credentialing resource center journal · when niehaus first began managing virtual teams for a...

Credentialing Resource Center Journal

In a traditional medical staff services department (MSSD), everyone works in the same building, often in the same office. However, that is starting to change, and MSPs must be prepared to work on or manage virtual teams, according to a session at the NAMSS National Educational Conference and Exhibition, held in October in New Orleans.

As health systems acquire more facilities, build new hospitals, or move some tasks to CVOs, these changes mean more MSPs will be working with colleagues in different locations, perhaps with management in another office. Managing these virtual teams presents some different challenges and new twists on traditional team building and conflict resolution, according to Amy Niehaus, CPMSM, CPCS, MBA, a consultant with the Greeley Company, who presented “Is Anybody Out There? Working and Managing in a Virtual Environment” at the NAMSS conference.

When Niehaus first began managing virtual teams for a previous employer about eight years ago, “it was probably not the best experience it could have been,” she says. Initially, Niehaus explained, she tried to manage far-flung teams as if they were in her home office. “I was exhausted. When I was in a location, I wasn’t fully there. … I was focusing on them, but I was also worried about what was going on in other locations. My teams probably felt a little lost

Resources

Prepare to credential and manage in a virtual world

'What do you do?'Build a log of your tasks and the time you spend on each, and you might also build a case for more staff, find opportunities for improvement, or be amazed at your department’s efficiency.

Physician licensure compact updateThe finalized document, coming soon to some state legislatures, aims to streamline multistate licensure for physicians, and could also ease the verification process for MSPs.

Neurophysiological monitoringMedical technicians can get one level of professional certification in neurophysiological monitoring; physician specialists get higher-level training.

Getting projects to take flightRosemary Dragon, CPMSM, CPCS, offers this advice for taking on—and launching—your trickiest credentialing and privileging assignments. Just take them ‘bird by bird.’

P5

P8

P10

P12

CLINICAL PRIVILEGEWHITE PAPERS

We are constantly updating our library of Clinical Privilege White

Papers. Here are a few of the most recently updated papers:

Download the latest papers from www.credentialingresource-

center.com.

DECEMBER 2014Volume 23Issue No. 12

• Registered nurse first

assistant—Practice area 101

• Neurophysiological monitoring—

Practice area 187

• Certified nurse-midwife—

Practice area 164

• Radiation oncology—

Practice area 121

• Nurse practitioners in

bariatrics—Practice area 461


2 HCPRO.COM © 2014 HCPro, a division of BLR. For permission to reproduce part or all of this newsletter for external distribution or use in educational packets, contact the Copyright Clearance Center at copyright.com or 978-750-8400.

December 2014

managing his or her time and providing deliverables. Good virtual team members are very results-oriented. They must also have very strong communication skills that stand up to a lack of face-to-face interaction.

Getting the messageStrong communication and effective management

are essential to virtual team success, Niehaus says. Developing a good team requires building relationships, as well as promptly finding and managing conflicts. Other keys to effective virtual teams are:

• Use technology appropriately. For example, email is good for relaying information and can be used for conversations, but it has its limits. “I always tell my teams, if you can’t convey your message in one to two email responses, then you need to pick up the phone and have that discussion because you’re not being clear or it obviously doesn’t fit email,” Niehaus says.

• Listen carefully in telephone conferences. Virtual team managers need to listen carefully to team members’ tone of voice, inflection, and pitch; they must really tune in to what their colleagues are saying and think carefully about how to respond, says Niehaus.

• Repeat important messages. Everyone will walk away from a conference call with a different

Follow UsFollow and chat with us about all things healthcare compliance, management, and reimbursement. @HCPro_Inc

Credentialing Resource Center Journal (ISSN: 1076-5980 [print]; 1937-7339 [online]), the newsletter of the Credentialing Resource Center (CRC), is published monthly by HCPro, a division of BLR, 75 Sylvan St., Suite A-101, Danvers, MA 01923. Enrollment fee in the CRC is $499/year or $899/two years. Credentialing Resource Center Journal, P.O. Box 3049, Peabody, MA 01961-3049. Copyright © 2014 HCPro, a division of BLR. All rights reserved. Printed in the USA. Except where specifically encouraged, no part of this publication may be reproduced, in any form or by any means, without prior written consent of HCPro, or the Copyright Clearance Center at 978-750-8400. Please notify us immediately if you have received an unauthorized copy. For editorial comments or questions, call 781-639-1872 or fax 781-639-7857. For renewal or subscription information, call customer service at 800-650-6787, fax 800-639-8511, or email [email protected]. Visit our website at www.hcpro.com. Occasionally, we make our subscriber list available to selected companies/vendors. If you do not wish to be included on this mailing list, please write to the marketing department at the address above. Opinions expressed are not necessarily those of CRCJ. Mention of products and services does not constitute endorsement. Advice given is general, and readers should consult professional counsel for specific legal, ethical, or clinical questions.

