Administrators in Medicine

AIM Best of Boards

Sharing the Best Practices of State Medical & Osteopathic Boards











Special Thanks to the AIM Best of Boards Committee:

Tina M. Steinman, Committee Chair

Executive Director, Missouri State Board of Registration for the Healing Arts

Linda J. Bergmann, Committee Member

Executive Director, Osteopathic Medical Board of California

Gary R. Clark, Committee Member

Executive Director, Oklahoma Board of Osteopathic Examiners & Past President of AIM 

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Best Practices 

The Brightest Ideas

Innovative Solutions

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Welcome to the AIM Best of Boards Awards Page

Celebrating the 6th Anniversary of the Awards Program

Enter Now for 2005 Awards to be Presented at the AIM Annual Meeting in Dallas, Texas on May 11, 2021 - See e-Entry Form on Left Side Bar

The 2004 Award Recipients were Announced at the AIM Annual Meeting in Washington, DC on Wednesday, April 28, 2021

Congratulations to the 2004 Award Recipients!

This Year's AIM Best of Boards Award Goes to the

New York Office of Professional Medical Conduct

New York Office of Professional Medical Conduct
Two Call Case Resolution Strategy

Description:

Two Call Case Resolution Strategy, developed and implemented to quickly and efficiently address less serious consumer complaints of physician misconduct.

The Two Call Case Resolution Strategy was developed to assist consumers who have complaints against physicians, but whose concerns are of a less serious nature.   Through direct, personal contact by a Board physician with both the complainant and the respondent physician, these cases can be resolved quickly, often within a matter of days, to the satisfaction of both the respondent physician and the complainant.  Investigative resources can then be diverted to more serious matters requiring full field investigation.

 

NEW  YORK STATE OFFICE OF PROFESSIONAL MEDICAL CONDUCT

 

BEST OF BOARDS

ADMINISTRATORS IN MEDICINE

 

two call case resolutions 

Many of the complaints received against physicians and physician assistants involve matters that are not “serious” in the sense of public harm, but are nonetheless very upsetting and serious to the complainant.  While there may be no legal grounds for action by the State Board, complainants may feel their issues have been ignored and seek recourse through other channels, such as their elected representatives, or continue to demand action by the Board.

 

The “two call case resolution” strategy was developed and implemented in an effort to identify and appropriately resolve selected cases more quickly and efficiently.  Using this strategy, the Office of Professional Medical Conduct (OPMC) was able to close more than 225 cases during the past two years.  This approach also eliminated the resource depleting and time consuming process of securing records and conducting interviews.  

 

The cases selected for “two call” resolution are typically those involving interaction between a single patient and a physician and/or their staff; cases in which there is no significant patient harm; allegations that do not rise to the level of being acts of professional medical misconduct that would suggest a more significant resolution; and cases where there have been no previous complaints of a similar nature.  The two calls referred to are made to the complainant and to the subject physician.  We believe it is important that a Medical Board or staff physician carry out the “two call” strategy.  A physician lends greater credibility in discussing the issues of concern raised with the complainant and the physician, in almost all cases, and can make entree to the subject physician a reality.

 

Complainants, almost without exception, are extremely pleased that their concerns have received personal attention via a telephone call from a physician of the State Board.  Likewise, the subject physician is often pleased to have an opportunity to discuss a case in which he/she is usually aware that there was a problem and to learn that the case is to be closed without further action.  The State is satisfied that an effort has been made to have a physician amend certain practice patterns that may impact adversely on the patient public.  The OPMC is satisfied that a large number of cases are resolved with minimum utilization of resources and in a timely fashion.  In this way, attention can be directed to more serious cases.
 

Basic Elements of Two Call Strategy

 

·      Selected cases are identified as meeting the criteria for a “two call” case.

·      These cases have been opened with a case number and basic information such as complaint form or letter of complaint, the identity of the complainant, physician, and telephone numbers of the parties.

·      A worksheet is completed outlining the available information (Attachment 1).

·      A plan is developed as to how to proceed, determining which party to contact first and what will be discussed with the parties.

·      The two calls are made.

