Hospitalist credentialing. Pt case logs?

[deleted322863]

I have signed a contract for hospitalist position at private hospitalist group. I am able to provide everything asked from me except clinic/inpatient case logs. How would that even possible with hundreds to thousands of patient encounters throughout residency ? If anyone familiar with this issue and can give me a potential solution,would greatly appreciate.

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[geripalgal]

Maybe check with your residency program and see if they have something in their records that will satisfy this requirement

 

[chessknt]

That is an insane requirement, their credentialing committee should be fired.

 

[IM2GI]

What is the specific requirement that they want you to fulfil? Is this for things like paras/thoras or just for inpatient privaledges?

 

[jm192]

I have signed a contract for hospitalist position at private hospitalist group. I am able to provide everything asked from me except clinic/inpatient case logs. How would that even possible with hundreds to thousands of patient encounters throughout residency ? If anyone familiar with this issue and can give me a potential solution,would greatly appreciate.

For my residency, it was required to have x number of inpatient case logs. We had to do them ourselves. Other places did it for the residents. If you used Epic, there's a way to run a report for every inpatient encounter you've ever had/done. If you've used something else, I don't know.

Your residency office should have SOMETHING. If not, check with your hospitals Billing office.

 

[jm192]

That is an insane requirement, their credentialing committee should be fired.

I'm not saying you're wrong, but I've worked at 2 hospitals as an attending hospitalist and both have required it.

 

[IMreshopeful]

I'm not saying you're wrong, but I've worked at 2 hospitals as an attending hospitalist and both have required it.

How woukd you even do this - I never documented all my patients

 

[Helen Wheels]

I am a PGY-3 IM resident finishing up residency in a few weeks. My residency program required that we complete logs of all our patient encounters, procedures, lectures attended, and topics read on every rotation and submit them to Med Ed. I also have signed a contract to start work as a hospitalist upon graduation and the new job required that I provide them copies of all patient and procedure logs from the last year.

I would think in most EMRs there is a way to obtain a report of all patients seen over a given time period?

 

[chessknt]

What is the point of doing residency or becoming board certified? If that doesn't imply basic competence for inpatient care why would simply logging a patient encounter do so?

Will they accept a statement from your PD stating that, surprisingly, someone who graduated from residency in his/her program is competent to do the field of medicine they trained in?

 

[jm192]

How woukd you even do this - I never documented all my patients

The data exists. We had to keep track of it. We had access to a website built specifically for this. We were a community-hospital based residency, but we did (some) rotations at big academic centers. My understanding was that their programs handled it for them.

Step 1: Talk with your residency and see if this exists. There has to be some criteria for them to consider you competent in order to pass you. If you've seen 2000 hospital patients but never touched core diagnoses--there's a problem. You present the mind-set that because you completed residency that you're clearly competent--but the residency itself has to have proof for themselves that you are competent to pass. I'm betting the data exists.

Step 2: Your billing office will have it. If you completed residency that means you wrote notes that were billed. They'll have a way to extract the billing data which should include the top 4 diagnoses for each patient/note.

 

[jm192]

What is the point of doing residency or becoming board certified? If that doesn't imply basic competence for inpatient care why would simply logging a patient encounter do so?

Will they accept a statement from your PD stating that, surprisingly, someone who graduated from residency in his/her program is competent to do the field of medicine they trained in?

You're looking at your residency diploma as a trump statement that you're good.

The problem is residencies vary in terms of inpatient/outpatint.

Also, dates matter. If you haven't done inpatient in so many months--maybe a year? Then the concern becomes you forget some things.

But as I've said multiple times--that data exists. Either your residency or your billing office will have it.

 

[jm192]

What is the specific requirement that they want you to fulfil? Is this for things like paras/thoras or just for inpatient privaledges?

I think one part of this is dates:

How long has it been since you've had inpatient experience.

The other part is the spectrum of disease you've cared for. Are you seeing most of the bread and butter stuff?

 

[crafted222]

I think one part of this is dates:

How long has it been since you've had inpatient experience.