EDITORIAL ADVISORY BOARD

Carol S. Cairns, CPMSM, CPCSSenior ConsultantThe Greeley CompanyDanvers, Massachusetts PresidentPRO-CON Plainfield, Illinois

Becky Cochran, CPMSM, CPCSDirector of Medical Staff Services San Juan Regional Medical CenterFarmington, New Mexico

Christina W. Giles, CPMSM, MSIndependent Consultant, Medical Staff AdministrationNashua, New Hampshire

Kathy Matzka, CPMSM, CPCSMedical Staff ConsultantLebanon, Illinois

Robert W. McCann, Esq.PartnerDrinker Biddle & Reath, LLP Washington, D.C.

Maggie Palmer, MSA, CPMSM, CPCS, FACHENational Director of Credentialing Tenet HealthcareDallas, Texas

Sheri Patterson, CPCSPresidentMSO Staffing Telecommuting Solutions Newport, Oregon

Sally J. Pelletier, CPMSM, CPCSAdvisory Consultant, Chief Credentialing Officer The Greeley CompanyDanvers, Massachusetts

Anne Roberts, CPMSM, CPCSSenior Director, Medical AffairsChildren’s Medical Center Dallas, Texas

Elizabeth “Libby” Snelson, JDLegal Counsel to the Medical StaffSt. Paul, Minnesota

Fatema Zanzi, Esq.AssociateDrinker Biddle & Reath, LLP Chicago, Illinois

Product Manager, Digital SolutionsAdrienne Trivers

Managing EditorMary [email protected]

This document contains privileged, copyrighted information. If you have not purchased it or are not otherwise entitled to it by agreement with HCPro, a division of BLR, any use, disclosure, forwarding, copying, or other communication of the contents is prohibited without permission.

because I wasn’t there all the time, and they didn’t know me. It’s hard to trust someone you don’t know.”

Niehaus began to learn about virtual management to improve as a manager and teammate. Her presentation was based on her insights from managing and working with virtual teams in multiple states and other coun-tries, as well as research and training experiences.

Thirty years ago, there were no virtual teams because there was no way to collaborate remotely. However, “today we can talk to anybody, anytime, anywhere almost instantaneously,” she says—noting that this capability brings both advantages and barriers. “Maybe you’re starting to work on policies and procedures, centralizing credential activities. We’re seeing teams in multiple [office] locations, people working from home, a lot of different situations. How do we work with that?”

Some companies have as much as half the workforce working virtually, according to Niehaus. However, it’s important to train both virtual managers and team members to work effectively.

For starters, not everyone is cut out to work from home. “You need to be self-motivated and focused on doing good work [without having] anyone observing you,” she says. The employee is responsible for


3HCPRO.COM© 2014 HCPro, a division of BLR. For permission to reproduce part or all of this newsletter for external distribution or use in educational packets, contact the Copyright Clearance Center at copyright.com or 978-750-8400.

December 2014

• Post pictures and profiles of teammates on the organization’s shared space.

• Hold 15-minute virtual coffee breaks once in awhile. • Incorporate chitchat into communications and

meetings. “If you were face to face in a meeting, you would be saying ‘Hi, how are you? How was your weekend?’ Think about bringing that into your virtual communications as well,” says Niehaus.

• Use team-building activities. These don’t have to be big events like bungee-jumping; small and simple can be effective, she says. For example, Niehaus has asked new teams to spend two minutes describing something that is sitting on their desk or hanging on their wall, such as photos or awards.

Conflict managementWorking with someone in another location can make

conflict resolution harder than if the person is in the same office. It is critical to determine if an issue is an interpersonal conflict or something related to the work, Niehaus says. Although interpersonal conflicts can be thorny, fortunately they don’t crop up often because workers aren’t in the same location.

Task-related problems are a lot easier to deal with. The key is to address issues as quickly as possible; otherwise, task-oriented problems can speedily morph into personal issues. Tools such as online discussion boards can help resolve conflicts or questions. Shared spaces can give team members the opportunity to share opinions and voice concerns.

Sometimes, conflicts arise because team members’ goals aren’t clearly defined beforehand. Don’t assume that everyone on a virtual team knows who’s doing what. “Document it and make sure everybody is very clear about the role they play on the team, what they’re responsible for, and when things need to be done. That goes for the manager of the team as well as team members,” Niehaus says. Develop clear, concise goals and indicate how performance will be measured. “Don’t leave that vague in any way.”