·      A Memorandum of Investigation is created with a synopsis of the case and the calls made (Attachments 2-7).

·      When appropriate, closure letters are sent to the parties.

·        At any point in this process when information is revealed indicating that further investigation is warranted, the case may be reassigned. 

 

If the issues of the complaint are clear from the complaint letter and do not require clarification by the physician, the initial call most often is made to the complainant patient.  The caller will only speak with the complainant with the exception of those occasions when the complainant defers to a spouse or family member.

 

Strategies for Successful Interaction with the Complainant

 

·        The conversation is opened by the physician introducing himself or herself as a physician employed by the New York State Department of Health, Office of Professional Medical Conduct.

·        The Board physician then indicates that he/she has read the complaint and thanks the individual for bringing this matter to the State’s attention.

·        A discussion and elaboration of the issues, or an explanation is invited.

·        As appropriate, although not always, the Board physician acknowledges the concerns raised by the complainant.

·        The complainant is advised that there will be personal contact with the subject physician and that the complainant’s concerns will be raised.

·        The discussion with the subject physician will incvlude what changes should be made in the future conduct of practice.

·        In closing, the following important points are made to the complainant:

·        A permanent record of this case will be kept so OPMC can recognize any future pattern of similar behavior possibly leading to more significant action.

·        Because of the complainant’s report and the State’s action, similar behavior on the part of the subject physician may be prevented.

·        Once again, thank you for bringing this matter to the State’s attention.
 

The response of the complainant is almost uniformly positive:

            “I never thought I would hear from someone from the State Board.”

“This is all I really wanted to have happen so that it won’t happen to other patients.”

            “Thank you very much for your call.”

 

Strategies for Successful Interaction with Subject Physician

 

·        When speaking to office staff, refer to yourself as doctor, but it is not necessary to identify yourself initially as being with the Department of Health.

·        Introduce yourself to the physician as “Doctor…..of the Department of Health.”

·        Immediately open the discussion by saying “Doctor, I have a matter on my desk that I believe can be resolved today and now if you will be kind enough to spend a few moments talking to me.”  This opening statement is the key to keeping the physician in contact with you.  Refer to “the case” as “a matter.”  It is less threatening.

·        Without identifying the complainant (the identity of the complainant is confidential in New York State), review the elements of the complaint.

·        Listen to the subject physician’s story, which often will be quite different from that of the complainant.

·        After dutifully listening to the physician, outline the elements of concern in the matter.  Invite the physician to make those changes necessary to avoid similar complaints.  Many physicians are interested in hearing this information so that they can amend their practice patterns.

·        Thank the physician and indicate that the case will be closed.  (Now you can use the word “case.”)

 

Closure Letters

 

It is not always advisable to send closure letters, especially one to the complainant.  Such a letter often inflames the complainant in a matter which they have been informed will be closed.  If the complainant requests a closure letter, it is permissible to send such a letter and indicate that “the physician has been made aware of the concerns you have raised.”  This is true, but is not necessarily judgmental.

 

Physicians often want closure letters and should receive one if requested.  In that letter, it is permissible to recount the concerns raised and suggested changes in practice patterns.

This Year's AIM Best of Boards Honorable Mention Goes to the

 Texas State Board of Medical Examiners

Texas State Board of Medical Examiners

1) Efforts to Streamline the Licensure Application Process Without Compromising Quality &

2) The Legislative Strategy to Strengthen the Board’s Regulatory Powers and Increase its Resources

Description:

1) Efforts to Streamline the Licensure Application Process Without Compromising Quality

Categories – 1) Product 2) Policies, Procedures and Guidelines 

The Texas State Board of Medical Examiners made dramatic improvements last year in licensure efficiency through a major revision to the existing physician licensure application,  the addition of upstream screening and categorization of applications by complexity. 

For years the Texas State Board of Medical Examiners had to respond to complaints of applicants, employers, and elected officials about the length of time required to get a license in Texas.  The agency process was effective in screening out unqualified physicians; however, it was constantly under fire for a perceived lack of efficiency.   