The other part is the spectrum of disease you've cared for. Are you seeing most of the bread and butter stuff?

This seems like excessive vetting. The programs are accredited, and graduating should mean that one have met the requirements, especially with respect to spectrum of diseases. Requiring case logs for procedural competence is understandable, but to request a log of all patient encounters in order to ascertain correctness of diagnoses etc, as you opined, makes PDs and faculty look like jokers that cannot be trusted to train residents.

 

[jm192]

This seems like excessive vetting. The programs are accredited, and graduating should mean that one have met the requirements, especially with respect to spectrum of diseases. Requiring case logs for procedural competence is understandable, but to request a log of all patient encounters in order to ascertain correctness of diagnoses etc, as you opined, makes PDs and faculty look like jokers that cannot be trusted to train residents.

If your training is sound, I don't understand your aggravation here. Your PD's have to have a series of boxes to check--they're asking to see the boxes.

Again, some programs may have lighter inpatient loads. If your'e at Hopkins I'm sure you're getting more than enough. If you're at Southern Memorial Baptist maybe you're seeing less. It's been fairly standard procedure for what I've seen so far.

 

[chessknt]

If your training is sound, I don't understand your aggravation here. Your PD's have to have a series of boxes to check--they're asking to see the boxes.

Again, some programs may have lighter inpatient loads. If your'e at Hopkins I'm sure you're getting more than enough. If you're at Southern Memorial Baptist maybe you're seeing less. It's been fairly standard procedure for what I've seen so far.

I've credentialed 5x and never been asked this. Residency programs, especially large ones, already are bogged down in beurocracy enough as it is, ******* General credentialing committee thinking they should question the validity of the program because the acgme isn't as good as they are is just another example of totally pointless administrative leeches destroying american healthcare.

Now if the residency had dissolved or been put on probation due to low volume that is totally understandable, but a blanket requirement is lazy and inefficient.

Whats next, being asked to provide case logs for every phone call I've answered to have pager privileges or how many cbcs I've interpreted to have access to the labs tab? How many prescriptions I've written?

 

[IMreshopeful]

If your training is sound, I don't understand your aggravation here. Your PD's have to have a series of boxes to check--they're asking to see the boxes.

Again, some programs may have lighter inpatient loads. If your'e at Hopkins I'm sure you're getting more than enough. If you're at Southern Memorial Baptist maybe you're seeing less. It's been fairly standard procedure for what I've seen so far.

If you go to a community residency where the highest acuity patient that’s taken care of is a DKA and ship out anyone sick, sure that might be reasonable. But if you’re at a good academic residency or even a high powered community residency then this is silly in much opinion. If you trained at anything decent with broad exposure then it goes without saying that you should be able to take care of these sorts of patients.

This doesn’t completely apply to me since I’m in a subspecialty obviously. But we keep logs of echos, caths, nuclear studies etc and once we demonstrate that we have met a certain competency level and possibly taken boards in those specialties, that is considered sufficient for employers.

 

[jm192]

If you go to a community residency where the highest acuity patient that’s taken care of is a DKA and ship out anyone sick, sure that might be reasonable. But if you’re at a good academic residency or even a high powered community residency then this is silly in much opinion. If you trained at anything decent with broad exposure then it goes without saying that you should be able to take care of these sorts of patients.

This doesn’t completely apply to me since I’m in a subspecialty obviously. But we keep logs of echos, caths, nuclear studies etc and once we demonstrate that we have met a certain competency level and possibly taken boards in those specialties, that is considered sufficient for employers.

But that's the problem. If you're a hospital and you get someone from a place that doesn't take care of a lot of sick--how do you know that as a hospital? You're not going to have different processes for different residencies.

I'm not saying it's good, right, ok or what have you. It's just reality at this point.

 

[jm192]

If you go to a community residency where the highest acuity patient that’s taken care of is a DKA and ship out anyone sick, sure that might be reasonable. But if you’re at a good academic residency or even a high powered community residency then this is silly in much opinion. If you trained at anything decent with broad exposure then it goes without saying that you should be able to take care of these sorts of patients.

