What Do We Do With This? Managing Adverse Information

CAMSS 41st Annual Education Forum May 18, 2012

Presented by:Patricia E. Brown, BSCJ, CPCS

Maggie Palmer, MSA, CPCS, CPMSM

Objectives

How the National Practitioner Data Bank (NPDB) Continuous Query Report (CQR) works and how to manage it

Benefits and Risks of Sharing Information

Review guidelines for safely disclosing information

NPDB – Continuous Query

Benefits ~ Show Me The Money!

NPDB-Individual Query Costs

1000 docs – 100 new apps x 4.75 = $475

500 reappts x 4.75 = $2,375

100 addt’l privs x 4.75 = $475

Annual Total =$3,325

NPDB – Continuous Query

Benefits ~ Show Me The Money!

Continuous Query Costs1000 docs x 3.25 = $3,250100 new apps x 3.25 = $325

Annual Total = $3,575

Is the CQR worth the $250 more annually?

YOU BET!

NPDB – Continuous Query

• No more querying NPDB at reappointment

• No more querying at time of new privilege requests

• Meets JC, DNV, HFAP and NCQA standards

NPDB – Continuous Query

Finally Someone Works For YOU!

• Reports of any actions are sent directly to you. Usually within 24 hours of being reported to the NPDB.

NPDB – Continuous Query

ChallengesUnderstanding the process and

enrollment decisionsManaging mass reports

EnrollmentAudits

Handling reports as they come inDisenrolling

NPDB – Continuous Query

EnrollmentDecide who to enroll

Low Volume only?Temporary Privileges?Honorary/Emeritus?Administrative?

NPDB – Continuous Query

Enrollment

• It’s easy! You can export from your credentialing software.

• If you don’t have credentialing software consult the NPDB ~ they have a comprehensive guide book.

NPDB – Continuous Query

Audit Mass enrollment lesson learned:

Enroll applicants Assign your own CQ Practitioner number Save report electronically for surveyor access No need to print out each confirmation with mass enrollment Compare enrollment against medical staff and applicant

rosters

Dis-enroll “Off Staff/Termed” applicants who withdraw or denied.

NPDB – Continuous Query

NPDB – Continuous Query

CQR Reports

• What if a report is received after credentialing but while applicant is going through review process?

Sharing Information

Sharing Information

BenefitsCredentialing for the communityReduces duplicative processes (health

system)Possibly reduce incidences of “serial

applicants”Build network with your peers

Sharing Information

Risks

Improper disclosure

Knee jerk reaction to information before investigating

Loss of credibility

Sharing Information

Types of ways to obtain/share

Peer to peerHearsay Media reports

Sharing Information

Peer to Peer

Encrypt email

Phone call

Face to Face

Sharing Information

Hearsay SMOKE: ER physician with some past “issues” with

complaints of sexual innuendo and is harassing towards nurses. There have not been any formal complaints just hearsay…lots of it. Nurses are reluctant to report a physician.

FIRE: One night ER doc treats a homeless woman for an overdose and spends an usual amount of time with her. A few weeks later the hearsay changes from nurses being harassed to the doctor is using patients as sexual partners in exchange for prescription drugs and/or money.

INFERNO: About six months later the ER doctor is charged with coercing the homeless woman to have sex with his wife while he watched for money (the patient turned him and an no drugs were involved) and now an investigation by the Medical Board and subsequent lawsuit is in progress.

Sharing Information

Hearsay Risk Management/Legal CounselDocument your attempts to obtain

formal reportsGoogle Filter practitioners

Sharing Information

Media reportsInnocent until proven guiltyCollect articles Google filterTumbleweedCourt documentsMBC action reports

Policies & Guidelines

Release language Absolute Immunity Release from liability Indemnify and hold harmless

Attestation questions to consider: Do you have a release agreement with any

organization? Do you have a behavioral agreement? Have you ever had a time limited appointment?

Policies & Guidelines

Court documents are public

Read them! Do they outline compliance requirements or restrictions

Is the application compliant with requirements?