When a new executive director, Dr. Donald Patrick, arrived in 2001, one of his first acts was to take a copy of the agency’s application and attempt to complete it. He found it to be complicated, lengthy, confusing and redundant. The 32-page application contained all the questions needed for any applicant, whether from a domestic or foreign medical school, applying for the first time or applying for relicensure. He directed staff to reduce the application to no more than 10 pages. Various parties reviewed the application so that the core elements that must be asked of any applicant could be determined. Questions unique to a specific type of applicant were added to that type of application. Thus the 32 page generic physician licensure application metamorphosed into eight different applications, unique to each situation, ranging from 3 to 11 pages.  

Dr. Patrick then asked the Physician Licensure staff to brainstorm on further methods to streamline the application process without compromising quality. The agency could not afford to add additional staff to this department. The Physician Licensure staff devised a plan to use call center staff members to initially screen physician licensure applications. Initial screening involves a simple review of the application packet against a checklist for required items. No analysis of documents is done at this level. Screeners immediately correspond with the applicant by email to inform him/her which items are still lacking. Every new item received generates another informative message to the applicant. Once the application packet is complete, it is passed on to Physician Licensure for a thorough content analysis of the documents. This new process has made the call center staff happier, because now they are trained and have access to documents that allow them to efficiently take the calls of the physician licensure applicants. Formerly, these calls were routed to the over-burdened Physician Licensure investigators. By extension, the applicants are more satisfied with the process because they get fast, accurate communication from very early on in the process. The Physician Licensure investigators can work more efficiently, because the applications they receive have at least a base of complete documents.  

The TSBME has achieved further efficiencies by categorizing applications according to their complexity. The agency can now fast track low complexity applications and get more good doctors licensed quickly. Uncomplicated applications were processed  in an average of only 22 days during the last fiscal year. It took an average of only 35 days for any physician licensure applicant, regardless of the complexity of the application, to complete the all of process except the personal interview and jurisprudence exam. This reduction in processing time has resulted in a notable decrease in the overall time to get licensed.  In the beginning of fiscal year 2003, before the new approach was implemented, it took 134 days on average to license a physician in Texas.  By the first quarter of fiscal year 2004, it took only 59 days, and that figure is still decreasing.  

Board members, trade associations, and elected officials report a sharp drop in complaints regarding physician licensure. Greater efficiency in this area increases the number of quality healthcare providers  licensed to serve the citizens of Texas. The TSBME has managed to create this streamlined process, while increasing communication with applicants and decreasing the amount of time needed for licensure.  Furthermore, the increased efficiencies in the licensure process have allowed the agency to reallocate scarce staff resources from the licensure department to meet needs in enforcement.

2) The Legislative Strategy to Strengthen the Board’s Regulatory Powers and Increase its Resources

The Texas State Board of Medical Examiners took advantage of increased visibility created by negative publicity to gain legislative backing for strengthened laws and greater resources for the under-funded agency during the 2003 legislative session. 

As the session approached, the Texas State Board of Medical Examiners was in the center of the brewing storm over medical malpractice and tort reform issues.  The agency was targeted by the competing interests: medical professionals, trial lawyers, consumers, elected officials and the business lobby,.  At the same time, a major Texas daily newspaper ran a series of stories depicting the harsh truth that bad doctors were not being adequately disciplined.  

In the midst of this adversity, TSBME launched a bold and successful strategy to strengthen its regulatory powers and increase its resources. State agencies in Texas are strictly prohibited from “lobbying” state officials, so the strategy was to use legislators’ questions about the negative publicity to tell the full story of both the agency’s new vigor and its lack of resources.  The agency used the glaring media spotlight to its advantage, drawing on skilled, committed staff and board members to communicate with legislators while they had their full attention. 

Its message for the legislature:

1)      “The people of Texas demand a strong regulatory system to ensure that medical care is delivered by competent physicians.”

2)      TSBME acknowledged previous regulatory weaknesses.

3)      TSBME needed laws and resources to meet public demand.

4)      Events had created a separation of TSBME from the professional associations and the agency’s priority was public protection. 

