Friday, October 9, 2015

Dual License L.Ac.s and Hospital Practice

10.9.2015 draft
keywords:  credentialing, privileging, hospital sponsor, PCM, KSAs, biomedical training, hospital culture

Related topics:  Hospital Sponsor

Author/Editor:  Megan Kingsley Gale
Contributing authors:  Fujio McPherson, DAOM, ARNP 
If you are a dual-licensee reading this, please chime in on the comments section.  Would love to hear form you!

Dual-licensed L.Ac.s and strength brought to EAM Hospital Work

A dual-licensed L.Ac. brings great strength to his/her work in the hospital.  Because she also has a Western medical health care license (MD, DO, DC, ARNP), she has a foot in both worlds.  She understands hospital culture and can be a wonderful advocate for single-licensed L.Ac.s into hospital setting.  These dual-licensees, in practice have often been the first L.Ac.s into hospitals.  They have been hired under their non-L.Ac. health care license.  Some have slowly incorporated more EAM work into their clinical practice (when hospital culture was right, they added acupuncture and EAM procedures to their “delineation of clinical privileges”).  Some, in the case of some VA/VHA L.Ac.s, were hired under their non-L.Ac. license for the job of an L.Ac.  i.e. an RN-L.Ac. hired to do full-time L.Ac. work, but no current occupational code existed in hospital system for hiring L.Ac., so hired and credentialed under RN licensed, but position description is entirely L.Ac., not RN and practice work is all L.Ac.  Same example for PA and DC.

Dual-licensees make great primaries on hospital Integrative Medicine research projects.


Negatives to dual-license L.Ac.s in hospital practice

When push comes to shove, these L.Ac.s often find themselves doing more of the non-L.Ac. healthcare work because that is (area of need) where hospital needs them first.  This is less common with RN-L.Ac.s.  Very common with MD-L.Ac.s and ARNP-L.Ac.s.  Non-dual licensees do not have this pull toward two-jobs-in-one.  An L.Ac.-only can not have his time divided into other health care duties.  So, an L.Ac.-only is time and cost-efficient.  Less education expenses to pay back.  Can be counted on to provide only EAM services (not also injections, PAP smears, surgery, etc) to a dedicated clinic.  Having a dedicated L.Ac. clinic is essential to consistent patient care and outcomes.


Dual-licensee distinctions

PCM-L.Ac. and non-PCM-L.Ac.

PCM-L.Ac.
Non-PCM dual-license L.Ac.
Ex:  MD-L.Ac., ARNP-L.Ac., DO-L.Ac,
These are occasionally PCM, depending on state law:
D.C.-L.Ac, ND-L.Ac, PA-L.Ac.
Definite non-PCM dual-modern medicine licenses that seem to help in L.Ac. hospital practice:
RN-L.Ac.—RNs are not providers
PsyD-L.Ac.—clinical psychologist who is also an L.Ac.
MPH-L.Ac.—one of most common dual-licenses for L.Ac.s.  Master of Science in Public Health is a nice fit for EAM providers.  In hospital setting you are likely to work in admin positions or in positions where you are creating community health programs.  Not always clinical work.
PCMs are clearly providers, based on their non-L.Ac. license (MD, DO).
The non-L.Ac. license seems to help these “duall-ees” understand hospital culture and navigate the system.  Sometimes the non-PCM first license has caused confusion when these duallees want to work clinically as L.Ac.s.  The clinical work of an L.Ac., while not PCM, is provider level 2 work.  If the non-L.Ac. license is not in provider work, it may be counter to duallees first position description to do L.Ac. clinical work.  (example:  RNs do not have acupuncture in their scope of practice.  The RN-L.Ac., to do acupuncture, must be hired under L.Ac. PD to be clearly able to do so.  Trouble arising when their PD does not give credit for their L.Ac. background.
A PCM-L.Ac. is usually hired under the PCM license and gets the L.Ac. scope added/granted as part of his/her clinical privileges, sometimes called "extended privileges"


Recommendation to L.Ac. education leaders—making Dual-licensees more common!!

We know dual-license L.Ac.s are door-openers for our field of EAM in:

Research

More jobs

Federal work

Hospital work

Integrative medicine clinics

Specialty clinics

Inpatient work


So, what can we, as a profession, especially at our education institutions, do to make dual-licensees more common?

The discussion continues in comments section, email list, and in our social media groups.  

