Not only is this a complete failure by the doctor, but it is a failure by the hospital for not ensuring this doctor did not perform this surgery.
But what do you think? I would love to hear from you! I welcome your phone call on my toll-free cell at or you can drop me an e-mail at jfisher fishermalpracticelaw.
John H. Fisher, P. The firm seeks every opportunity to assist in improving the lives of those around the Country and looks forward to meeting others with a similar goal. Our Blog. As every physician knows, the healthcare industry is highly regulated.
Those regulations exist to protect patients and their right to good quality of care standards. Credentialing and privileging are but two of the many regulations that physicians need to follow. Filling out the forms, providing the documentation, and going through the process can be tedious and time-consuming.
Credentialing and privileging help healthcare organizations reduce fraud and abuse. Anyone can lie on a CV, fake a license, or create phony letters of recommendation. The processes of credentialing and privileging ensure that patients are seeing legitimate, licensed doctors at all times. The first step in getting credentialed is to know the regulations in your state.
The application, verification, and approval process can take between 90 and days. Start the process as early as possible. Filling out your credentialing application can be a tedious process.
And, depending on the hospital or insurance network, you may need to submit a pre-application first. A pre-application is a way to quickly weed out physicians who are not eligible or qualified for credentialing. The pre-application searches for basic information about you, including criminal records. It also looks for records of disciplinary actions and checks that you have the required board certifications. If there are any red flags, you may be asked to provide more information.
Credentialing can be denied if you fail to comply. Qualified eligible physicians will not have any issues with the pre-application process. You will need to provide your own health status and vaccination records. You will need to agree to provide proof of all liability insurance and malpractice liability certificates. You will also need to accept the bylaws and regulations as set forth by the hospital or medical group. In addition, you will need to include copies of your licenses, a copy of your CV, and letters of recommendation.
Once you submit your official application, follow up with a call or email to confirm receipt of your application, and confirm that it is in review. In some cases, the credentialing board may contact you for additional information.
If they do, provide it promptly — otherwise, your application could get rejected or delayed. Always keep copies of your application and any additional documents you send. If there is a snag or a delay in the process, it will be helpful to have those records on hand.
This cost is incurred by the hospital or healthcare practice, not the individual physician. If you are in private practice and need credentialing for an insurance provider, you should expect to pay the credentialing costs yourself. You will also need to pay for credentialing of any physicians you hire to join your team.
There are a variety of third party credentialing services that hospitals and healthcare practices can hire to handle the process. When selecting a credentialing service , look for an experienced provider that can customize a plan for your hospital or practice. The cost of privileging varies. Depending on who you are employed by, it may be covered under administrative costs.
For primary care doctors, making rounds at the hospital in the morning or at night also took away from their already limited time and availability to see their other patients at the office. How could they justify keeping people waiting in their lobby for appointments while they spend a couple hours at the hospital?
It also was unfair to the patient, as test results and medication adjustments at the hospital had to wait until your doctor returned and could review information. Now, there are more than 50, hospitalists in the United States.
Hospitalists are the point person for patient care at the hospital and effectively serve as the primary care physician for a patient during their hospital stay. They — along with emergency room staff, other doctors, and hospital administrators — decide who gets admitted and when. The days of a primary care physician admitting one of their patients thanks to their privileges are over. Not anymore. With the rise of the hospitalist role, admitting privileges for primary care physicians are few and far between.
In addition to hospitalists who run the show at the hospital, ER doctors and nurses are still obligated to admit the most urgent patients first. No admitting privileges are going to replace that responsibility. That much is true for both traditional and concierge practices. With proper authorization in accordance with HIPAA regulations, you can authorize the hospital to share information with your doctor.
You or your family member can also contact your doctor to provide the information themselves. With concierge medicine, the difference comes in the access you might have and the availability of a doctor to quarterback your care in the hospital. With fewer patients, a concierge medicine physician could have the time to speak with you or the hospital staff about your care as opposed to just running from appointment to appointment.
If it is a matter of some seriousness, the physician should request a conference with those involved and be ready to support his or her decision, while being open-minded when listening to what others have to say. If the physician and hospital have agreed to resolve an issue through changes in practice or through continuing education, for example, the physician must be sure to put the change into effect or get the continuing education, whatever the case may be.
Failing to follow through on the agreed resolution invites removal from the medical staff in short order. Action Step When a physician agrees to obtain continuing education or change his or her practice pattern, the physician should implement the change immediately and attend the continuing education promptly. The physician should also report back to the hospital periodically on his or her compliance with the agreement.
Today, a physician cannot always get staff privileges somewhere else. Physicians should remember that the hospital board has broad discretion in controlling admission to or on its medical staff and is insulated to some degree from legal liability by federal law. Physicians could risk losing privileges at any hospital by taking the attitude that their privileges at that hospital are less important because of opportunities they think they might have at some other hospital.
A physician under that kind of scrutiny is at risk of a reprimand, if not summary suspension. This does not mean that physicians should call a lawyer whenever a peer review committee wants to talk to them, but if they are the subject of multiple inquiries, they may need legal advice.
Action Step Physicians who are under scrutiny by peers or a hospital committee should seek legal advice from a lawyer. There is a time to fight and a time to mediate or negotiate, but physicians need the advice of a lawyer to make their way through the maze of hospital bylaws and medical staff requirements.
Regulating a hospital medical staff involves balancing the interests of both the practitioner and the hospital. When those interests compete, there can be an adverse effect on patient care sufficient for the hospital to consider excluding the practitioner from the medical staff. Avoiding these mistakes and following the action steps suggested should resolve the sometimes competing interests in favor of the practitioner remaining on the medical staff.
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