Performance Monitoring, Poliner, and P4P (Audio Conference)

AUDIOCONFERENCE ON TAPE, CD 0R AUDIO ARCHIVE

Sponsored by Credentialing & Peer Review Legal Insider

presented on September 19, 2007

The perfect storm for credentialing and peer review is on the horizon.

All of the following are generating significantly more quality and utilization data for hospitals to assess and act on:

• New Joint Commission Medical Staff standards that emphasize ongoing performance monitoring
• Expected quality outcome standards that drive the use of pay-for-performance criteria for reimbursement decisions
• The practice of profiling physicians regarding length of stay (LOS), cost per patient visit, outcomes, number of tests ordered, and other factors

Listen to HCPro's audioconference for Performance Monitoring, Poliner, and P4P: Address quality and utilization while avoiding peer review litigation and learn legal lessons in select credentialing, privileging, and data collection methodologies or processes that are the most troubling to MSOs.

Learn to take appropriate action.

The Poliner case, which involved a cardiologist who obtained a $366 million verdict (later reduced) as a result of a wrongful summary suspension, taught us that hospitals must sometimes consider other less drastic remedial measures to find the balance of encouraging physicians to improve quality and utilization while, at the same time, protecting patients. This presentation steers you in the right direction.

Discover concrete suggestions on how to avoid costly legal pitfalls.

This 90-minute audioconference provides "in the trenches" practical insight and concrete suggestions on how to:

• Gather and protect collected data
• Get the medical staff to buy into the process
• Reduce your legal exposure and thereby reduce costs
• Deal with industry and government demands regarding quality outcomes and utilization on an intra-professional, rather than adversarial, basis with your medical staff

TAKE A LOOK AT THE AGENDA

1. Industry developments
   1. The Joint Commission medical staff standards/ongoing performance monitoring
   2. Expected quality outcome standards driving public and private payers in using pay-for-performance criteria in reimbursement decisions
   3. The practice of profiling physicians regarding various factors (LOS, cost per patient visit, outcomes, number of tests ordered, etc.)
2. The Poliner case
   1. Cardiologist obtained a $366 million verdict (later reduced) as a result of a wrongful summary suspension
3. Identification of remedial measures to improve quality and utilization without triggering hearings and NPDB reports
4. The Golden Rules of Peer Review
5. How to deal with over-utilizers: Can a hospital impose disciplinary action when other remedial efforts have failed?
6. When, if ever, should summary suspensions be used?
   1. What conditions would trigger a summary suspension?
7. Taking steps to ensure the data your organization are collecting are treated as confidential
8. Q & A

LEARNING OBJECTIVES

At the end of the program, participants will be able to:

1. Identify remedial measures that can help hospitals improve upon quality and utilization rates that don’t trigger hearings or NPDB reports
2. Discuss the “golden rules of peer review” and illustrate how they apply in performance monitoring
3. Classify what might constitute an “over-utilizer” and discuss whether a hospital can impose disciplinary action when other remedial efforts have failed
4. Identify situations and conditions under which summary suspensions might be used, if at all
5. Construct/discuss ways to ensure that data concerning privileging and credentialing at your hospital stays confidential

MEET THE SPEAKERS

Carol S. Cairns, CPMSM, CPCS, is a senior consultant at The Greeley Company, a division of HCPro, Inc. She brings over 35 years of experience in healthcare management to her work with hospitals and medical staffs nationwide. Cairns applies her management and clinical experiences to help healthcare providers develop solutions to their unique needs and objectives. She has a particular expertise in credentialing and privileging.

Michael R. Callahan, JD, is a senior partner in the Health Care Practice Group in the Chicago office of Katten Muchin Rosenman, LLP. His national practice concentration includes the areas of hospital/physician relations, medical staff bylaws, credentialing and peer review, and regulatory compliance. He has successfully represented hospital and medical staff clients in over 100 state and federal lawsuits involving peer review disputes and heads the firm's HIPAA and Compliance Practice groups.

WHO SHOULD LISTEN?

Medical staff professionals, medical staff coordinators, credentialing coordinators, credentialing specialists, medical staff leaders, risk managers, quality managers, in-house counsel

NEW PARTICIPATION OPTION

In addition to the regular participation options for HCPro audioconferences, audio tape or audio CD, we are pleased to offer a new option, an audio archive. Audio archive allows you to download the program and play it back at your convenience through your computer or MP3 player.

Purchase a tape, CD, or audio archive of the program and listen when you can. It's also a perfect training tool for new staff or as a refresher for veteran staff.

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