Cultural differences can cause conflicts as well. “Different countries have different ways in which they make decisions. Develop guidelines, if possible, to help people understand what to expect,” she says.

Trust is built and measured differently in a virtual environment. “Most often it’s measured in reliability.

interpretation of what was talked about and decided, so it’s very important to follow up with an email that in-cludes topics of discussion, decisions, and due dates to ensure everyone is on the same page. The information should also be posted on the organization’s intranet site or other shared space so everyone has it as a reference.

• Identify personal preferences. “Everybody’s different—we don’t all want to communicate in the same way,” says Niehaus. Some people are constantly in email, making that the best way to reach them. Others only look at email occasionally, so a phone call might work better. Using instant messaging may be the answer for team members who are on the phone all day. “Understand that everybody works differently.”

• Consider cultural differences. This doesn't just mean people working outside the U.S. Even in different regions of the country, it’s important to understand customs, holidays, and special occasions in different regions.

• Address language barriers. People who have heavy accents can inhibit communication and under-standing. Speak slower and use confirming statements, Niehaus advises. “If you need to, use a translator.”

• Identify commonalities, but explore differences as well. People are a lot more alike than you might imagine, and working with someone who enjoys the same things you do might make a project go a little more smoothly. However, the differences are also important. Getting to know how team members handle stress, workloads, and deadlines will go a long way toward creating a successful virtual team, Niehaus says.

Relationship buildingBuilding the relationships necessary for team suc-

cess is difficult when team members are in different locations. Trust does not come easily when teams never meet in person. Nevertheless, all teams must depend on each other. In the absence of face-to-face interaction, water cooler conversation, and after-work get-togethers, how do you develop those relationships? Niehaus suggests virtual team managers:• Create online questionnaires to learn more about

each other, asking questions such as “What do you do in your spare time?” “What are your goals?” and “What is your dream vacation?”



December 2014

If a manager senses a lack of engagement by team members, he or she should assess their participation in conference calls, bring them out, and ask questions. “Is there an issue that needs to be addressed? Look at motivation,” says Niehaus. “Are they volunteering to take on work, volunteering for new roles and responsibilities, or is everyone hanging back? Be aware of what’s going on with your team.”

Inclusiveness should extend to celebrating accomplish-ments, she says. It’s very easy to celebrate when all mem-bers of a team are in the same office, but not when they’re in different locations. Try to celebrate such that everyone can participate—giving out gift cards, for example. “You don’t want to have celebrations in a way that excludes people just because they’re physically not there.”

Sometimes the first step can be the most crucial when it comes to building camaraderie. It can be very expensive to bring everyone in for a meeting, but doing so in the very beginning of a project, allowing everyone to meet each other, can go a long way to a successful team endeavor, she says. Then, “develop your com-munication strategies, let them know how often you’re going to communicate, what methods you’re going to use, what updates you’re going to provide, what will be posted. Set that expectation, and go to the shared site on a regular basis to stay on top of what’s going on.”

Three keys to successNiehaus concluded with three keys for virtual

management and team success: 1. Virtual teams do not work for every project and every

situation. For example, if a project is critical and short in duration, it will be hard to manage scattered team members. There won’t be enough time to develop working relationships and trust. “It might be best to pull together people who are colocated and put them in a room until it’s done,” Niehaus says.

2. Virtual teams are different from on-site teams. “Make sure you have training for the managers as well as team members and can address the barriers and obstacles that might emerge,” notes Niehaus.

3. Invest in training, knowledge, and face-to-face meetings to have successful teams. “We work more and more with virtual members, and we just need to be prepared to be successful in whatever we’re working on,” says Niehaus. H

Are you as a team member going to deliver on what you’re assigned to do, and are you going to do it on time? If not, you’re losing trust from your teammates and manager.”

Lack of input can be as troublesome as conflict, so it’s important to avoid the out-of-sight, out-of-mind dilemma. “It happens a lot with virtual teams because you feel left out when you’re working from home, as opposed to someone who’s just working in another location,” Niehaus explains. “Do what you can to stay in touch with everybody so they’re feeling like they’re part of the team, no matter where they’re located.”

Picking leadersEffective leadership makes or breaks virtual

teamwork. An ineffective leader will have a hard time meeting goals and deadlines. Ensure that leaders have the right skill sets and give them the right training, Niehaus advises. That includes technical training on project management tools, as well as team building and interpersonal skills. “The team needs to know what they’re working on, how they’re going to get there, and have that direction” to achieve the goal. People can get disengaged, but managers who provide timely feedback, conduct team-building exercises, and seek face-to-face time when possible can help prevent team members from checking out, she says.

