31 May 08 23:15 | DebOh said...:
This seems to conflict with another theme that is arising from the new FPPE and OPPE standards - streamlining the credentialing/ privileging of practitioners to a more manageable and meaningful process. The increasing use of hospitalists has changed medical practice. Some very fine physician practices now have many high quality physicians who do not practice within the hospital because they've hired one of their own hospitalists. This one hospitalist can not do all of the H&Ps for outpatient surgery, nor would we want them to because they don't know the patient as well. There is a dependance on the the group for support prior to patient's requiring hospitalizations. The problem for the hospital becomes the depth and breadth of compliance with the MS credentialing and priviledging standards for the physicians who never practice within the hospitals but provide supportive services, such as H&Ps. These physicians know the patient the best and their insight is often excellent. When hospitals are forced to only use privileged physicians for H&Ps, they are forced to privilege many more physicians than those who support the hospital. This means compliance to the MS standards for volumes of physicians.

This being said, there should be some means of ensuring the credibility of the H&P - perhaps the applicability of the MS standards could be rethought from a practical perspective to reach all goals - quality / safety of patient care, reduction of Medical Staff membership to a more manageable and realistic size and credible support for the MS.

13 Feb 08 17:02 | NapoleonKnight said...:
I don't think that anyone has an issue with the fact that a person who has been granted privileges should perform a patient's medical history and physical exam. Where issues arise, from a clinician's perspective, is when you talk about updates to the history and physical. For the majority of patients, if they have their history and physical done within 30 days, if they have a problem or issue, they will make contact with their physician. Any issues that they have regarding this will be addressed, and a determination made if the procedure should go forward. Assuming that the answer is yes the procedure should go forward, then the question is does another history and physical exam need to be done. The clinical reason for the procedure has not changed, gallstones, cataract, knee pain, hip pain. If the patient does not have any new or additional complaints, then requiring someone to see and do another history and physical exam does not seem to add much value to the process. If any new issues or concerns are identified in the intake nursing assessment, it would seem reasonable that those are brought to the attention of an individual who has been granted privileges, and the patient would need to be examined and cleared. If in their screening there are no issues identfied, then doing an exam will not add value in my mind. My understanding is that CMS has changed their requirements, saying now that an examination must be done as well.