Nebraska LIVE Show: Credentialing & Confessions

[00:00:00] Welcome back to Credentialing Chronicles where we spill the tea on the doctors you see. And we're spilling it baby all across America. So what's happening in the Nebraska Medicine Board? Okay.

[00:00:26] Well, apparently the board was under investigation by the Nebraska Attorney General. What is happening in Nebraska? I was so excited to get to Nebraska and taste the corn but I don't know about that. Yeah, no, yeah. We found, there was a couple of really crazy things that we found in Nebraska when we were looking at our spilling of the tea. You go first or whatever we want to do. Yeah, I mean this thing.

[00:00:52] Yeah, so this short story here that I found. I can't hear you. Yeah, so this short story that I found, it was that the University of Nebraska stepped in and replaced the entire board. Okay? They apparently said y'all don't do good, kick it out. And in- All y'all fired. All fired. Yeah. And installed an interim physician heavy board. Mm-hmm. And then there was fights and disputes and lawsuits. What's so good?

[00:01:21] Because y'all don't play in Nebraska. I mean, really, that's what's happening in Nebraska. Did y'all hear about that? No. Well, look it up. I don't know. Well, I'm just saying y'all can definitely tune into Credentialing Chronicles because we are highlighting all news articles. Tell me about it. In your area today. Okay, so Shannen, where's your story? So tell me. Spill some tea on Nebraska. What did you find? I, mommy. Are you ready? Tell me. No, I don't know if I'm ready.

[00:01:51] Okay, you really are. I was excited to go to Nebraska. Well, can I, how far, how, how long is it? Well, this isn't even about a provider. No? No. No, what is it about? No, this isn't. So let me tell y'all. I have six daughters, okay? If y'all have any daughters, it's okay, we love each other. But I always tell my daughters, I'm always like, don't you put me in no nursing home? Because, honey, I'd have took care of you. You know, I'd have made you a princess. Like, I love you.

[00:02:20] Four of my daughters are all 22 and up. So they're all grown. They, you know, some of them marry, honey. Got good lives. And then I, you know, met this sexy Puerto Rican man, y'all. And I winded up having two more babies with him, okay? So there it is. So I have all these daughters. And so I always say, you better not put me in no nursing home. Well, this story, y'all, comes straight out of a nursing home in Nebraska, okay?

[00:02:45] And we are going to talk about the risk of access, okay? Because it has nothing to do with a provider. So there is this woman in a nursing home, you all. And it's not a random story. I don't even need my cards. Because it hits so close to home. Because literally all my four older daughters, I tell them this all growing up, you know? But what happened was, is an elderly woman was in a nursing home here in Nebraska. You know, she has dementia.

[00:03:15] She has some of the Alzheimer's, you know, neurological disorders. And there was a gentleman there. The gentleman is a janitor. He was not a provider. He was not a, you know, CMA. He was not a nurse. You know, I mean, and I know that, you know, we always talk about providers. But this gentleman was a janitor. And so he came in through the HR process of being onboarded on the HR spectrum of that.

[00:03:44] And again, we don't know, right? Me and Nyleen constantly advocate for background checks and credentialing. Yep. Not just on initial, on re-credentialing. Yeah, but I think we need to teach HR. I mean, really, I think we should make sure. We're just trying to get people to understand that there's credentialing people out here. That's a whole lot. That's next season. Oh, okay. Okay. So when we're thinking about it, I was like, okay.

[00:04:07] So every night, y'all, Mr. Janitor Man going in there to the elderly woman's bedroom and assaulting this woman every night. And nobody's knowing about it. And nobody's doing about it until a strong woman noticed something, had a feeling that didn't feel right, and reported it. Again, do we believe that the first report was even listened to? No. Why? Why? Because they don't have anybody making a complaint.

[00:04:34] Well, I mean, poor Marjorie don't know what's even happening to her. How is she supposed to make a complaint? You know, and so when we're looking at it, the biggest risk sometimes is not our providers, right? It's just even having access to our patients. And so the fact that this gentleman had access to this woman, and I mean, you know, these assaults happened over 7, 8, 9, 10 times. These were ongoing assaults where, at this point, he was just going and making nightly deposits into this poor woman.

[00:05:01] And, I mean, it's just, it's very, very, you don't want to think about it that way, right? But ultimately, you have to think about it that way because that's what she went through. And, you know, he was charged. He was, you know, convicted. They're going through the process right now. But, again, when we're thinking about our HR process and we're thinking about how we are onboarding people, it's really about access. Who has access to our patients? Absolutely.

