Guest guest Posted November 27, 1998 Report Share Posted November 27, 1998 In a message dated 11/27/98 7:05:38 AM Eastern Standard Time, mhurley@... writes: << As long as you have a signed referral you can see the patient. Your treatment plans are sent to the referring physician >> If the issue is credentialing however, my understanding is that there may need to be some process in place to verify the credentials of the referring physician. If a physician is on staff, you know they are appropriately credentialed, but if they are not, is there a mechanism to verify credentials? This was part of the JCAHO preparation process in a hospital-based home care agency (it may be different in other settings). As a manager I was responsible to orient my staff to agency policy if a JCAHO reviewer asked " How do you know if your orders are coming from a licensed physician? " . I'm assuming someone somewhere must have been asked that question..... ------------------------------------------------------------------------ Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 27, 1998 Report Share Posted November 27, 1998 Mark, as part of a 560 bed tertiary care, trauma hosp, with a 400 bed LTC facility, 120 bed behav. health facil., and an OPD, we HAVE NOT run into the same problem. Was credentialing the problem for them? The problems we have had have been more related to IS and billing, not regulatory agencies. Sue Lauer Westchester Med Center Valhalla, NY > MD Orders > > Hope everyone had a great Thanksgiving!! > > We have a small rehab dept (2 PT, 1 OT) as part of a rural acute > hospital and attached nursing home. We see primarily outpatients that > may be referred from a fairly wide area, many returning to get local > follow-up after a " downtown " hospitalization. > > During our last JCAHO survey, mention was made (not a citation, > however) that we accept MD orders/referrals from non-staff docs. > Apparently this is fine with JCAHO for free-standing clinics but not > when rehab is hospital-based. Understandably, our staff docs are > reluctant to blindly co-sign outside orders without having ever seen > the patient. And having some sort of credentialling process for every > referral source is simply not practical. > > I would again like to pose the question to the group ... how do you > handle non-staff out-patient referrals? > > Thanks in advance, > Mark > > ----------------------------------- > Mark R Eliason, PT > Apple Valley, MN, USA > meliason@... > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 27, 1998 Report Share Posted November 27, 1998 Mark, I don't know where JCAHO is coming from. I am sure that your state Practice Act does not limit who you can recieve referrals from (relative to on staff or not). As long as you have a signed referral you can see the patient. Your treatment plans are sent to the referring physician anyways so I really don't understand their issue. ------------------------------------------------------------------------ Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 27, 1998 Report Share Posted November 27, 1998 Mark, I have no earthly idea what your surveyor is talking about! I have never heard of such a point from JCAHO. Sounds to me like you may need some serious clarification however, since you weren't cited it is probably a moot point. Don't get me started on JCAHO! Ken Mailly, PT Re: MD Orders Mark, I don't know where JCAHO is coming from. I am sure that your state Practice Act does not limit who you can recieve referrals from (relative to on staff or not). As long as you have a signed referral you can see the patient. Your treatment plans are sent to the referring physician anyways so I really don't understand their issue. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 27, 1998 Report Share Posted November 27, 1998 We are a 250 bed rural acute inpatient hospital setting. We have no problems with outside referral sources [or which we have many] and do indeed have a basic credentialing procedure in place that is not that difficult. We have had no difficulty in our most recent and anticipate nodifficulty in our upcoming survey. I think that particular reviewer had a unique interpretation and certainly his stance is open for additional questioning re: his intent. You are right, having your own medical staff sign off on outside referrals is a challenge. Marcia Hall, PT Director Pottsville Hospital Mark R Eliason wrote: Hope everyone had a great Thanksgiving!! We have a small rehab dept (2 PT, 1 OT) as part of a rural acute hospital and attached nursing home. We see primarily outpatients that may be referred from a fairly wide area, many returning to get local follow-up after a "downtown" hospitalization. During our last JCAHO survey, mention was made (not a citation, however) that we accept MD orders/referrals from non-staff docs. Apparently this is fine with JCAHO for free-standing clinics but not when rehab is hospital-based. Understandably, our staff docs are reluctant to blindly co-sign outside orders without having ever seen the patient. And having some sort of credentialling process for every referral source is simply not practical. I would again like to pose the question to the group ... how do you handle non-staff out-patient referrals? Thanks in advance,Mark ----------------------------------- Mark R Eliason, PT Apple Valley, MN, USA meliason@... Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 27, 1998 Report Share Posted November 27, 1998 If we get an order from a non-va physician, the patient needs to have the order countersigned by a VA physician.. ------------------------------------------------------------------------ Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 4, 1998 Report Share Posted December 4, 1998 Sounds reasonable to me. If the physician didn't want a particular discipline to do the eval/treatment, they could specify that or cross out the statement. Sara At 11:04 AM 12/3/98 -0600, you wrote: >I have a question somewhat related to MD referrals, seeking guidance. Is there any reason why our referral forms could not include a statement that said, " All upper extremity diagnosis may be seen by PT or OT unless specified. " This is so we can utilize OT better without having to call the MD office, and request another referral. In other words if the MD signs an order for therapy which includes that statement, and the patient is seen by an OT vs. PT are we covered? any input would be appreciated. >JIM BOR RPT >St. 's Hospital. > >>>> " Mark R Eliason " 12/01 6:34 AM >>> >Thanks to all for the informative replies and opinions! > >It is highly unlikely (and not very useful) that existing medical staff will >agree to " rubber stamp " a co-signature on outside referrals never seen by >them. > >The suggestion to formally verify and document licensure is a practical and >useful avenue. This can easily be done through our State Board of Medical >Practice. > >We will probably look into the feasibility of granting some sort of > " Temporary Outpatient Prescriptive Privileges " based on license verification >(etc) that would also cover OP lab and radiology procedures. > >I have also become aware of a second caveat related to a physician's >Medicare eligibility. A referring physician who is on HCFA's " Black List " >would presumably not be eligible to sign a valid Plan of Treatment for >Medicare reimbursement. Of course we would know the Medicare status of any >of our Staff docs but outsiders would be more of a potential problem. Any >thoughts on THIS tangent?? > >BTW, the specific notation we received (at " Significant Compliance " ) related >to MS.5.14: > > " The organization establishes mechanisms for hospital-specific appointment >and reapppointment of medical staff members and for granting and renewing or >revising hospital-specific clinical privileges. All individuals who are >permitted by law and the by the hospital to provide patient care services >independently in the hospital have delineated clinical privileges, whether >or not they are medical staff members. " > > " It was noted that physical rehabilitation treats an occasional patient on >orders from a physician who is not privileged through the medical staff >privileging process. " > >I believe Dick is absolutely correct that this is an issue of assuring that >the Medical Staff maintains control and oversight of all hospital >activities. > >----------------------------------- >Mark R Eliason, PT >Apple Valley, MN, USA >meliason@... > > >------------------------------------------------------------------------ > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 6, 1998 Report Share Posted December 6, 1998 In a message dated 12/3/98 11:21:49 AM Central Standard Time, jbor@... writes: << In other words if the MD signs an order for therapy which includes that statement, and the patient is seen by an OT vs. PT are we covered? any input would be appreciated. >> we have done something similar and had no problem fro the MD's, however...you may find that the patients insurance will not covering the same treatment provided by an OT in place of a PT ------------------------------------------------------------------------ Quote Link to comment Share on other sites More sharing options...
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