AAOS On-Line Service June 1998 Bulletin

June 1998 Bulletin

Surgical staff credentialing survey, 1997

The Task Force on Educational Effectiveness surveyed chairpersons of orthopaedic surgery at academic/teaching hospitals (excluding residency directors) and at community hospitals to determine the level of continuing medical education and training that is required at various levels and to determine how to meet future CME needs. "We attempted to determine the basis on which the granting of privileges or conversely, the restriction of privileges was done," said James Kasser, MD, task force chairman. "Some requirement of advanced training in specific areas was necessary." The similarity of responses to most questions by chairpersons of academic/ teaching hospitals and community hospitals is remarkable, said Aaron G. Rosenberg, MD., a member of that task force.

Question Academic/Teaching Hospital Community Hospital Summary

1.Specific surgical privileges for staff appointees are determined by: 49.1% = Dept. Chairperson
2.5% = Rep. of Chair
24.5% = Committee
38.4% = Combination 26.1% = Dept. Chairperson
1.5% = Rep. of Chair
44.8% = Committee
38.8% = Combination Department chair determines privileges for a majority of Academic/Teaching Hospitals; while a committee is the predominant mechanism for Community Hospitals

2.Surgical privilege qualifications are 46.4% - Specified procedure by procedure
13.4% = Specified by general specialty orientation
44.1% = Divided into general and specific 44.8% = Specified procedure by procedure
11.9% = Specified by general specialty orientation
45.5% = Divided into general and specific Seems to be a split decision: almost half of each hospital type specify procedure by procedure; while the other half divide into general and specific.

3. Requirements for granting specific surgical privileges are: 36.6% = Standard, regardless of degree of surgical complexity
64.0% = Graded by degree of surgical complexity 42.1% = Standard, regardless of degree of surgical complexity
57.9 % = Graded by degree of surgical complexity Majority of each hospital type grant privileges, based on degree of surgical complexity.

4. Specific privileges may be denied due to a lack of specific training: 90.5% = True
9.5% = False 84.3% = True
15.7% = False Overwhelming majority of each Hospital type may deny privileges due to a lack of specific training.

4a.If True, please list some typical procedures: 46.6% = Spinal instrument.
23.6% = Lasers
14.7% = Spine Surgery
12.3% = Hand Surg./Recon.
10.4% = Microvascular Surg.
8.0% = Total Joint Revision
7.7% = Chondral Transplant
7.7% = Complex Arthroscopy
4.9% = EMG
Under 6.0% = 49 other listing 64.8% = Spinal instrument.
23.9% = Lasers
8.0% = Spine Surgery
9.1% = Hand surg/Recon.
4.5% = Microvascular Surg.
9.1% = Total Joint Revision
6.8% = Chondral Transplant
6.8% = Complex Arthroscopy
8.0% = EMG
Under 6.0% = 49 other listings Spinal Instrumentation claims the largest area of concern in regards to specific training and privileges for each hospital type; with lasers training as the next largest group.

5.Certain procedures may require evidence of advance training: 86.5% = True
13.5% = False 80.6% - True
18.7% = False Requiring evidence of advanced training for certain procedures seems to be standard for both hospital types

6. Continuing medical education requirements are needed to maintain surgical privileges: 62.1% = Yes
37.4% = No 71.6% = Yes
28.4% = No Majority of each hospital type require CME to maintain privileges.

7. Whether institution has a formal method for monitoring surgical morbidity and mortality: 95.9% = Yes
3.7% = No
0.5% = Don't know 86.8% = Yes
12.5% = No
0.7% = Don't know Overwhelming majority of each hospital type have a formal method for monitoring morbidity and mortality.

8. Whether there is a threshold for notifying surgeons of excessive morbidity and mortality: 60.7% = Yes
38.1% = No
1.2% = Don't know 59.5% = Yes
39.7% = No
0.7% = Don't know A slightly lesser majority of each hospital type maintain a threshold for notifying a surgeon of excessive morbidity and mortality.

9. Whether there is an attempt to benchmark, cost evaluate, otherwise differentiate between surgeons' performance on hospital staff: 57.9% = Yes
41.6% = No
0.5% = Don't know 42.5% = Yes
54.3% = No
3.1% = Don't know Although a close split, a slight majority of Academic/Teaching Hospitals attempt to formally differentiate between surgeons' performances; while a slight majority of Community Hospitals do not.

Please describe #9: 14.0% = Cost Analysis
9.8% = Cost/Dr. of Total Joint Replacement
7.8% = Hospital Stay
6.2% = Complication Rate
6.2% = Admin. Keeps track of cost/O.R. time for specific procedures and surgeons
3.6% = Surgeons compared to each other in costs, length of stay, complication rate
1.6% = Utilization review
1.0% = Utilizing consulting firm for cost analysis
Under 6.0% = 54 other listings 14.3% = Cost Analysis
14.3% = Cost/Dr. of Total Joint Replacement
4.8% = Hospital Stay
0.0% = Complication Rate
0.0% = Admin. keeps track of cost/O.R. time for
specific procedures and surgeons
9.5% = Surgeons compared to each other in costs, length of stay, complication rate
7.1% = Utilization review
7.1% = Utilizing consulting firm for cost analysis
Under 6.0% = 54 other listings For those that attempt a formal differentiation between surgeons' performances, both hospital types utilize cost
analysis to the same degree and Cost/Dr. of Total Joint Replacement to a close degree; however, Academic/ Teaching hospitals seem to give more weight to hospital stay, and complication rate individually, and admin. tracking of cost/O.R. time, where as, Community Hospitals concentrate more on surgeon comparison, based on a combination of costs, length of stay, and complication rate plus Utilization Review and utilizing consulting firms for cost analysis.