If you found this information helpful or interesting, please considering donating to or sponsoring the project and joining the email list.

acronymns
EAM--East Asian Medicine.  I current favor this term over the following to describe our modern practice:  TAM (traditional Asian Medicine), AOM (Acupuncture and Oriental Medicine).  In May 2016, President Obama signed a bill to eliminate the term "oriental" from all federal documents because the term is derogatory.
VA/VHA--veteran's administration or veteran's health administration
IM--integrative medicine
PCM--primary care manager
L.Ac./EAMP--state license titles for Acupuncturists.  "Licensed Acupuncturist (L.Ac.)" and "East Asian Medicine Practitioner (EAMP)".  L.Ac. is the most common state title.
PCMH--patient-centered medical homes




 

Monday, October 5, 2015

Credentialing and Privileging Process part 3, FPPE, OPPE, and Peer Review

Credentialing, Privileging, and Professional Practice Evaluation (FPPE and OPPE)

updated 8.26.2016
Keywords:  credentialing, privileging, FPPE, OPPE, quality assurance, peer review, LIP
Related posts:  Credentialing and Privileging section
Related section in the Coding and Charting Manual:  work in progress (link here)

In credentialing and privileging Licensed Independent Practitioners (LIP), The Joint Commission (TJC) established the following quality assurance processes, “Focused Professional Practice Evaluation (FPPE)” and “Ongoing Professional Practice Evaluation (OPPE)”[i].  FPPE is the process a new hospital hire goes through the first year or so of practice.  This is commonly a more detailed and thorough vetting and review process than OPPE.  After the FPPE is complete and the practitioner is no longer “new”, commonly OPPE is used as a professional review and quality assurance measure. [Note that FPPE is always used for a new hospital hire.  It may also be used again (on an established hire) if a practitioner is flagged as performing substandard care.]  

FPPE and OPPE basic guidelines are set by TJC.  Every hospital has specific institution-specific versions of FPPE and OPPE for any provider that falls into the Licensed Independent Practitioner (LIP) category of provider-type.  These institution-specific guidelines follow TJC standards.  [TJC Standards Search page[ii]]  OPPE may include any of the following, as determined by the institution:  periodic chart review, direct observation, monitoring of diagnostic treatment and techniques, possible discussions with consulting providers, nursing personnel, and administrative personnel[iii]

Peer Record Review (periodic chart review by a peer or peers) is common practice for quality assurance and falls under the requirements that fulfill both FPPE (new hospital hire) and OPPE (established hospital employee).

If you are interested in commenting on a TJC standard: 
“The Joint Commission provides a Standards Online Submission Form as one of the means of soliciting questions about the standards.”  TJC invites providers to use the form and send them your questions and thoughts about the standards in their “how to comment on a standard” webpage: and directed to the TJC Standards Interpretation Group through the online standards question form.

Remember, when TJC looks at creating a standard, they judge it by the following criteria:
Does it have a strong evidence-base?
Does it have a strong relationship to patient outcomes/clinical care?
Does it support a health care organization’s goal of patient safety and quality of care?
Does it have benefits that outweigh the costs?
Does it support a health care priority which impacts quality and safety?


References  





[i] In 2004 The Joint Commission (TJC) renamed “Peer Review” as “Focused Review of Practitioner Performance” and since 2007, it has been known as “Focused Professional Practice Evaluation (FPPE)” and “Ongoing Professional Practice Evaluation (OPPE)”. 
[ii] From Standards page, search keyword “OPPE”.  Under “Hospital and Hospital Clinics” category, then OPPE-Intent.  “The intent of OPPE allows the Hospital/Critical Access Hospital to identify professional practice trends that impact quality of care and patient safety as it relates to privileges granted to the Licensed Independent Practitioners.”
[iii] From Standards page, keyword “OPPE”.  Under “Hospital and Hospital Clinics” category, then OPPE-data collection guides
[iv] From Standards page, keyword “FPPE”.  Under “Hospital and Hospital Clinics” category, note the following links for FPPE:
Components of Design Process
Monitoring Timeline
*Intent*
New Privileges
Pre-defined Process
*4 Required Components*
Peer Review

Links for OPPE:
Low volume practitioners—data use from another organization
Medical/cognitive specialties
*data collection guides*
*Intent*

Pioneer Perspectives--Learning from Hospital Practice EAM Pioneers


Starting Acupuncture and East Asian Medicine (EAM) in a Hospital:  Perspectives from Pioneers


Contributing authors, interviews with subject matter experts (SMEs) aka the pioneers:
related topics:  Community Outreach, Pioneer Perspectives

Pioneer Perspectives is a chapter of the Hospital Handbook project that
interviews pioneers in hospital practice East Asian Medicine/Acupuncture.

Goals:  Highlight a Pioneer and his or her work and contribution to our field
How does that work tie in to hospital practice?
How and why is this important and relevant to the current hospital EAM/Acupuncturist practitioner?
What wisdom would this this Pioneer share?

Topics will likely include (not an exhaustive list):
starting up a clinic, SOPs, etc
internships, externships
Research 
Patient Centered Outcomes
Creating an EHR to capture data from EAM provider notes