Reinforcing goals via different communication, and periodically reassessing them, is also essential. “New projects come up you had no idea were going to happen; things occur that you didn’t plan for, and you have to reassess those priorities to make sure they’re still realistic and you can achieve them,” says Niehaus. As things change, it can be helpful to create a reference tool so virtual team members know where to go for answers to their questions, she adds.

Lack of cooperation can be another concern for virtual teams, but the underlying issue there might be “virtual trust” and inclusiveness. For example, if a manager is in the same office with a team member, he or she might give that team member updates first because it’s convenient to do so. However, managers should try to treat every member of the team the same regardless of location—and make sure everyone gets the same information at the same time, she says.



December 2014

Time measurement is the first step to time management

It’s been said that you can’t manage what you can’t measure. Therefore, time management starts with time measurement. For MSPs, logging tasks and the time devoted to each can also help others understand just what happens in the medical staff services department.

Some answers to the question “What do you do?” are available. For example, the Credentialing Resource Center’s 2014 MSP Salary Survey found that MSPs at every salary level spend time on verifying credentials and privileges, meeting management, and risk management.

According to NAMSS survey data, each MSP handles an average of 112 credentialed providers. Credentials offices spend twice as much time on credentialing and privileging compared with operations. Turnaround time for verifying an application is 53 days for acute care hospitals and 51 days for specialty facilities, according to the same survey.

Logging the time spent on medical staff duties can be a daunting task, but it can also be an eye-opener for non-MSPs. Recently, Marna Sorensen, CPMSM, director of medical staff services at Portneuf Medical Center in Pocatello, Idaho, shared a study of time spent on medi-cal staff duties at her facility. (The form on page 6 and 7

has been abridged due to space constraints. You can see the complete document at www.credentialingresource-center.com.) On this sample form, the number on the left is the volume—for example, the number of physician application requests. The number on the right is the total number of hours the task requires.

Sorensen developed the form in 2011 as a defense against criticism of turnaround times. Portneuf has a medical staff of about 300. “I was trying to emphasize what our scope is in this department—it’s very broad—and how much time everything takes,” she says. “So if there’s ever any question [from physicians or others] about ‘why do you need two people for 300 practitioners?’ that would be the answer.”

It also helps show the value of what her two-person department does, and figure out where changes are necessary, what activities take the most time, or "where we could economize or have a volunteer help," Sorensen says. “Every year we go through this, and it’s nice to have all the time down so we can figure out where to make changes. So far I haven’t found any good way to take something off the list, but sometimes we can implement some efficiencies.” H

The Credentialing Resource Center Symposium is back!

Mark your calendar for March 12–13, 2015, for the return

of the Credentialing Resource Center Symposium at Caesar’s

Palace in Las Vegas. Join us as we bring MSPs and medical

staff leaders together to discover innovative approaches to top

medical staff challenges.

Industry experts Hugh Greeley; Carol S. Cairns,

CPMSM, CPCS; Sally Pelletier, CPMSM, CPCS; and

Todd Sagin, MD, JD, will offer best practices and winning

strategies to overcome the most challenging issues facing

the field today.

This two-day seminar will help attendees conquer

credentialing and privileging challenges, expertly educate

and support their medical staff, protect their institution

from negligent credentialing suits, learn from experts in the

credentialing and medical staff services field, and bridge the

gap between MSPs and medical staff leaders.

Register now to take advantage of our early bird rates!

Credentialing has evolved, and so has the CRC Symposium! Go to http://hcmarketplace.com/

the-credentialing-resource-center-symposium or call 800-650-6787 to find out what’s new.

http://www.credentialingresourcecenter.com

http://hcmarketplace.com/the-credentialing-resource-center-symposium



December 2014

Sample MSO time study

Used with permission

Responsibility 2012 2013 2014 Total

Hours Number/Estimated Hours 2080 hrs/yr 52 wks x 40 hrs/wk – 168 non-‐productive hours (PTO) = 1912 total yearly hrs 315 Practitioners Current 03-‐13 Credentialing Application Requests 79 x 1.5 hrs ea

