It is part of our Thanksgiving custom to consider the blessings we have and acknowledge our appreciation. With the doom and gloom filling our newspapers and nightly news programs, it’s easy for us to overlook the positive in our lives. This is an appropriate time of year for MSPs to contemplate the availability of primary care physicians in our communities.

I’m very fortunate to live in an area serviced by two very large health systems with significant supply of both primary care and specialists. I know that is not true in many communities and it appears that this situation will become even more dire. I found the information presented in a recent article in Medscape article regarding the attitude of primary care physicians in the United States very disturbing.

It was reported that more than half (60%) of 12,000 general practice physicians would not recommend medicine as a career. The number of primary care physicians is going to be significantly reduced due to retirement, cut-back on the number of patients seen, and reduction of work hours. Major factors contributing to physician dissatisfaction? Non-clinical paperwork, overextension, and being overworked.

This year I can honestly say that I’m very thankful for personal health, a healthy family, and excellent primary care physicians who keep me and my family well. I’m thinking about my Christmas wish: Quality health care available to all of us!

Happy Thanksgiving!

Carole La Pine, MSA, CPMSM, CPCS

An interesting opinion piece in the Washington Post on what the authors perceive to be the five biggest myths about U.S. healthcare. Myth number one? That the best healthcare in the world can be found right here in this country:

Todd Morrison
Managing editor

Does the term "physician assistant" still adequately describe what they do? Or does the title no longer adequately describe their range of responsibilities? Stephen Lyons, a physician assistant in Las Vegas, writes that the term no longer stands up:

Maybe in the early 1970s, PAs mostly assisted their physician employers, supervisors, and mentors directly, by extending their eyes, ears, and hands. And maybe in the early days of every new PA’s career, he or she is truly an assistant. But time marches on, and the medical world and health care delivery have evolved. We have evolved with them. Our title has not. It no longer is a helpful descriptive of our role.

Dr. Kevin Pho, who blogs at kevinmd.com, echoes those same thoughts and wonders:

Do patients truly understand the role and scope of the physician assistant? Will it require more public education? It's important, because there is no doubt that PAs will play a growing role as health delivery is reformed.

Todd Morrison
Managing editor

While U.S. economists haven’t yet “officially” announced that the U.S. is in a recession, it’s likely only a matter of time before they do given that things continue to slow. As you already know, the healthcare industry isn’t immune.

A new report by the American Hospital Association (AHA) finds that because of the tough times, nearly half of all the hospitals they surveyed are considering postponing purchases in clinical technology.

The also found that hospitals are finding an increase in the number of patients unable to pay for care, and nearly 40 percent report a drop in overall admissions. When forced with having to prioritize expenses, some people are simply choosing to go without.

“Many hospitals are beginning to see the effects of the economic downturn with more than 30 percent of survey respondents reporting a moderate to significant decline in patients seeking elective procedures, and nearly 40 percent of respondents reporting a drop in admissions overall. The majority of hospitals surveyed also noted an increase in the proportion of patients unable to pay for care. Uncompensated care was up 8 percent from July to September versus the same period last year, according to the report,” an AHA press release states.

Perhaps you’re seeing these trends at your facility.

Todd Morrison
Managing editor

The election is over and U.S. citizens have an opportunity to hold our new president-elect accountable for fulfilling his campaign promises. I’ll admit in the past, I have not always remembered what the candidates promised so it was not easy to judge whether or not the elected kept his/her promises. This next year will be different for a number of valid reasons.

First, we’ve have reached the point where the cost of healthcare coverage is at an all-time high. In 1993, the Clinton Administration tried to roll out a revamped healthcare system, but it never got off the ground in Congress, and subsequently failed to have any real impact whatsoever.

We desperately need some type of health care reform, and time is running out.

Second, our current economic situation can only lead to an increase in the number of uninsured in this country. When this occurs the results are increased emergency room services, less spent for preventative health care, and ultimately patients seeking medical attention when diseases or injuries are extreme.

For MSPs this is not merely politics as usual but rather significant changes in our work environment. The two issues that will impact all health care entities are cost reduction and increased access to services. This is going to be an important time to learn what each organization is doing in reaction to those two critical issues. It was reported that healthcare companies, drug makers, insurers and other healthcare delivery systems are preparing for possible dramatic changes to the healthcare industry. This is an opportunity for us to look for ways we can be part of the solution rather than another element of the problem.

