environment
Assessment. Those same factors are equally
applicable to hospitals.
• Public Expectations:
– Increased focus on “transparency” in health care;
– More informed consumers;
– Liability environment: negligent credentialing,
vicarious liability, breach of fiduciary duties.
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Current Environment for Hospitals’ Assurance of
Ongoing Competency
• Increased Emphasis on Continuous Improvement in
Medicine:
– CMS initiatives on Value Based Purchasing;
– Hospital financial performance tied more directly
to the quality of clinical care provided by
physicians, as opposed to just the nursing staff;
– Push towards evidence based medicine;
– Pressure to respond to rapidly evolving
technology.
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Challenges to Hospital Assurances of Ongoing
Competency
• Time and personnel intensive:
– Decrease in interest of engaged medical staff
members to assist;
– Nursing and other personnel shortages.
Physician shortages makes it difficult to do peer
review or peer comparisons, reluctance to risk
losing physician in specialty.
Specialization of physicians makes it difficult to do
peer review or peer comparisons; raises the
question of what does the physician need to be
competent to do?
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Challenges to Hospital Assurances of Ongoing
Competency
• Less hospital-based practice to evaluate due to
development of office based practices, ASCs,
freestanding care centers, hospitalists,
• Lack of a single “gold standard” for maintenance of
competency: Board certification, differences among
national professional organizations.
• “Turf wars”: For example, radiology v.cardiology;
general surgery v. vascular; gastroenterologists v.
surgeons.
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Challenges to Hospital Assurances of Ongoing
Competency
• Lack of flow of information between state licensure
agency:
– Lack of information about open investigations of
physicians;
– Length of time it takes to conclude state
investigations;
– Settlements with physicians to end the
administrative process.
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Current Practices in Assuring Ongoing
Competency
• Medicare Conditions of Participation and Joint
Commission requirements impose a duty on Medical
Staffs and Hospitals to assure physicians are
competent and are granted appropriate privileges.
• Historically, competency evaluated at two points in
time: at initial appointment and every two years at
reappointment.
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Current Practices in Assuring Ongoing
Competency
• Increasing focus on assuring ongoing competency.
• The Joint Commission: new nomenclature, but not
new concept:
– MS 08.01.01 (2009 Standards): The organized
medical staff defines the circumstances requiring
monitoring and evaluation of a practitioner’s
professional performance.
– Focused professional practice evaluations (FPPE)
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Current Practices in Assuring Ongoing
Competency
MS 08.01.03 (2009 Standards): Ongoing professional
practice evaluation (OPPE) information is factored
into the decision to maintain existing privileges(s), to
revise existing privilege(s), or to revoke an existing
privilege prior to or at the time or renewal.
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Current Practices in Assuring Ongoing
Competency
• Emphasis on practitioner specific review at initial
appointment or upon grant of new privileges:
Credentials Committees and MECs recommend
observation, chart review, data to be collected.
• Reappointment data collected: use of medications;
use of blood and blood products; operative
procedures; clinical practice patterns; departures
from established practices; autopsies; sentinel events
data, patient safety data.
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Current Practices in Assuring Ongoing
Competency
• Going beyond data and incorporating incident
reports, grievances, documentation/charting issues,
professionalism.
• Key indicators determined by specialty (OB csection rates).
• Focus on indicators for primary care.
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Current Practices in Assuring Ongoing
Competency
• Using OPPE and FPPE to assess competency in the
“gap” periods.
• Changing focus of “peer review” from being
associated only with disciplinary process.
• Changing focus to “clinical quality” reviews: routine
reviews and collaborative reviews of all
practitioners, just not those whose cases “fall out” on
indicators.
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Convergence with MOL
• Hospitals are limited to assessing competency based
on what occurs within their walls and only within the
scope the physician practices at the facility.
• Physicians are practicing less and less within
hospitals.
• These trends make it more important that there is
another entity overseeing competency assessments.
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Convergence with MOL
• The only entity consistent to all physicians in the
state is the state licensing agency.
• State licensure agency can serve as the repository of
all information about a physician.
• CLE should be related to the physician’s practice.
• Analogy to lawyers: many states require CLE every
reporting period related to professionalism and
ethics.
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Convergence with MOL
• More transparency in state investigations of
physicians;
• More consistency in imposition of discipline and
clearer determinations about physicians;
• Exchange and flow of information between hospitals
and licensing agencies.
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