Applications 62 x 17 hrs ea

42/714

Applications withdrawn/incomplete/not meeting criteria 21 x 2 hrs ea

Meet with Clinical Service Line Chief to review files 25 x 1 hr ea

42/21

Resident applications 29 x 1 hr ea

29/29

Temporary Privileges 8 x 2.5 hr ea

7/7

Reappointments 147 x 8 hr ea

300/2400

Reappointments not returned (retire/resign/relocate) 40 x 1 hr ea

1212

FPPE Routine 62 x 1.5 hr ea

42/63

FPPE Issue Based 2 x 13 hr ea

1/32

Expirables 293/average 5 each x .5 hr ea

1488/744

New Practitioner On-‐Boarding 15 x .5 hr ea

42/21

Medical Staff Office Handbook development & maintenance weekly x 1 hr ea

300/45

Prepare Board Referrals 10 x 1 hr ea

12/12

Post-‐meeting notifications (e-‐mails, letters, database updates) 25/50 Medical Staff Meetings Meeting with Chair to set agenda 103/48 Prepare agenda, copy packets 103/50 Catering and location reserved 103/24 Multiple meeting notices 103/48 Attend meeting 103/258 Minutes 103/103 Distribute minutes for review 103/24 Meeting follow-‐up (correspondence etc) 103/98 Track attendance 103/24 Medical Leadership Committee 40/40 Medical Executive Committee 12/25 Credentials Committee 12/25



December 2014

Sample MSO time study (cont.)

Source: Marna Sorensen, CPMSM, director, medical staff sevices, Portneuf Medical Center, Pocatello, Idaho. Used with permission.

Used with permission

Responsibility 2012 2013 2014 Total

Hours Wellness Committee 4/10 Other (ad hoc, Bylaws, Physician Development, IMOC, Physician Satisfaction) 15/30

Administrative Payroll 26/13 Maintain knowledge of legal requirements/contact hospital counsel as needed

52/26

Performance evaluations 1/3 Clerical Supplies 12/15 Filing 330/180 Labels, lists, reports 52/52 Scanning archived files 20/20 Secretarial duties (phones, e-‐mails, correspondence) 365/365 Data base management 325/325 Financial Budget preparation and review 12/6 Bills/invoices 12/12 Reimbursement 12/12 Dues/fees collection/management 313/152 Communication Respond to information requests from outside sources 204/102 E-‐mail blasts on behalf of other departments/individuals 899/56 Assist in acquiring/editing articles for various communications 11/5 Survey Readiness Standards review/study 52/50 File audits 313/252 Perspectives Distribution 12/4 Maintain documentation for TJC and other regulatory agency surveys 52/52 Maintain AMP Medical Staff Chapter 12/12 Document Review Clinical privileges 53/53 Rules 36/5 Policies 36/16 Bylaws 36/6 Forms 36/9 Medical Staff Leadership Support Weekly meetings with Credentials Committee Chair 42/42 Weekly meetings with Medical Staff President 42/42 Counsel, orient, and support Medical Staff officers and leaders 42/178



December 2014

Interstate Licensure is ready for state votes

The Federation of State Medical Boards (FSMB) recently released the final draft of its Interstate Medical Licensure Compact. The model legislation, if adopted by enough state legislatures, is seen as a way to address the growing need for physicians in underserved areas, as well as the growing interest in telemedicine.

The Interstate Medical Licensure Compact would streamline the process of licensing physicians to practice in multiple states by allowing participating states to share credentialing information. Physicians seeking to practice in multiple states would not have to submit separate applications for each state.

“I think it has been long recognized that physicians, for various reasons, have a need to practice in multiple jurisdictions. It’s not telemedicine alone, although that certainly seems to be ramping up,” says Lisa Robin, FSMB director of advocacy.

For several years, state medical boards have been exploring options to increase license portability so that physicians would only have to be primary-source credentialed once, rather than having to repeat the process for every state they wish to practice in.

An interstate compact was especially appealing to Wyoming due to its small population, says Kevin Bohnenblust, JD, CMBE, executive director of the Wyoming Board of Medicine. “We’ve got the ninth largest state [in landmass], but we have the smallest population, and with that it becomes very challenging to get physicians to be able to care for our patients.”

As a result, only 40% of physicians that hold licenses to practice in Wyoming actually live in the state, Bohnenblust says. The other 60% are split between locum tenens and out-of-state physicians, mostly from metropolitan areas, that come in and do clinics once or twice a month.

Licensure through the compactThe compact must be approved by the legislatures

of at least seven states to take effect. In turn, member states would establish the Interstate Medical Licensure Compact Commission to set policy and administer the compact. The commission would consist of two voting representatives from each member state. Bohnenblust,

who was also on the drafting committee, says each state gets two representatives so that states with separate allopathic and osteopathic boards are able to give each a vote on any actions the commission may undertake.