Question	Academic/Teaching Hospital	Community Hospital	Summary
1.Specific surgical privileges for staff appointees are determined by:	49.1% = Dept. Chairperson 2.5% = Rep. of Chair 24.5% = Committee 38.4% = Combination	26.1% = Dept. Chairperson 1.5% = Rep. of Chair 44.8% = Committee 38.8% = Combination	Department chair determines privileges for a majority of Academic/Teaching Hospitals; while a committee is the predominant mechanism for Community Hospitals
2.Surgical privilege qualifications are	46.4% - Specified procedure by procedure 13.4% = Specified by general specialty orientation 44.1% = Divided into general and specific	44.8% = Specified procedure by procedure 11.9% = Specified by general specialty orientation 45.5% = Divided into general and specific	Seems to be a split decision: almost half of each hospital type specify procedure by procedure; while the other half divide into general and specific.
3. Requirements for granting specific surgical privileges are:	36.6% = Standard, regardless of degree of surgical complexity 64.0% = Graded by degree of surgical complexity	42.1% = Standard, regardless of degree of surgical complexity 57.9 % = Graded by degree of surgical complexity	Majority of each hospital type grant privileges, based on degree of surgical complexity.
4. Specific privileges may be denied due to a lack of specific training:	90.5% = True 9.5% = False	84.3% = True 15.7% = False	Overwhelming majority of each Hospital type may deny privileges due to a lack of specific training.
4a.If True, please list some typical procedures:	46.6% = Spinal instrument. 23.6% = Lasers 14.7% = Spine Surgery 12.3% = Hand Surg./Recon. 10.4% = Microvascular Surg. 8.0% = Total Joint Revision 7.7% = Chondral Transplant 7.7% = Complex Arthroscopy 4.9% = EMG Under 6.0% = 49 other listing	64.8% = Spinal instrument. 23.9% = Lasers 8.0% = Spine Surgery 9.1% = Hand surg/Recon. 4.5% = Microvascular Surg. 9.1% = Total Joint Revision 6.8% = Chondral Transplant 6.8% = Complex Arthroscopy 8.0% = EMG Under 6.0% = 49 other listings	Spinal Instrumentation claims the largest area of concern in regards to specific training and privileges for each hospital type; with lasers training as the next largest group.
5.Certain procedures may require evidence of advance training:	86.5% = True 13.5% = False	80.6% - True 18.7% = False	Requiring evidence of advanced training for certain procedures seems to be standard for both hospital types
6. Continuing medical education requirements are needed to maintain surgical privileges:	62.1% = Yes 37.4% = No	71.6% = Yes 28.4% = No	Majority of each hospital type require CME to maintain privileges.
7. Whether institution has a formal method for monitoring surgical morbidity and mortality:	95.9% = Yes 3.7% = No 0.5% = Don't know	86.8% = Yes 12.5% = No 0.7% = Don't know	Overwhelming majority of each hospital type have a formal method for monitoring morbidity and mortality.
8. Whether there is a threshold for notifying surgeons of excessive morbidity and mortality:	60.7% = Yes 38.1% = No 1.2% = Don't know	59.5% = Yes 39.7% = No 0.7% = Don't know	A slightly lesser majority of each hospital type maintain a threshold for notifying a surgeon of excessive morbidity and mortality.
9. Whether there is an attempt to benchmark, cost evaluate, otherwise differentiate between surgeons' performance on hospital staff:	57.9% = Yes 41.6% = No 0.5% = Don't know	42.5% = Yes 54.3% = No 3.1% = Don't know	Although a close split, a slight majority of Academic/Teaching Hospitals attempt to formally differentiate between surgeons' performances; while a slight majority of Community Hospitals do not.
Please describe #9:	14.0% = Cost Analysis 9.8% = Cost/Dr. of Total Joint Replacement 7.8% = Hospital Stay 6.2% = Complication Rate 6.2% = Admin. Keeps track of cost/O.R. time for specific procedures and surgeons 3.6% = Surgeons compared to each other in costs, length of stay, complication rate 1.6% = Utilization review 1.0% = Utilizing consulting firm for cost analysis Under 6.0% = 54 other listings	14.3% = Cost Analysis 14.3% = Cost/Dr. of Total Joint Replacement 4.8% = Hospital Stay 0.0% = Complication Rate 0.0% = Admin. keeps track of cost/O.R. time for specific procedures and surgeons 9.5% = Surgeons compared to each other in costs, length of stay, complication rate 7.1% = Utilization review 7.1% = Utilizing consulting firm for cost analysis Under 6.0% = 54 other listings	For those that attempt a formal differentiation between surgeons' performances, both hospital types utilize cost analysis to the same degree and Cost/Dr. of Total Joint Replacement to a close degree; however, Academic/ Teaching hospitals seem to give more weight to hospital stay, and complication rate individually, and admin. tracking of cost/O.R. time, where as, Community Hospitals concentrate more on surgeon comparison, based on a combination of costs, length of stay, and complication rate plus Utilization Review and utilizing consulting firms for cost analysis.

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