Emergency Medicine of Idaho



April 2019 CQO UpdatesEMI/Hospitalist Meeting: Each quarter Matt and I meet with the SLICA leadership to discuss all topics affecting both of our groups. Recently, they completed various surveys regarding the other departments that they work with. The feedback for the ED was very positive. The main issues we discuss this past month was the Observation/Inpatient issue which still comes up. Please include this in your dialogue with admitting services, as some surgical patients may only meet observation criteria initially. If in doubt, start with observation. If an inpatient order is input and then the patient is downgraded, it triggers a big CMS review, etc. New Hire Proctoring: As EMI has expanded with new physicians and APP’s so has the process of proctoring changed within the Medical Staff Offices with St. Luke’s. In order to make this process more formal and streamlined from a corporate standpoint, I proposed several options to the BOD. Here is an outline of what was decided:All new hires (Physician and APP) will receive a physician proctor to be assigned by the CQO. If assigned to an APP, this will extend beyond one year (however the feedback portion is limited to the 12 month period per Medical Staff). ?The goal is to foster a long term relationship between the APP and physician. ?Trying to limit APP:Physician proctoring to 1:1 in order to limit the burden on one particular provider and maximize the individual oversight. ?There is no OPT out, this is a shared responsibility for all shareholders. Extenuating circumstances will be reviewed on a case by case basis.Responsibility is for 12 months and involves chart review which will be facilitated by the CQO and Medical Staff Office.If you are asked to proctor a PA, a license with the Idaho State Board of Medicine is required and will be covered as a corporate expense.Proctors will provide feedback to the CQO on a 1 month, 3 month, 6 month, 9 month, 1 year cycle. The CQO will provide a form and facilitate feedback to the Medical Staff Office.A proctor will on be assigned 1 new hire per year and will not be responsible for multiple hires at one time in order to reduce burden on proctors, but provide a 1:1 relationship and maximize the experience for the new hire.The goal of this new process is to try and formalize the process and provide the best experience for new hires and proctors to cultivate a positive onboarding experience for the entire group.St. Luke’s Peer Review: As part of all the restructuring, the peer review process is undergoing some changes. These changes were presented to the department peer review committee in April and will be voted on at MEC in May. Here is the summary of changes:Old rating system goneNew system: CR0-→CR4 with CR4 equating to unacceptable care, CR2 equating to acceptable with educational component and CR0 being exceptional care. Allowed 2 CR4 ratings per 2 year cycle (unchanged), allowed 6 CR2 ratings per 2 year cycle.NO APPEALS processIt was discussed at length at our meeting about the lack of an appeals process and the new CR2 limit of 6 per 2 year cycle. This will be taken back to the PEC prior to the MEC vote. Dr. Washington, Dr. Timmel and myself are available to discuss further.MIDAS and Case Feedback: I want to thank everyone who has had to respond to my emails seeking further clarification on cases coming through MIDAS. In an effort to make the process better, if you have any suggestions or feedback on how I’ve presented the information or suggestions for improvement, please let me know. I’m always looking on ways to make the process better.Patient sign out/hand off: I plan to start meeting with interested individuals in May to start reviewing this process and making it more efficient and streamlined. Its not TOO LATE to sign up and participate if this is something you find beneficial and want to be a part of the process. Email me and I’ll add you to my list! ................
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