Flashpoints in the Medical Staff World Horty, Springer & - - PDF document

▶
flashpoints in the medical staff world
SMART_READER_LITE
LIVE PREVIEW

Flashpoints in the Medical Staff World Horty, Springer & - - PDF document

Oct 03, 2023 111 likes •586 views

Flashpoints in the Medical Staff World Horty, Springer & Mattern Making the Medical Staff Meaningful 1 Wrong question: How do we get physicians to participate in the medical staff? ? Better question: What can the medical staff do to

slide-1
SLIDE 1

1

Flashpoints in the Medical Staff World

Horty, Springer & Mattern

Making the Medical Staff Meaningful

slide-2
SLIDE 2

2

Wrong question: How do we get physicians to participate in the medical staff?

?

Better question: What can the medical staff do to bring value to the life/practice of physicians – across the continuum?

slide-3
SLIDE 3

3

Collegial environment critical to joy in profession. Picture of joy is not a selfie.

(Some speculate that a contributor to the high physician suicide rate is increasing isolation.)

slide-4
SLIDE 4

4

American Foundation for Suicide Prevention (2014)

300-400 physicians per year.

Major Risk Factors

  • Depression
  • Bipolar
  • Alcohol/substance abuse

No evidence that work-related stressors linked to elevated physician rates.

slide-5
SLIDE 5

5

  • Medical students: 15-30% higher than

general population

  • Male physicians: 70% higher than

males in other professions

  • Female physicians: 250-400% higher

than females in other professions

Medical staff must create support for its membership in many arenas: Celebrate! Start each meeting with a joyful patient story. You have many.

slide-6
SLIDE 6

6

Remember why you do what you do.

Why did you choose health care?

  • To please a parent?
  • Passion for science?
  • A doctor you admired?
  • Money?
slide-7
SLIDE 7

7

Formal and Informal Meetings That Matter

  • Well planned
  • Substantive
  • Safe educational programs – starting with
  • rientation:
  • The Board and what it does
  • Administration
  • Support staff
  • Preceptoring (buddy program)

Formal and Informal Meetings That Matter

  • Expanded role of Wellness Committee
  • Consultation without stigma
  • Publicize its role
  • Facilitate consultations
  • Communicate in myriad ways
  • Require members to access available

information

  • Informal, supportive, short get-togethers
  • Hotlines for news and concerns
slide-8
SLIDE 8

8

Formal and Informal Meetings That Matter

  • Food is love: meet in cafeteria or physician

lounge each Tuesday at 6:00 a.m. or 11:00 a.m. for all who can make it

  • Congressional dining room and the demise
  • f collegiality
  • Be the go-to source for information,

assistance (like the Rapid Response Team that is available to help with EMR)

Leadership Development

slide-9
SLIDE 9

9

  • Recruiting, grooming your successors
  • Leaders “self-select” (with

appropriate encouragement)

  • True leadership – visionary, quality-

driven

  • Medical Staff [physician leadership]

college

  • Someone told you:
  • “You’d be great at….” or
  • “Your skills would really move this

project….” or

  • “You are so well-respected by your

peers, you’d make a terrific.…” or

  • “Please help me out by reviewing

these cases and.…”

slide-10
SLIDE 10

10

Introduce new leaders with small “wins.”

Celebrate/reward good work

slide-11
SLIDE 11

11

Thanks.

Physicians in Governance

slide-12
SLIDE 12

12

No longer required by CMS, but “direct consultation” with “individual responsible for medical staff.”

Direct consultation: “a discussion

  • n matters related to the quality
  • f medical care provided to

patients periodically (at least twice per year)….”

slide-13
SLIDE 13

13

“Governing body (or subcommittee) meets with the medical staff leader(s) either face-to-face or via a telecommunications system permitting immediate, synchronous communication.”

Physicians on Boards?