David Broder ended his most recent column in the Washington Post entitled "Rising Hope for Healthcare" with optimism. “No question, it will be a tough fight. But you can see the possibility of success,” he wrote.

Do you believe that the chances for real reform are better than ever now? Let’s pay attention to what happens next.

Carole La Pine, MSA, CPMSM, CPCS

It has been reported that the critical care work force will be significantly reduced by 2030 (estimated 22 to 25% shortage) and that hospitalists will be filling in the vacancies in the intensive care units. The question that is raised is what is the clinical practice scope of hospitalists in the ICU? Not all hospitalists are intensivists nor are all intensivists hospitalists.

One of the major differences between the two categories is the delineated clinical privileges. In an article by Gretchen Henkel (Hospitalist.2008; 12(10):2-3, John Wiley & Sons, Inc), Dr. Michel Gropper, Vice chair of the Department of Anesthesia at University of California, San Francisco, is quoted saying that intensivists conduct procedures such as ventilator management, placement of central lines, and sedation while hospitalists write orders for antibiotics, nutrition and fluid management. Although hospitalists should have experience and be comfortable working in the ICU, the average hospitalist should not be granted ICU privileges without documentation that specific criteria is met.

At another institution in Lincoln, Nebraska, hospitalists provide 24/7 coverage performing such privileges/procedures as placing central lines but intensivists are called in for consultation and more complicated critical care procedures such as chest tube placement, Swan-Ganz catheters, and difficult ventilator management. In an ideal situation, recruiters would be searching for hospitalists with training and experience in the ICU. A fine line exists for hospitalists who may meet criteria for ICU privileges and recognition of individual limitations. When a co-management arrangement is in place, hospitalists working with intensivists, the outcome can be what has been demonstrated in Lincoln: a 50% drop in mortality rate and zero ventilator-acquired pneumonias or central line-related infections in over two years.

Is it possible for hospitalists and intensivists to form collaborative partnerships to care for patients in the intensive care units? MSPs should take a careful look at the delineation of privileges granted to hospitalists and those granted to critical care physicians making sure that the required criteria is clearly established and documentation is provided.

Carole La Pine, MSA, CPMSM, CPCS

There are 23 states in the US that have adopted the American Hospital Association’s recommendation to standardize the color codes of patient wristbands. The rationale for this recommendation is that some caregivers work in more than one facility and standardization will ensure that quick and appropriate care is administered. Although the AHA is not promoting the use of color-alert wristbands, it is encouraging consistency in the color designation: Red – allergy, yellow – fall risk, and purple – do not resuscitate.

The colors were selected based on the following:

* Red means stop; therefore, a red wristband alerts the caregiver to check medication, food or treatment for possible allergic reactions.
* Yellow indicates “caution”, “slow down” or “take precaution”. This color indicates the patient may need special assistance when walking or being transferred to prevent falling.
* Purple. No special explanation was provided for its selection. However, it alerts caregivers that the patient has an end-of-life directive on the patient’s chart.

Does this all sounds reasonable and in line with quality patient care? Are there other issues that impact the use of color-coded wristbands. For example, allergic reactions can change or not previously be reported. In the use of the purple band, there are definitely issues as patients may change their minds as their health conditions change or the patient may not want others to know of his/her decision.

There are other issues that may present problems such as color blindness of caregivers (does anyone test for this?) and the current fad of wearing wristbands in support of various causes (pink for breast cancer awareness).

If a hospital does implement the use of standardized color-coded wristbands, I encourage the medical staff to have a very clear policy on use, documentation, and verification protocol.

What’s in place at your hospital? Do you have a policy to cover color wristband use?

Carole La Pine, MSA, CPMSM, CPCS

I have found that I rely more and more on email as my major vehicle of communication. I've set some rules for myself that I want to share with you in order to make your communications more effective or at least more responsive.

First, set a timeframe for answering email. For me, it is within 24 hours. However, when I'm in the office, I answer as soon as possible. I know what it feels like to be on the receiving end and not hear from your contact for days.