This doesn’t completely apply to me since I’m in a subspecialty obviously. But we keep logs of echos, caths, nuclear studies etc and once we demonstrate that we have met a certain competency level and possibly taken boards in those specialties, that is considered sufficient for employers.

I work for a staffing company, and have never been asked for it by them.

The hospitals I've gotten privileges through have.

 

[chessknt]

But that's the problem. If you're a hospital and you get someone from a place that doesn't take care of a lot of sick--how do you know that as a hospital? You're not going to have different processes for different residencies.

I'm not saying it's good, right, ok or what have you. It's just reality at this point.

How do logs of patients show that I am experienced taking care of sick people? Are they analyzing all the icd10 codes I have ever put on my notes? Critical care time billed? The problem is dka can be billed as critical care and, oh look, if they have a uti it can be sepsis too!

I can guarantee that much thought is not going in to this. Some office hamster or washed up doctor administrator decided that x number of inpatients seen (pulled straight out of the ass mind you) equaled competence. I would actually be concerned about the health of a hospital system with this requirement as it screams gross incompetence at the administrative level--if they can't streamline something they can actually understand how are they going to keep the hospital open once the macra cuts slam them over the next 5 years?

 

[jm192]

How do logs of patients show that I am experienced taking care of sick people? Are they analyzing all the icd10 codes I have ever put on my notes? Critical care time billed? The problem is dka can be billed as critical care and, oh look, if they have a uti it can be sepsis too!

I can guarantee that much thought is not going in to this. Some office hamster or washed up doctor administrator decided that x number of inpatients seen (pulled straight out of the ass mind you) equaled competence. I would actually be concerned about the health of a hospital system with this requirement as it screams gross incompetence at the administrative level--if they can't streamline something they can actually understand how are they going to keep the hospital open once the macra cuts slam them over the next 5 years?

Logs are literally a list.

They want to pretend they’re doing their due dilligence.

I’m not here to argue with everyone.

I’ve told you how to find the info.

Good luck.

 

[geripalgal]

Option 1: ask your residency program if they have any such log, or can provide you with a letter approximating total number of encounters (i.e, avg resident census B x number of inpatient months)

Option 2: inform the credentialer that such data is not available, sorry! They have to contact your Residency PD anyway for other stuff...

Option 3: forget about this job if you think its not worth the work.

 

[jm192]

Option 1: ask your residency program if they have any such log, or can provide you with a letter approximating total number of encounters (i.e, avg resident census B x number of inpatient months)

Option 2: inform the credentialer that such data is not available, sorry! They have to contact your Residency PD anyway for other stuff...

Option 3: forget about this job if you think its not worth the work.

Option 4: Contact Billing for your residency and see if they can extract the data.

But I agree with option 3. Everyone's on this soap box about them trying to undermine residency--a job is a job. They can ask you for whatever they want. If you don't want to give it to them don't and move on.

 

[deleted322863]

Thanks everyone fro chiming in and thoughtful suggestions. After a bit of back and forth about viable options, as there were no logs since not required by ACGME, decided for "Option 1: ask your residency program if they can provide you with a letter approximating total number of encounters (i.e, avg resident census B x number of inpatient months)". Will update if it works.

 

[Raryn]

This is insane.

My residency program can easily give # of procedures I did (thoras, paras, lines, tubes, whatever). They would have no clue how many patients I took care of over the course of my 3 years. They could probably write a letter stating something like "Raryn did X ward months, Y ICU months, and our average census for an inpatient service is Z", but no log exists.

Ditto with my fellowship program and the same question.

 

[bananas85]

I have signed a contract for hospitalist position at private hospitalist group. I am able to provide everything asked from me except clinic/inpatient case logs. How would that even possible with hundreds to thousands of patient encounters throughout residency ? If anyone familiar with this issue and can give me a potential solution,would greatly appreciate.

Contact the medical records department. They will be able to provide you with a list. Its usually generated by EMR on the back end so something like

Sepsis ---- 86 patients
HCAP ------ 45 patients
Coagulopathy ----- 10 patients


etc.