[00:05:29] Because I don't want to be there. And that's why everybody has to be run through the OIG and the SAM because that is where your janitors and your food workers and have a background check for everybody. Do any of you have a hospital that does not do background checks? Or clinic or facility. Or clinic or a facility. You guys don't do background checks. Yeah. There you go. Do any of you all have a facility that doesn't do background checks on Recred? See, yeah.

[00:05:58] And so, again, those are just advocating. So, when you guys are going through your quality improvement measures every single year, do not stop suggesting those things. You know, we really need to get those background checks. But, again, they're trying to save money. Right. You know, but really it's saving patients knowing that if somebody is out there doing things in between credentialing periods that we're able to catch and disclose to the board so that they have an informed decision of whether or not to hire that provider. Mm-hmm. Absolutely.

[00:06:27] So, that is my very tragic and sad story from Nebraska that I will now use to definitely tell my daughters not to put me in a nursing home. Well, I don't know. With the nursing homes here in Nebraska, I don't know. That's kind of scary. It's everywhere. It's not just in Nebraska. Oh, that's true. That's true. I've seen them all over the United States. Like, this is something that's happened. I mean, I'm from Texas, and I've seen news articles in Texas. I mean, wait, honey. Wait till we get to the T's. Ooh. Okay.

[00:06:54] So, let's talk a little bit about updates for you guys. I'm going to get a little, I guess, spilling the tea of what's coming in Nebraska, which I thought was really... No, you really did a deep dive. Yeah, I thought this was so cool, and I don't know how much you guys do to stay ahead of the legislatures that are coming,

[00:07:16] or what the organization, obviously your state associations, are really responsible to ensure that you are keeping up with any legislative updates that are going to happen in your state, and things you should be looking for and monitoring. I highly recommend that you guys, at least once a year, when you're doing your policy revisions or bylaws review, just go ahead and see if there's any legislature changes. I know California has a good way of doing that.

[00:07:44] Florida Association has it as part of their newsletter. They alert of any legislative changes. So, let's talk a little bit about credentialing law changes that legislation in Nebraska is looking to change that's going to change your life. Life. Okay, so licensure for an ITP. Do y'all know what an ITP is? Internationally Trained Physician.

[00:08:14] And it's a hot topic that is coming through a lot of states because they're trying to use this as a form of filling in provider shortages. Provider shortages. Which we've talked about. Well, guess what state already passed this? Guess what state? Tell me the state. Florida. Florida, guys. Come on. It's always Florida. Whoever said Nebraska. Y'all just getting over here to the right. I was saying to the left.

[00:08:40] This is considered legislation that is in their writings right now that they're looking to pass. And they've already passed it. No, they haven't passed it yet. Oh, they're thinking. They're thinking about it. But it's going to change their world if it does pass. And I'll tell you why. So, hold on. Before I tell you why, it's going to be crazy. So, again, Miami. Don't mean to bring it up. But in Miami. So, I had a doctor. And ITP. Who came. And we tried to run him through the AMA. And it doesn't exist. His name doesn't exist. He goes, well, I'm not a member of the AMA. And I said, well, how do you have this?

[00:09:09] And he goes, well, I have an ECFMG. And I said, what? I said, how do you get an ECFMG? And it's not on the AMA. I'm very confused. Because of the residency. I'm so confused. Well, no. They don't do a residency. No, no, no. More. They don't. No. The older ones did. The older ones. So, now, all they're doing is passing the USMLE, which gives them the ECFMG. So, one and two. Gives them the ECFMG.

[00:09:33] And then all they have to do is find a program that will give them a supervising doctor to work with them. Not a formal training program. As long as they have an active license out of the country and they are enrolled in this program, they can obtain a license to practice in the state. So, when we tried, yes, we verified the doctor's license.

[00:09:57] But there's no way of finding out how to verify their education. Because we'd have to, like, contact Iran. And that's not a good place to try and contact a verification right now. Turkey. That's a problem. And, I mean, it just provides another gap.

[00:10:21] And so, you know, it's, again, it's trying to find a way to, you know, help provider shortages. Right. But then it's, like, creates all of these obstacles for medical staff professionals. Yeah. To verify. You're going to have to learn how to speak Arabic and Farsi. Okay. So, I mean. And FYI. Nyleen does. No, I don't. Sing it. Sing it, Nyleen. Okay. I do know a couple songs in Arabic. And I do actually. I sing it to our Uber drivers frequently.

