Nearly 75% of all hospitals do not have a good written Policy and Procedure on how to handle Affiliation Verification. This is a huge legal exposure for your hosptial from both practitioner defamation lawsuits as well as those similar to Kadlec v. Lakeview.
In response to the Kadlec case as well as other cases, our PHDB Consulting Division has created an indispensable tool for hospitals’ medical staff office: A Policy and Procedure Implementation Manual for Response to Verification of Hospital Affiliation.
click here for more information |
The defendants in the case, Lakeview Anesthesia Associates and Lakeview Regional Medical Center (LRMC) were found by the federal district court to have intentionally omitted material adverse information about a physician when responding to Kadlec Medical Center’s credentialing inquiry. The court ruled that a hospital owed a duty not to misrepresent directly, or by omission of “material” information, to an inquiring hospital. A jury trial awarded multi-million dollars in damages to Kadlec. You can read more about the case at these links:
www.mhalaw.com/mha/newsroom/legalAlerts/HealthCare09_06.pdf
www.msspnexus.com/documents/Kadlec05.pdf |
 Without a doubt, this case will incur greater legal exposure for hospitals and additional workload for MSSPs. Clearly, the industry will need to make some drastic changes to improve the quality of communication with their peers, but several challenges remain for medical staff departments:
- Fear of legal risks result in inadequate information on responses
- Lack of written policies and procedures on how to respond to requests
- Other hospitals’ forms are all different with variations in questions
- Medical staff department usually not qualified to answer competency questions
- Medical Director does not have the time to respond to all the questions
- Understaffed and under budgeted
Some have misinterpreted the Kadlec case by identifying the “template” letter as the culprit. In reality, evidence showed that it was the intent to mislead by withholding information as the reason the ruling went against the defendants. The “smoking gun” which supported such evidence was the finding of letters sent to other hospitals did not contain the same content as the letter sent to Kadlec. This emphasizes the need for medical staff departments to implement processes that ensures content-consistent responses. |
Another important point to remember is that under the federal Health Care Quality Improvement Act (HCQIA) liability is limited for peer review issues. Under this law, a hospital is immune from damages for providing information unless it knowingly provides false information. However, some cases have established that this law will not protect a hospital if bylaws / policies and procedures are not followed (Estate of Blume vs. Marian Health Center, 03/14/2007), or if they don’t exist at all.
The Kadlec case has confirmed the need for documented policies and procedures when it comes to communications with other health care organizations about practitioners’ quality and competency. Based on our estimates, over 75% of hospitals in this country do not have any written Policies and Procedures specifically covering the verification of practitioner hospital affiliation. |
In response to the Kadlec case as well as other cases, our PHDB Consulting Division has created an indispensable tool for hospitals’ medical staff office: A Policy and Procedure Implementation Manual for Response to Verification of Hospital Affiliation.
click here for more information |
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| How Do I Establish a Written Policy & Procedure? |
| 5 Questions Every Hospital Should Ask Themselves |
| What is a Participating Hospital? |
| "Just as the NPDB eliminates many letters and phone
calls to obtain malpractice claims history and disciplinary
action, we feel PHDB will eliminate many steps in the process
to obtain rapid reliable hospital affiliation information.
Also, now that we route all verification requests to the
PHDB, we have more time for other important tasks in the
Medical Staff Office. I encourage all hospitals to participate." |
Linda Waldorf, Manager of Medical Staff Services
Duke Health Raleigh Hospital, Raleigh, North Carolina |
| "It's about time something like the PHDB existed!
With recent cutbacks in our office, the PHDB is providing
us the opportunity to serve other hospitals better and faster
by giving them instant access to verifications of our medical
and allied health staff. Hospitals can now forego printing
and mailing verification letters and go directly to the
PHDB for instant verification letters, which in turn will
save them time. And...it's easy to become a Participating
Hospital. After viewing our options, the PHDB provided us
exactly what we needed...they've helped to make our MSS
lives more efficient and easier!" |
Shari McCuiston, Credentials Coordinator
Denton Regional Medical Center, Denton, Texas |
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