If adopted, the compact wouldn’t change a state’s existing rules of practice; it would simply make it easier for a physician to get a license in another state. The physician would still have to comply with each state’s laws and rules.

To be eligible for licensure through the compact, a physician must meet the following requirements:• Pass the United States Medical Licensing Examina-

tion or the Comprehensive Osteopathic Medical Licensing Examination within three attempts

• Hold a specialty certification or a time-unlimited specialty certificate recognized by the American Board of Medical Specialties or the American Osteopathic Association’s Bureau of Osteopathic Specialists

• Never have had a license to practice medicine subjected to discipline by a licensing agency

• Not be under active investigation by a licensing agency or law enforcement authority in any state, federal, or foreign jurisdiction

• Never have had a controlled substance license or permit suspended or revoked by a state or the DEA

To obtain a license from a member board through the compact, a physician would need to file an application with the medical board of his or her state of principal license. According to the legislation, the state of principal license is either the physician’s state of primary license, where at least 25% of his or her practice of medicine occurs, the location of his or her employer, or his or her state of residence for federal income tax purposes.

The principal state’s medical board would then evaluate the physician’s eligibility for licensure and perform a criminal background check, including fingerprinting or other biometric data verification, before issuing a letter to the commission verifying or denying the physician’s credentials. If verified, the physician would then complete the registration process with the commission, pay any applicable fees, and be issued an expedited license from the member board.



December 2014

The typical licensure process requires that a state’s medical board perform primary-source verification of a physician’s credentials; however, states participating in the compact would not have to do that. According to the model legislation, certain qualifications, such as medical education, graduate medical education, and results of licensing examinations, would not need to be primary-source verified again since the principal state’s medical board would have already taken care of it.

“Our vision of this process is something on the order of a few days, maybe a week or two at the most, but a defi-nite time savings over anything else,” Bohnenblust says.

In contrast, physicians looking to obtain an initial or subsequent medical license through normal means can typically expect at least a 60-day wait from the time an application is filed to when it is granted, according to the AMA. The wait can be longer for physicians who graduated from medical schools outside of the U.S., or if the application is filed during the peak period of April to September.

License renewals and disciplinary actionsExpedited licenses would be valid for the same

period of time as those held by physicians who were licensed by traditional means. Also, according to the legislation, if a physician doesn’t maintain a full and unrestricted license in his or her state of principal licensure, any expedited licenses obtained through this process would also be terminated and a renewal would not be granted.

The compact also outlines the disciplinary actions member boards may take against physicians licensed through it. For example, if a physician’s principal state license is surrendered or relinquished in lieu of discipline, revoked, or suspended, then all of a physician’s licenses from other member boards will be automatically placed under the same status. Even if the principal license is reinstated, licenses in other states will remain in that status until the member boards take their own action to reinstate.

Similarly, if a physician’s license is surrendered or relinquished in lieu of discipline, revoked, or suspended by a member board other than that located in the state of principal license, then all other licenses issued by other member boards will be automatically suspended for 90 days. The member boards can then

use this period to investigate the action according to their state’s medical practice act.

Also, if a member board takes a disciplinary action against a physician, any other member board may impose the same or lesser sanction, or pursue a separate disciplinary action against the physician consistent with its state’s medical practice act, according to the legislation.

The growth of telemedicineFor some states, the major draw of the compact may

be the ability to take advantage of the streamlined licensure process to increase access to telemedicine services, especially to rural or underserved areas. Last April, the FSMB issued guidelines for the appropriate use of telemedicine technology. Among its recommen-dations to member boards, the model policy stated that physicians who practice telemedicine should be licensed in the state where the patient is located.

Bohnenblust says he’s seen the use of telemedicine growing in popularity in his state, starting with a few services, such as teleradiology and telepathology. “As technology adapts, as practice methods adapt, as patients become more comfortable, as physicians become more comfortable, we’re seeing telemedicine expand into areas like ICU monitoring, telestroke, and ER work,” he says.

The compact may also benefit states that have more than enough physicians. “Those states may not have the need for more physicians to treat their patients, but they may want to help their physicians to have more opportunities to work across state lines. So it turns out to be a win of a different type for them, but still a win,” he says.

What’s next?With the final draft of the compact complete, it’s now

up to state medical boards and legislatures to decide if they want to adopt it. Robin says that the FSMB has been invited by states over the next several months to give presentations about the compact, to provide information and clarify any questions states may have.