This brings me to my second "rule" - when I'm out of the office, I post a message stating the dates I will be unavailable. This allows the person on the receiving end to know that I am not currently available so he/she will not be expecting an immediate reply.

Another rule I have is to fully read the message that I have received. For some reason we consider email as brief dot-points and usually skip over much of the content. I agree that emails should be relatively short and not lengthy single paragraphs. Readers (like me) will not read those long communications. I will print them off with the best intention of responding later ... but that is very hit/miss. I try to keep my emails short, to the point, and clear about my expectation. This allows the receiver to know what I am expecting even though it is considered an informal communication.

Email is considered informal communication, however it needs to be "good" communication. By that I mean that it should be check for spelling, punctuation, and complete sentences. Let us not fall into the text-message mode where we need to learn yet another language in order to communicate, foregoing every English lesson we ever learned. LOL.

I could not be effective in my job without email. I expect quick responses and I expect that the reader has taken the time to fully read my message so that the response it clear as to what I have asked or requested. For me, email is my primary source of communication. I put it in the same category as effective letter-writing. When it fails, however, I pick up the telephone for that one-on-one conversation that usually takes care of all issues.

Email - let's use it, not abuse it.

Carole La Pine, MSA, CPMSM, CPCS

The current US economic situation is affecting many health care facilities leading to a direct impact on many MSPs. Sad to note that one of the first items to get cut from our budgets is funding for educational opportunities. It matters not that the realized benefits of education programs such as audio conferences, Webinars, and various on-line learning session far out weigh costs. These type of educational forums are an effective, economic alternative to local, state and national conferences that require travel.

In most situations I'm a positive person preferring to see the glass half full rather than half empty. So in our current economic environment where funds are very limited, I prefer to look for ways to obtain education for free. How can MSPs continue to gain knowledge, improve procedures and keep current with changing accreditation standards and/or regulatory compliance requirements? The answer: NETWORKING. Almost every state has an association for MSPs. Now would be a great time to get in touch with state leaders to tune in to the state network. One way to identify current state leaders is through the National Association Medical Staff Services’ (NAMSS) Web site. NAMSS can also serve as an excellent source for networking. What's the cost? Annual membership dues. You'll need to check with your local state association for more information regarding membership dues and check the NAMSS web site for information of NAMSS membership.

Networking - very cost effective!

Carole La Pine, MSA, CPMSM, CPCS

To all my fellow MSPs, let me say that we have a wonderful opportunity this week to let our patients, practitioners and the public know the tremendous job we do on their behalf. This week, National Medical Staff Services Awareness, is especially important because we are being recognized at a national level for the vital role be play in the delivery of quality health care. I urge you all to let folks know the vital role you play.

Often I am asked what I "do" and I respond "I work for a healthcare system" (substitute hospital, managed care plan, large group practice). Then I usually get asked "Are you are nurse"? Depending on my mood at the moment, I may respond, "No, I make sure that nurses and doctors are competent to met your health care needs". Or I might say, "I'm the one who investigates the practitioners who take care of your family members." Many response get the wide-eyed expression and comment "Oh, I didn't know!"

It is our job, especially this week, to promote our profession. Are you not sure how to do this? Here's what I've observed other do: A managed care plans had exciting fun and activities promoting daily quizzes similar to Jeopardy with prizes for the winners. Others organizations have requested funding from the medical staff dues to hold a special luncheon or purchase a token or appreciation (flowers, candy, etc.). My delight was achieved when I learned that the medical staff support dues supported educational opportunities (NAMSS conference) to recognize the role of the MSP at their facility.

I know that speaking out will gain us recognition. So even if you are shy, unsure, reluctant, please speak out NOW to those you come in contact with! This week only ....or perhaps at other opportunties.

I am so proud to be a colleague of those in this esteemed profession. Please join me in saying "Congratualtions" to jobs well done!

Carole La Pine, MSA, CPMSM, CPCS

All week long we’ve been speaking with MSPs about what National Medical Staff Services Awareness week means to them. Some of these responses appear below. Please add your thoughts in the comment boxes at the end of the post.