[00:10:51] Okay. At conferences. Okay. Your duet. This is not swilling the tea on Nyleen. Okay. But I love it. I'll play some Arab music for you guys during happy hour. It's actually really fun. We can do some belly dancing. I love it. Okay. So, the legislature states, like I told you, they're going to give them a three-year license with a one-time renewal of another three years.

[00:11:17] And during those six years, it's going to be with a supervising doctor. And like I said, they're going to be applying at your hospitals because they will be given a license in Iowa. But yeah, you don't know how you're going to verify education. So, good luck with that. If y'all figure it out, let me know. It's coming. It's already passed in several states. And it's on the legislature for discussion in Nebraska. Just letting you guys know. But really, that's your tools. You know, your FPPE. You can FPPE every year. You can monitor behavior patterns.

[00:11:47] Trends. Okay. Confession session. Confession session. Okay. See, she's going to be doing the karaoke hour. We need to do karaoke. You know, Shannon doesn't mean karaoke. My daughters make me. Okay. You guys ready? He was a top revenue generator for our facility. No one wanted to question him. So, no one did. And then someone got hurt.

[00:12:18] That's it. That's all we get. More of the team. But I couldn't contact the anonymous people and say, hey, give me more. If you're sending in tips, I mean, a paragraph. You don't have to say names. You know, you guys get it now. But we're happy that you're sending them in. Yes. Okay. So, next. Next legislature.

[00:12:45] We are going to look at an expansion of scope of practice. This is going to affect your delineation of privileges and your criteria. So, the presentation you heard earlier, just make sure you have that handy. Because if this legislature passes, they are going to have a complete independent practice of certified nurse midwives.

[00:13:10] So, similar to CRNAs practicing independently, they want nurse midwives to handle all obstetric care and vaginal deliveries, all kinds of deliveries by themselves. Independently, prenatal care, postnatal care, all being done by a certified midwife. They are also looking to expand the scope of practice for athletic trainers.

[00:13:39] Now, this one pretty much knocked me off my heels. Yeah, I remember. Because it was, they want them to work in clinical, and check this out, surgical settings. Surgical. That's what, that's what she's saying, y'all. Surgical. They're in the OR already? Yes. That's terrifying. Yeah. They came to our office, though. We've had to credential them. Of course. And did you update the privileges to?

[00:14:08] And they're all. What did you do? Tell us. Spill the tea, girl. I told you, I just brought it. And this ain't anonymous. Yeah. This is live. Tell us. What happened? Well, it was off because they were, we had an ortho surgeon that was actually bringing them in as their first assist already. I'm sorry. Can you give me one second, sexy mama? Does any of our people have a mic for her? Yeah. Does any of our people have a mic for her? I know Iowa had no talking, but we got Nebraska talking. So go Nebraska. Sorry.

[00:14:39] Oh, no. She's right. No, no. No, no. No, no. No, no. No, no, no. No, no, no. No, no, no. Okay, come on. I'm the nurse from Iowa. No, the nurse. You're the nurse. And we're here. Thank you. You're the nurse. Yes. So we found out through our quality department that we had an orthopod who was taking their athletic trainer into the operating room to function as his surgical versus assist. So that was fun. And so, well, they're not credentialed.

[00:15:08] But wait, what educational competency did you guys end up doing once you found out? And what procedures? They literally were an athletic trainer. That's what their education was. Right. That's what the legislature said. And they had a certification, a surgical certification that basically allowed them to be a first assist. Now, in researching this, there's like four different ones that athletic trainers can have. Some allow them to close. Some allow them to with grafting skin on the back table.

[00:15:36] It's like, and they're all different ones. So they're very specific when you're privileging about it. Yeah, but her husband was not meant to be in surgery. So we had to say, you need to go back to school. Oh, good. Wow. She did. But yeah, we, and so we researched and the certification had recommended privileges actually for this athletic trainer. But basically, yeah, we treat them basically as a surgical versus assist, but we had to create a whole new privilege form for them within the scope of practice for an athletic trainer.

[00:16:05] It's pretty limited to what they can do. Did you put some additional supervision in, maybe a year provisional or something? We just require that the, they could not be in the OR alone. Without the supervising physician, we required a supervising physician agreement. Okay. In the OR, yeah. So she can't. Anybody, if it helps you, take notes, baby. Take notes, because we all need to help. We had multiple hospitals in the state of Iowa when we ran into this problem, and I didn't find anybody else. We had that happening at the time. Wow.