“Certainly state boards are talking about it now. I think that there are some that formally endorsed it and will be taking it forward to their legislatures,” Robin says. “That will be something we will be actively tracking, knowing what the states are doing.” H



December 2014

Practice area 187

Neurophysiological monitoring

Editor’s note: HCPro’s Credentialing Resource Center is constantly adding to and updating its library of Clinical Privilege White Papers, which outline sample privileging criteria and background research for a wide range of medical specialty and subspecialty areas, procedures, and allied health practice areas. Following is an excerpt from the newly updated white paper Neurophysiological monitoring—Practice area 187.

BackgroundNeurophysiological monitoring refers to any

measure used to assess the functional integrity of the peripheral or central nervous system. Neurophysi-ological monitoring can be performed by clinical neurophysiologists or by intraoperative monitoring technologists, and it occurs in the OR, ICU, or other acute care setting.

Clinical neurophysiologists are experts in the electrophysiological function of the nervous system. They monitor and are able to identify new neurologic impairment, identify or separate nervous system structures, and demonstrate which tracts or nerves are still functional. In the OR, clinical neurophysi-ologists work with surgeons to protect patients from neurological damage during surgery. This allows the surgeon to reduce the risk of postoperative neuro-logical deficit, including weakness, loss of sensation or hearing, or impairment of other bodily functions.

Intraoperative monitoring technologists are trained in electroencephalography (EEG) or evoked potential tests and may have an associate’s or bachelor’s degree, or certification from the American Board of Registration of Electroencephalographic and Evoked Potential Technologists (ABRET). Intraoperative monitoring technologists’ responsibilities include patient preparation, equipment setup, data acquisition and trending, troubleshooting, and providing technical descriptions of data to the surgeon.

Two credentialing boards, the American Board of Neurophysiologic Monitoring (ABNM) and the ABRET, offer certification examinations for neurophysiologic intraoperative monitoring. Both exams test candidates’

experience and knowledge base for two levels of intraoperative monitoring practitioners.

ABNM’s neurophysiologic monitoring certification is designed for the clinical neurophysiologist whose primary responsibility is to provide interpretation of the monitoring data with appropriate clinical correlations. ABRET’s Certificate in Neurophysiologic Intraoperative Monitoring is intended for monitoring personnel technologists involved with the technical aspects of monitoring, including patient preparation, equipment setup, data acquisition and trending, troubleshooting, and providing technical description of the data to the surgeon.

Physicians (neurophysiologists or neurologists) may also be certified in neurophysiological monitoring. Physician practitioners usually supervise technician-level employees and interpret data after a case.

For additional information, please see the following Clinical Privilege White Papers: • Practice area 144—Neurology • Practice area 155—Neurological surgery • Practice area 242—Intraoperative neurophysiologi-

cal monitoring

Involved specialtiesNeurology, neurological surgery, clinical

neurophysiology

Positions of specialty boardsABCN The American Board of Clinical Neurophysiology

(ABCN) grants physicians certification with special competency in intraoperative neurophysiological monitoring. Applicants must successfully complete residency training in neurology, neurosurgery, or psychiatry in an Accreditation Council for Graduate Medical Education–approved training program and must be board-certified in one of those specialties.

Additional requirements include a minimum of 12 months of training and supervised experience in clinical neurophysiology following the completion of a primary residency.



December 2014

ABNMThe ABNM grants certification in neurophysiological

monitoring. To apply for certification, candidates must meet the following eligibility requirements:• A minimum of a doctoral degree in a physical science,

life science, or clinical allied health profession and at least three years’ experience in neurophysiologic monitoring with at least one case per month.

• Successful completion of two separate graduate-level courses, one in neuroanatomy and one in neurophysiology, from an accredited institution.

• Primary responsibility for professional interpre-tation of data and technical supervision in a minimum of 300 surgical procedures. A case log (Case Log I) of the 300 surgical procedures must accompany the application.

• A separate case log (Case Log II) of at least 165 cases across six categories, including a minimum of:

– 45 spine – 15 spine tumor and lesion – 45 cranial tumor and nonvascular lesion – 10 interventional neurophysiology – 45 vascular – 5 ear/nose/throat cases

• A statement from a qualifying, training neuro-physiologist describing the training in the interpre-tation of neurophysiological data provided to the applicant, including documentation of at least 25 monitored cases in which training was provided.

• Successful completion of the Certification Examina-tion in Neurophysiologic Monitoring Part I–Written.

Candidates successfully completing Part I are eligible to take the examination for a period of three years, during which they can take the second part (Part II–Oral) up to three times. If a candidate does not pass Part II within three years, he or she must apply for, retake, and pass the written portion of the exam. Those who pass both Part I and Part II are considered board-certified for a period of 10 years.