“The celebration and recognition of Medical Staff Services Professionals Week allows us to not only receive deserved recognition for what we contribute each day, but it also gives us an opportunity to reflect on how we can give the same deserved recognition back to the profession.

For most of us I think we can say that we did not set out to be a Medical Staff Services Professional but thanks to the forward thinking of our founding members we fell into a rewarding career in a profession that is recognized by the medical field and healthcare industry as an important key in the deliverance of good quality healthcare. In addition, we are privileged to work with the most intelligent people in our society and help to provide guidance to them in the administration of their leadership roles that provides for a great medical staff further translating to great patient care.

Our profession is changing rapidly and on the edge of looking different in years to come. I encourage you to take this week to reflect on what you can do through volunteerism to our chapters, state associations and national associations, to help our leaders on all levels of the organization assure that our profession keeps up with the changes that have started to take shape to further assure that the professionals that follow us will share in the same or even more rewarding career that we enjoy today.”

Bonnie Conley, CPCS, director of medical staff services at Trinity Medical Center in Carrollton, TX.

“National Medical Staff Services Awareness Week is our opportunity to be recognized, nationally, just as so many other healthcare professionals are. It is confirmation that ours is truly a healthcare profession that is important to the overall wellbeing of the patients we serve.”

Terry Wilson, BS, CPMSM, CPCS, director of medical staff services at Flagler Hospital in St. Augustine, FL.

“Unfortunately, our hospital does not recognize this week. With as much work that I do and the hours of dedication, it would be nice and welcomed to have some type of recognition. I am curious to all the other answers.”

Bonnie Edlebeck, medical staff coordinator at Dickinson County Healthcare System in Iron Mountain, MI.

-- Emily Berry, associate editor

In my role as an editor at HCPro, I spend a lot of time talking and listening to MSPs. It’s through these interactions that I often get a sense of the environment in which our readers work—and it’s not as uniform as you might think. I’m not talking about the size or location of the environment, although that does play a role. I’m talking about the respect that others in the organization give to an MSP.

This respect is reflected in the way the medical staff interacts with you, your job description, and your salary. If you read our 2008 CRC Salary Survey, you saw these discrepancies for yourself. Thirty-nine percent of credentialing coordinators reported making between $30,001-$40,000 per year, while ten percent reported making $50,001-$60,000 per year. And a few of you (one percent) reported making over $70,000 per year.

I’m sure all of you would like to be in that last category, just as you would like to be respected by others in your organization for the serious and demanding work you do. After all, if the job that you do is similar to the jobs your peers do nationwide, shouldn’t the respect you receive be similar, too?

Garnering the respect you deserve starts with respecting yourself and presenting a professional face to the world. It is also earned by educating others about your role and negotiating a fair job description.

I encourage you to take a moment to share the ways you’ve earned respect in your organization in the comment boxes below. By helping to elevate the status of one MSP, you help to elevate the profession as a whole, and isn’t that one of the goals of National Medical Staff Services Awareness Week?

Emily Berry, associate editor

It’s National Medical Staff Services Week!!! My wish for all MSPs this week is that each and every one of you receives deserved recognition for your work in your organization.

It is a fact that MSPs are a very valuable tool in their organization’s risk management tool kit. Analyzing credentials files and identifying “red flags,” MSPs are constantly on the look out for warning signals where a higher level of scrutiny for a particular credentials file would be warranted. MSPs also recognize that once all verifications are complete the real focus is to evaluate the appropriateness of a practitioner for appointment and to determine that practitioner’s competency for clinical privileges requested.

I recently wrote a white paper that addressed competencies for MSPs. Within that white paper, I likened MSPs to air traffic controllers and the important but behind the scenes work they do to protect passengers. Like the air traffic controller, MSPs must constantly be on the look out for potential problem practitioners, be able to analyze the situation, and react appropriately in order to protect the patient and the organization from potential harm or injury.

If you have uncovered a red flag and your diligent follow up then led to a decision for that particular practitioner to not be appointed or granted privileges in order to protect patients and staff, we would love for you to share that story with us.

Sally J Pelletier, CPCS, CPMSM
Senior Consultant - Credentialing and Privileging
Executive Director - Credentialing Resource Center Consulting
The Greeley Company, a division of HCPro Inc.