Recognizing the increasing importance of public protection, the Board, leadership and staff had already begun dramatic improvements in 2002 and early 2003 and the agency had good news for legislators concerned about its effectiveness.  

The Legislative Strategy: 

TSBME had worked closely with the professional associations in previous legislative sessions. The associations had professed to look after agency interests along with those of the profession with their strong, well-funded lobby teams.  It was now clear that the interests of the regulatory agency and those of the profession were not the same, although they converged on some issues.  TSBME would have to speak for itself if public interests were to be well served. 

The legislative strategy included the following elements: 

Before The Session

·        Appointment of a Board Legislative Committee with political expertise, supported by informed and involved Board members.

·        Development of Legislative agenda outlining statutory changes needed to assure public protection.

·        Incorporation of consistent messages in all communications.

·        Visits by Executive Director to legislators in their district offices to discuss their concerns about issues, especially those highlighted in media. 

During the Session

·        Close monitoring of all legislation filed to

o       Identify bills that could enhance TSBME

o       Identify bills that could negatively impact the agency’s abilities.

·        Providing legislative staff with analysis of legislation affecting TSBME.

·        Constant presence in hearings and legislative offices of well-informed board members, demonstrating their involvement and commitment.

·        Contact with bill authors (or their staff) to constructively resolve problems before bills were heard in committee.

·        Ensuring legislative staff could reach agency staff during floor debates, any time, day and night.

·        Close monitoring of legislative action via webcasts when not in attendance.

·        Contacting legislative staff immediately to offer help when issues arose in debates.

·        Use of communications plan including

o       Direct and frequent communications with legislators and their staffs.

o       Graphic presentations of agency improvements.

o       Dissemination of packets of negative media coverage.

o       Board member contact with editorial boards, producing positive stories about agency improvements and needs. 

Legislative leaders responded by working closely with TSBME to address the problems and develop solutions. Although numerous bills were filed that could have negatively impacted the agency, none passed. Several bills were amended to meet agency needs. The major accomplishment of the session was unanimous passage of Senate Bill 104, landmark legislation which 

·        Strengthens the agency’s statutes with

o       expanded provisions for temporary suspension

o       new powers for temporary restriction 

·        Provides new resources through an $80 license surcharge providing

o       a 60% increase in funding in spite of statewide budget cuts

o       funding for expert physician consultants

o       funding for more competitive salaries to retain staff

o       20 additional staff 

SB 104 is now seen as a model for the state’s other health regulatory boards as the state seeks to standardize practices across professions. 

The strategy was effective because TSBME staff expertise and board member commitment and energy combined to establish credibility with an impressive track record before the session began, and through a Herculean effort during the session, to reach goals that benefited the agency, the legislators and the public.

FROM THE AIM ARCHIVE

The 2003 Award Recipients were Announced at the AIM Annual Meeting in Chicago on Wednesday, April 9, 2021

Congratulations to the 2003 Award Recipients!

2003 AIM Best of Boards Award Goes to the New Mexico Board of Medical Examiners

New Mexico Board of Medical Examiners
Statewide Application
Category: Product (e.g., a brochure, manual, etc.)

Description:

New Mexico’s “Statewide” Application

The New Mexico Board of Medical Examiners has been working with Hospital Services Corporation over the past eight months to standardize the application for licensure with the application for credentials.

Hospital Services Corporation (HSC) was formed in 1985 to develop programs for the health-care industry and in 1991 went into the credentials business to work on simplifying the process. The “Statewide” application started as a project between the state’s hospitals, health plans and physicians. It was developed in conjunction with the medical society and endorsed by physicians throughout the state. Today the application is accepted by all health plans and nearly all hospitals in the state. HSC has become a Credentials Verification Organization, certified by NCQA, used by five major health plans (a majority of physician panel membership in the state), 25 hospitals and over 30 physician practices.

Nearly everyone in the state was on-board except for the licensing board. The board still required use of a different application and accepted credentials provided by FCVS, but not by HSC.