[00:16:34] It's coming down the pipe. Well, it's coming down from the ground. So reach out. You guys get her number. Basically, they said it's to help because there is a provider shortage. Yeah. A provider shortage. This is a nurse shortage. It trickles. It trickles. It trickles. It trickles. So that's basically the answer now is to train athletic trainers to scrub in. Well, it's not only to scrub in. So when I was reading the legislature update. Well, no, she said they're grafting skin in the back of the... Yeah. Yeah. Yeah. Yeah. Yeah. Well, no.

[00:17:01] And here it says, including, check this out, authorization to administer specific emergency medication. Oh, no. How do you even be a nurse to administer medication? Like, not even an LPN could do that. Oh, my goodness. So it's crazy. And they're doing all this. So they leave Gold's Gym and they just roll on over to the... I mean, because that's what... I imagine you get pumped. You say, okay, I did this. Let me go do some surgeries. I mean...

[00:17:29] Maybe that's why we all look a certain kind of way. I don't know. I can't believe it. That's crazy. That's crazy. I'm glad. Thank you for sharing. Thank you for your experience. Yes. Please get her number. If it's rolling through through Nebraska, she could definitely be a resource to help you modify your privilege shortage. Yeah, exactly. Your privilege is a work. Just go to her. Yes. Yes. Yes. That is amazing. That's crazy. That's crazy. So watch your legislature. Look for the updates because you will have to write.

[00:17:58] You have to call her to get the new privilege form. And figure out your scope of practices with your people that are working at your facilities. Yeah. And again, I hate to be the person that says Google alert everything. But you can Google alert the word credentialing. You can Google alert the word privileging. Right. And any type of articles that are coming up, you know, that are changing legislation, you know, anything about that specifically in your state, even the code number, you can definitely

[00:18:25] add an alert to that and then kind of keep up with that development. So did you know that in order to do this process in Nebraska, which I'll give you guys some kudos. Still don't know about the corn, but okay. So I'll give you guys some kudos. Then that messes them on the corn. Apparently y'all have a program called the 407 Credentialing Review Program. Do you guys know about that program? Have you ever heard of that in Nebraska? No. Not y'all credentialed. Not y'all. Not y'all.

[00:18:54] Nebraska don't know the program. Come on. So y'all have. What is it called again? 407. Okay. Credentialing Review Program. Is that a zip code or something in Nebraska? No, I don't know. Okay. Well, anyway, it's called the 407 Credentialing Review Program. And it's a program that reviews and evaluates changes in the scope of practice for your state. And it goes through whenever someone submits for a change of scope and practice, like a nurse, midwife, or athletic trainer, it goes through a three-stage review process. It goes through a technical component.

[00:19:24] Then it goes to actually the Board of Health. And then it goes to the Director of Public Health for review to make these proposed changes. And they also serve as an advisory board to the Nebraska legislature to protect public health. So it's reviewed by, I guess, those people that have that degree that's like the MPH, the Master's in Public Health. I guess those are the people that work in that department. It's interesting, right? I don't know, baby. You better look into that as your next certification.

[00:19:53] I agree. Y'all see her name. She'd be... Her certifications precede her in the room. Oh, my goodness. But can we talk about something fun? Okay. I'm done with the legislation. Okay, fine. Okay. I was just trying to... Nebraska legislation doing a lot. Okay. That's what I'm going to say. I'm just helping them, you know. Okay. So telemedicine. When we're talking about provider shortages, one of the biggest area that we all know,

[00:20:21] and do we love telemedicine? Do we love it? Telemedicine, telemedicine. How many average telemedicine doctors do you guys have at your hospital? Do you just have them at your facility? Do you have five? Do you have ten? Shout it out. Thirty? Thirty? Fifty? A hundred? A hundred? A hundred. We have a hundred and fifty in my hospital in Georgia. Ooh! A hundred and we've got, yes, our cardiology, neurology, infectious disease. So they're coming. Yes.

[00:20:51] All that is telemedicine. Oh my goodness. Okay. So one of the things, one of the areas that we keep seeing over and over again is fraud in telemedicine. And so again, it's just one of the areas that we did. Yes. Yes. So did you hear about the nurse practitioner? I was going to say, do you want to, I was opening the door. But of course. But did you hear about the nurse practitioner? I think I want to. Okay. So this nurse practitioner had a license and she loved both of y'all because she was licensed in Iowa and Nebraska. And Nebraska.