CRC draft criteria

The following draft criteria are intended to serve solely as a starting point for the development of an institution’s policy regarding neurophysiological monitoring. The core privileges and accompanying procedure list are not

meant to be all-encompassing. They define the types of activities, procedures, and privileges that the majority of practitioners in this specialty perform. Additionally, it cannot be expected or required that practitioners perform every procedure listed. Instruct practitioners that they may strikethrough or delete any procedures they do not wish to request.

Minimum threshold criteria for requesting privileges in neurophysiological monitoring

Basic education: MD, DO, or PhD. Minimal formal training: ABNM or ABRET

certification, and successful completion of courses in neuroanatomy and neurophysiology.

Required current experience: Applicants must be able to demonstrate that they monitored at least [n] surgical procedures during the past 12 months.

ReferencesIf the applicant is recently trained, a letter of reference

should come from the director of the applicant’s training program. Alternatively, a letter of reference may come from the applicable department chair and/or clinical service chief at the facility where the applicant most recently practiced.

Core privileges in neurophysiological monitoring

Core privileges for neurophysiology involve monitor-ing neurological tests, which include but are not limited to the following: • Electromyography • EEG • Somatosensory evoked potential • Cortical mapping

ReappointmentReappointment should be based on unbiased,

objective results of care according to a hospital’s quality assurance mechanism. Applicants must be able to demonstrate that they have maintained competence by showing evidence that they had the primary responsi-bility for supervising/monitoring at least 100 surgical procedures annually over the reappointment cycle. In addition, continuing education related to neurophysi-ological monitoring should be required. H



December 2014

The MSP’s voice by Rosemary Dragon, CPMSM, CPCS

Taking things ‘bird by bird’your hospital, medical staff, or patients at risk if left unresolved. Keep in mind that we sometimes confuse urgency with importance. It is possible to spin your wheels working on seemingly urgent tasks all day long without addressing anything of true importance.

3. Find the easy wins. There may be items on your list that take 10–30 minutes to complete from start to finish. Although they may not take priority, one of the most limiting factors in accomplishing complicated projects is your psychological response to a list of action points with no end in sight. Your list will seem much more manageable if you can knock a few of these items off the list without much time or effort.

4. Take it “bird by bird.” Focus on one item at a time and push the rest of the list temporarily out of your focus. The current action item will feel more doable if you aren’t distracted by all of the other things you still need to accomplish.

If you get a sudden epiphany regarding one of the other tasks, jot it down quickly and then get back to the current “bird” you are working on. I find it helpful to knock out an easy win or two right off the bat to start the project feeling encouraged, and then begin working on the high-priority tasks. If you get discouraged along the way, cross off another easy win or two.

You will be amazed at how much you can accomplish when you are able to set your anxieties aside and focus on just one thing at a time. When you feel the apprehension rise up again, just remind yourself, “This is possible, as long as I take it bird by bird.”

Soon enough, your project will take flight. H

EDITOR’S NOTEDragon is medical staff coordinator at St. Anthony Hospital/OrthoColorado Hospital in Lakewood, Colorado.

As I write this on the heels of the 2014 NAMSS Educational Conference in New Orleans, I am recall-ing the wonderful Cajun delicacies and the wealth of excellent educational information received. Those of us who were fortunate enough to attend either in person or virtually had our minds filled to the brim.

However, attending an educational event like this one, where you identify areas of improvement, find creative ideas to tackle your greatest struggles, or identify areas of regulatory noncompliance, can be overwhelming once you’re back home. By the time this is published, several weeks will have passed since the conference, and if you haven’t put your lessons learned into practice yet, now is a great time to create a plan of action. But where do you start?

In Anne Lamott’s book for writers titled Bird by Bird, she shares a story from her childhood which I’ve found helpful. Lamott wrote that her brother was stressed over the task of writing a report on various types of birds. Her father encouraged him to tackle the overwhelming task at hand by simply working “bird by bird” through the writing project.

Lamott shared this simple illustration for those facing writer’s block, but I’ve found it to be a helpful reminder for any time that I am facing a daunting to-do list or a large project. 1. List it out. Go back to your conference notes

and review the slides from the presentations you attended. Create a list of the action points and ideas you had throughout the sessions and through your networking. Don’t go into detail or develop a complicated plan of action at this point. If there were slides or notes that went along with the item, just reference the location of that additional information and move on.

2. Prioritize. Identify those items on the list that are most important, such as regulatory non-compliance. These should be the items that put

credentialing resource center journal · when niehaus first began managing virtual teams for a...

Documents