  • How many?
  • How chosen?
  • Conflicts
slide-14
SLIDE 14

14

Physicians on Board committees Strategic Advisory Committee

slide-15
SLIDE 15

15

Eliminate Litigation

  • Define Standard of Care
  • Create Expectations
  • Education/Compliance/Enforcement
  • Assessment of high-risk practices

− Quality − Risk − Training − Documentation − Practice processes − Environmental hazards

slide-16
SLIDE 16

16

But, bad things happen.

  • Investigate
  • Disclose
  • Apologize (Sorry laws)
  • Remediate

What Is Cause of Litigation?

  • Bad outcome
  • Injury
  • Anger
  • Sense of unfairness
  • Vengeance
  • Patient/family wants to know

what happened (cases withdrawn at conclusion of discovery)

slide-17
SLIDE 17

17

PHTS Experience

  • A. Steps:
  • 1. Prompt reporting of incidents
  • 2. Prompt investigation, including

interviews

  • 3. Preserving records
  • 4. Meet with injured party/family
  • 5. Discuss facts openly
  • 6. Offer remuneration commensurate

with injury

PHTS Experience

  • B. Results:
  • 1. Financial savings – 66% ($8 million

from mid-2012 to mid-2014)

  • 2. EVERY SINGLE INCIDENT

avoided litigation

  • 3. Average cost of early resolution

case: $16,000

  • 4. Average cost of one “progressing

to lawsuit status”: $143,000

slide-18
SLIDE 18

18

Human benefits, too:

  • Sterile pack case
  • Picasso

Creative ED Call Solutions

slide-19
SLIDE 19

19

DO NOT try to solve one call problem at a time. Multidisciplinary task force designs solutions.

slide-20
SLIDE 20

20

Build fair call into all employment contracts. Create and market alternative multi-hour site for non-emergent care; permit immediate triage and transfer.

slide-21
SLIDE 21

21

ED directs all patients to hospitalists. ED contract (and bylaws) authorizes ED physician to admit to service of

  • n-call physician.
slide-22
SLIDE 22

22

Deferred compensation.

Old Is The New Useful

slide-23
SLIDE 23

23

“It is time.” Dignity in identifying and communicating with the aging practitioner.

slide-24
SLIDE 24

24

The Ultimate Balancing Act

  • Protect patients
  • Protect the practitioner
  • Protect other practitioners
  • Protect the organization
  • Comply with accreditation standards
  • Comply with Age Discrimination in

Employment Act (ADEA)

  • Comply with Americans with

Disabilities Act (ADA)

Options

  • Provision in Credentials

Policy/Bylaws for “Practitioners Over Age ______”

  • Late Career Practitioner Policy
  • Peer Review Policy
  • Practitioner Health Policy
slide-25
SLIDE 25

25

Practitioner Health Policy

Medical Staffs should evaluate their unique culture and decide if an age-based rule makes sense in their hospital.

slide-26
SLIDE 26

26

Benefits of a Rule

(e.g., a Bylaws Provision)

  • Protect patients
  • Reduce risk of negligent credentialing

claims

  • Treat all physicians the same (thus

reducing risk of discrimination claims)

  • Depersonalize issue

Drawbacks of a Rule

  • Overly inclusive

(affects physicians with no problems)

  • Controversial and inconvenient
  • Unnecessary if peer review process is

working properly?

  • Difficulty interpreting test results

(especially if no baseline)

  • Increased risk of discrimination claims
slide-27
SLIDE 27

27

Low Risk

  • Adopt and enforce evidence-based

volume requirements for procedures for all physicians

  • Concurrent chart review of certain

number of cases after age “x”

  • Annual reappointment
  • Concurrent proctoring of certain

number of cases

Some Risk

  • Require physician to have assistant

at surgery or back-up immediately available

  • Comprehensive physical and

psychological evaluations

slide-28
SLIDE 28

28

Do These Exams Yield Useful Information?

  • If no baseline to compare to, what

do results mean?