[00:21:22] So she had licenses in both states. But you know what she decided to do, Shannon, is that instead of doing telemedicine in Iowa and Nebraska, she decided to do what? Go to another state. Go to another one. And, and start seeing patients in some other state. Unlicensed. Unlicensed. And she decided to prescribe medication to these patients, treat these patients in other states.

[00:21:51] So that's on the telemedicine group that hired her, first of all. They should have never allowed her to do that. So shame, shame on the telemedicine provider group. Well, the result of doing that, because if you don't know, you still get the action, right? Yes. Yes. Even though you don't know that red means stop. If you pass the red light, you still don't get stopped by the cops. You're still going to stop. It don't matter. So she should have known better. Because we know that you are not supposed to treat patients at another state. Prescribe.

[00:22:19] Or prescribe in a state that you're not licensed to do so. Definitely. So according to the report, the violations included prescribing weight loss drugs without a valid patient provider relationship. Which, I mean, is it a big deal, Mylene? Hello. Oh, we all do need to lose a lot. Yes, I mean, is it? No, it's a big deal. I mean, it's a big deal. And then, obviously, practicing across state licenses without proper licensure. So what was the repercussions? What happened to her?

[00:22:48] She ended up losing both of her licenses. Iowa and Nebraska both took the licenses. So now you don't got a job. Because you didn't know you weren't supposed to practice without a license. And you're contributing. And you're contributing to provider shortages. Okay, confession session. Confession session time. Okay. Oh, this is a little bit longer. You ready? Let's see. I saw something that didn't sit right.

[00:23:17] And I stayed quiet because I didn't want to be difficult or get in trouble. And then things started to slip through the cracks. Of course. That's what it says. Oh. They slipped. Period. My advice. What is our advice to this anonymous lady or man? Not enough information. Not enough information.

[00:23:48] She got taken back to the game. Okay. Talk a little bit. Maybe talk a little bit. Maybe talk a little bit. And speaking about that, let's just wait two seconds and just say, guys, if you do follow us on Instagram or Facebook or LinkedIn or all the things, we have worked really, really, really hard. We've put in a lot of time, a lot of effort, a lot of love, sweat, tears, crying, trying

[00:24:13] to get to do this show for you guys and to have MSPs and represented and on a platform that's safe for us to talk about everything that we can talk about that we can't get in trouble for talking about. And we want to do it in a safe space. And a lot of diversity has been presented as well. Yeah. Yeah. I just wanted to put that in my mic. Oh, okay. I feel like I have a mic because you got a mic. So I'm like... You got the fancy one. Which one do I need to talk into?

[00:24:42] I don't need to talk into your mic. This is my mic for you. Okay. Sorry. Podcast moment. I'm sorry. So what were they talking about? Oh, we want you guys to engage. We want you guys to tell us your story. Spill your tea. Hey, look, if you direct message us, nobody's going to know. Nobody knows. Nobody knows. We're not sharing it with anybody. No. And we want to see the engagement and sharing and following because we don't have this, right? We're all so rigid and we're all so serious and we're all, yeah, about the certifications

[00:25:10] or, you know, all the studying and all these courses. We have to be rigid. We have to be serious, right? Yes. We are trained in that whole mannerism. But ultimately, like somebody in the board of directors of this whole thing that put the shebang together, she said yesterday in her words, quote, we are really fun people. We are.

[00:25:32] And I said, I think y'all are fun because MSPs are fun, you know, but it's this profession that makes us rigid, right? I mean, you know, yes. It makes us rigid and we do have to follow so many rules and regulations and all this stuff. But we're trying to have a little fun. So first of all, we want to thank you guys for, you know, obviously doing this, but we want you guys to engage. So we just wanted to take a second and do that little PSA for us because we do need help. So are we ready to place an age? And share it with other patients.

[00:26:01] We share it with elderly people because again, it's not just about MSPs, which if we, I mean, we, it is all about MSPs because we are MSPs, but MSPs are probably like what? One million people in the whole United States. I don't know. I say there's about a million MSPs. What do y'all think about a million? Do y'all, would y'all say about a million MSPs or maybe 500,000? What do you think? How many MSPs? I don't know. We have over 6,000 NAMS members. I can tell you that. Oh, 6,000 NAMS. Okay.