Following a gentle nudge by the legislature (House Joint Memorial 61), a Task Force was formed to look at ways to streamline licensing and credentialing. The Board’s Executive Director chaired the Task Force, determining that the most prevalent problem impacts physicians who are faced with a lengthy licensing process (at that time averaging over 80 days), followed by the credentialing process.

Although HSC had urged the Board to accept the Statewide application several years ago, there was a perception that the differences between the forms were too great. In late 2002 BME and HSC staff started meeting to overcome obstacles to sharing one form and accepting source documents obtained by HSC. In November 2002 Board rules were changed to accept documents from HSC and a contract has recently been signed between the two organizations to allow for the exchange of documents.

The final changes are being made to the application to incorporate the needs of all parties. The biggest compromise has been on the questions that are asked of the applicant, since both agencies feel strongly that their questions are the “right ones.” As a compromise, the one separate page that is for board specific information will have three questions that HSC participants have not approved, but we believe are essential. The extra page will also contain a photo of the applicant, a specific “applicant oath,” as well as information about licensing exams, another issue that is of no concern to the hospitals and health plans.

Applicants will have the option of using FCVS or HSC to provide source documents, or may apply directly to the board, at a higher cost. When the board office receives the Statewide application, a copy will be sent directly to HSC to initiate the process of obtaining source documents. This will give the applicant a head start on processing their credentials for third party payors and hospitals in New Mexico and eliminate the need for them to complete another long form. We think it will result in a winning situation for everyone involved, and significantly improve the overall turnaround time for physician licensure and credentialing in New Mexico. Not only will it be good for the physicians, but also good for the citizens of this State, where access to care is a major issue.

While the Board of Medical Examiners is starting the process, the Task Force envisions that in the future all health care licensing boards will use the Statewide application. It is currently used for credentialing all types of health care professionals and we think other licensing boards will feel comfortable implementing the new form when the initial problems are worked out.

2003 AIM Best of Boards Honorable Mention Goes to the Oklahoma Board of Medical Licensure and Supervision

Oklahoma Board of Medical Licensure and Supervision
A Living Professional Directory
Categories: 1) Outreach or Education; 2) Technological Improvement

Description:

We have created a "24 hour updated" directory (hence: Living) for doctors to electronically update their practice and personal information on-line (e.g., multiple practice locations, hospital affiliations, managed care networks, office hours and languages spoken, etc.) that are all a part of the directory that is available to the general public for selecting a physician. The incentive for the doctor to keep it current is the competition for patients through marketing. Secondarily, the physician uses the same process to renew his/her license on-line. I would anticipate having one of my employees at the meeting to run a live site and have handout material.

Information About the AIM Best of Boards Award

THE PURPOSE

The AIM Best of Boards Award Honors Best Practices:  State Medical and Osteopathic Board Executives and staff are always seeking new and better ways to do their jobs.   The problem is that few people outside of the Board ever know about these good ideas.  The AIM Best of Boards Award provides Boards with the opportunity to share the benefit of their accomplishments with other Boards and to receive recognition for their hard work. 

CATEGORIES

Boards are encouraged to submit one or more entries in any of the following categories:

1) Legislation/Rules;

2) Outreach or Education;

3) Policies, Procedures or Guidelines;

4) Product (e.g., a brochure, manual, etc.);

5) Technological Improvement.

CRITERIA

The Committee makes its decision based on the following criteria: 

1) Support for Board’s mission to protect the public; 

2) Education of the public and practitioners; 

3) Demonstration of partnership approach to problem-solving; 

4) Benefit to multiple Boards; 

5) Increased efficiency of Board operation.

  About AIM

Administrators in Medicine (AIM) is the National Organization for State Medical and Osteopathic Board Executive Directors. 

Founded in 1984, AIM is dedicated to serving Board Executives and Staff in their public protection work. 

 
  Visit the AIM DocFinder

AIM DocFinder Celebrating its 8th Anniversary www.docboard.org  The only online physician directory of its kind when it was launched in 1996 at the time of the Internet's infancy, DocFinder is still recognized for its easy to use search engine.  It remains the only combined public online physician database in the nation that has its direct source of data from state government licensing boards and that also remains free of charge to the public.