  • Even if decline noted, at what level

is it significant?

  • BUT – exams can be viewed as

flagging mechanism for focused review of practice and outcomes

High Risk

Automatic loss of privileges after a certain age.

slide-29
SLIDE 29

29

Age Discrimination in Employment Act (ADEA)

  • Applies to “employees”

(though some courts are interpreting broadly) over 40

  • Prohibits employment action based
  • n age
  • Applies to mandatory retirement,

mandatory testing, etc.

Can an aging policy treat all physicians the same (e.g., internists and surgeons)?

slide-30
SLIDE 30

30

Joint Commission Standard MS 11.01.01

Hospitals must have a process to address: − Education about impairment − Self-referral and referral from others − Confidentiality

Joint Commission Standard MS 11.01.01

Hospitals must have a process to address:

  • Evaluation of credibility of complaint
  • Monitoring
  • Reporting when practitioner is

providing unsafe treatment

  • Appropriate action
slide-31
SLIDE 31

31

Process

  • Education
  • Reporting
  • Fact-finding
  • Meeting
  • Evaluation
  • Resolution
  • Follow-up

Education

slide-32
SLIDE 32

32

  • Signs and symptoms of impairment
  • Importance of reporting
  • Downside of “enabling”

Policy should address: Education Reporting

slide-33
SLIDE 33

33

  • Emphasize confidentiality
  • Describe process for reporting by
  • thers
  • Encourage voluntary self-reporting

Policy should:

Reporting

  • Interview staff
  • Review relevant documents

Fact-Finding

slide-34
SLIDE 34

34

Is there enough evidence to meet with Man Legend?

  • A. Absolutely, YES!
  • B. Absolutely, NO!
  • C. It depends on whether there have

been other episodes of confusion.

Wrong Question!

You don’t need “evidence” or “proof” to meet with a physician.

slide-35
SLIDE 35

35

Plan the Meeting with Care

  • Don’t shoot from the hip
  • Have a game plan (and an end plan)
  • Review your documents – know

your own process!

  • Know your options

Meeting Plan the Meeting with Care

  • Anticipate denial
  • Emphasize confidentiality

Meeting

slide-36
SLIDE 36

36

  • Practitioner Health Committee

should select evaluating entity

  • Evaluation is NOT quick visit
  • Have evaluator complete form that

addresses relevant issues

Evaluation

  • Man Legend should sign

authorization permitting hospital and evaluating entity to communicate with one another and share information

Evaluation

slide-37
SLIDE 37

37

Conditions of reinstatement should be described in detail. Resolution

Physician Wellness Committee

slide-38
SLIDE 38

38

Policy provides for SAFE reporting. Mentoring, observer, subject matter leader in meetings.

slide-39
SLIDE 39

39

Assessments

  • CME
  • MOC (whether required by

Board or not)

Aging

slide-40
SLIDE 40

40

Balancing Act

  • Protect patients
  • Protect practitioner
  • Protect organization

Peer Review Across the Continuum

slide-41
SLIDE 41

41

“Intramural” Peer Review System vs. Site

slide-42
SLIDE 42

42

Same EMRs is a big boost… links community providers with others. Ambulatory Privileges

slide-43
SLIDE 43

43

Chief of Service (PMG role?) Too little data to review?

slide-44
SLIDE 44

44

Chart review, “peer” report

  • ffice visit.

Peer Recommendations

Peer evaluations:

  • MS.07.01.03: In circumstances where there are

insufficient peer review data available when evaluating an applicant for privileges, the

  • rganized medical staff uses peer
  • recommendations. A recommendation(s) from

peers reflects a basis for recommending the granting of privileges.

  • Peers: appropriate practitioners in the same

professional discipline as the applicant who have personal knowledge of the applicant.

slide-45
SLIDE 45

45

Create ambulatory privileges and FPPE (part of nurturing, collegiality).