Useful site for querying court documents:

Pacer.gov - Public Access to Court Electronic Records (PACER) is an electronic public access service that allows users to obtain case and docket information from federal appellate, district and bankruptcy courts, and the PACER Case Locator via the Internet.

Why document?

Advantages of good documentation

Creates a record; avoids “institutional memory” issues

Establishes your seriousness

Lays groundwork for legally defensible corrective action if necessary

Do not collect to crucify

Use care in deciding how collect and when to act

There must be a connection to patient care

DO NOT GOSSIP Remain professional even if others don’tAlways, always, always seek legal counsel

advice and guidance

Best practices for responding and disclosing

Responding to questionnaires

Respond to all questions Be truthful, accurate, objective, and base response on

clear documentation If a question asks for an explanation because of a

response provided, be brief and to the point Response, at a minimum, should provide enough

information to give the answer proper context. You need not go overboard, but you also want to avoid follow-up questions from the hospital.

Best practices for responding and disclosing

Have you pulled together all relevant documentation?

Reliance on rumor, innuendo, distant memories, or anecdotal information will only cause problems.

If you don’t know, you don’t know.

What form of waiver of liability did the physician sign?

Absolute or qualified? Need to read closely. No waiver, no response.

Best practices for responding and disclosing

Questions to ask before responding:• Are there any limitations on what can be

disclosed?• State confidentiality/immunity statute• Bylaws/policies which may limit the

response• Hospital cut a deal and has a

predetermined response

Best practices for responding and disclosing

Responding to ratings questions: If you don’t know because of little or low activity levels,

simply say so and do not provide rating responses Try to come up with an agreed-to approach on the

profile of a physician who should get highest, middle, and lowest ratings, and strive for consistency

Any rating of average or less will be viewed as evidence of a potential problem physician and may require an explanation

Always make sure you have facts and documentation to support any response

Best practices for responding and disclosing

Must you disclose response to physician?

No, although if requesting an absolute waiver, physician may not sign until you disclose the proposed response

If physician refuses to sign an absolute waiver, can you refuse to provide a response?

Yes, although you should inform physician that response will not be provided to requesting hospital, which likely will delay processing or result in involuntary withdrawal of application or even denial

Special Release Request

Re: Dr. NaughtyDear:This letter is in response to the verification request dated xx/xx/xx in

relation to Dr. Naughty. Dr. Naughty has been a member of the Medical Staff of Kadlec Medical Center ("Kadlec") since date.

In order to supply additional information regarding Dr. Naughty, Kadlec must receive a copy of Kadlec's Authorization and Special Release form signed by Dr. Naughty. To date, Kadlec has not received a signed Authorization and Special Release form with respect to Dr. Naughty and is therefore unable to provide additional information at this time. The release has been forwarded to Dr. Naughty.

Please feel free to contact me at 123-456-7890 in the event you should have any questions. If you obtain a signed copy of Kadlec's Authorization and Special Release from Dr. Naughty, please forward to my attention. Thank you.

Best practices for responding and disclosing

If questionnaires completed by more than one person (i.e., department chair and division head), attempt to coordinate and strive for consistency, if possible

Make sure that medical staff coordinator or other administrative personnel reviews response before it is sent out

Best practices for responding and disclosing

You could also advise physician that if contacted, you will tell hospital that you are withholding response pending signature on absolute waiver

Should I provide a copy of any portion of peer review record?

Never! Never! Never! Once document is released, you should assume that everyone and their uncle will see it, including one or more plaintiff’s attorneys.

Best practices for responding and disclosing

Am I obligated to respond to subsequent requests for additional information?

If first response was specific enough so as to provide a context or background to questionnaire answers, there is no need or requirement to provide additional information unless otherwise mandated by law

Use your judgment

Best practices for responding and disclosing

Should I ever provide verbal responses:

What if the hospital wants to know the “real story?”

What do we do with this now?

QUESTIONS?

Patricia Brown, BSCJ, CPCS

brown.patricia@scrippshealth.org

Maggie Palmer, MSA, CPCS, CPMSM

palmer.margaret@scrippshealth.org