[00:26:30] So I was, oh, maybe not a million. Yeah. I feel like, I was like, girl, we would have a job security. Yeah. Yeah. Okay. Maybe 50,000. But ultimately, I mean, we just want it to be an environment where, um, I remember being a young MSP and I just always felt like I was in competition. And I always felt like I had to prove myself. I always felt like I, I, you know, my, if my eyes weren't dotted or my T's weren't crossed,

[00:26:59] somebody was going to pull it out, spit it out, show it up, you know, and I had to be better and better and better, which is something that makes us who we are. And it's a, it's a beautiful, very hard training that we all go through. But, um, ultimately, you know, we have to be able to go through that training, right? Absolutely. Yeah. All right. Are we ready to play a game? Let's play a game. We do need to get you a little bit back. Okay. So we can play the game. I think we got it figured out. So board investigation is ongoing, but no outcome yet.

[00:27:29] Are we passing the file? No. Okay. Good. Are we stopping the file? Do we need more time to investigate? How much time? How much time do we leave a file in pending status? It's a trick question. I'm right with you, mama. I'm NCQ all day long. I'm right with you. No, it's read your bylaws. Yeah. I know you. That's why she's got the certifications.

[00:27:58] So read your bylaws. Okay. You're right. But she's right. Yeah. So read your bylaws, and it'll tell you how long you can keep a file pending. Okay. Next question. Provider wants privileges expanded beyond current documented training. Should we add something to make it pass the file? Anything? Okay. Stop the file? Yeah. We need more training.

[00:28:25] So y'all going to stop the file and say y'all need more training to do this? Yeah. Oh, so it don't even make it to your credentialing committee. Hold on. I got a story. Can I do a story? Yeah. I'll do a story. I'm happy that everybody said that it's not even making it to credentialing committee. Well, let me tell you. Okay. So this is a true story. I had an electrophysiologist who graduated with a fellowship as an electrophysiologist. Okay. And then she decided to move to Montana. Lived in Montana for six years and only did pacemakers.

[00:28:54] Came back and wanted to do a PVD. So a PVD apparently is some fancy procedure where you go in through one side of the heart and go through the other side of the heart. My credentials committee at first listened to us and we said, you know, she doesn't have the case logs to prove it. She needs at least 50 cases. She didn't have it. She's like, I'm board certified and I'm trained and I... And so we said, no. We went through the credentials committee for two months. We invited her to the credentials committee to sit on the credentials committee and talk about it.

[00:29:19] But they decided they were going to allow her to do it under direct supervision of the other electrophysiologist. But the other electrophysiologist was super mad because only one doctor can get paid for the procedure. He went into the first case to be a good player because he was an employed doctor. He ended up having to pull her hands off of the patient, ran into my office and said, she's going to kill someone. So once we did that, we brought him to credentials and then we had to take away the privilege.

[00:29:49] So, or had her... Real life. Yeah, that's a real story. Confession session! There's my confession. So yes. Okay, next. Let's do another one. Provider is approved elsewhere, but your internal review raises concern. Are we stopping the file? Are we passing the file? Are we needing more time to investigate?

[00:30:18] Oh, everybody's head was shaking. Y'all is on point. In Nebraska, Iowa. Exactly. And one of the things I'll talk about really quick is in, you know, I own a CVO. Nyleen does everything with the practices, the clinics, the surgery centers. And one of the things that we say is we are not the Gestapo of the file. It is you all that are the client, the manager of the file. We do what you say. And so a lot of the times, has anybody experienced the DEA being down the last couple of...

[00:30:48] Anybody experienced that? Because we've experienced that. And, you know, so some of our clients have said, I don't care. Give me the file. I don't care if the DEA is not verified. And so, you know, it's like, okay, per client, you know, here's the email. We put it in. But then we have two or three clients that say, we do care. I don't want that file anywhere near me until the DEA verification is in there. And so, again, on the CVO model, we get to be told what to do by you all.

[00:31:17] But on the hospital model, you know, some of the times those internal review concerns can literally keep a hold on that file. Yep. You know, and it's just sitting on them. Mm-hmm. Do we have another one, y'all? Oh, we got to do another confession. It's a confession session. You're losing your spunk. I am. I'm pretty happy hour. I'm pretty happy hour. Where's the spunk at?

[00:31:47] Okay, it's easing up for a while. I already did my confession. You have to do a confession. Do you want me to do a confession? Okay. Okay. Confession. Okay. I don't know. I'm like, how juicy is it going to be? I want to be anonymous. No. Okay. Okay. What did you do? I'm getting for Clem. Okay. What did you do? And then you say it like that.

[00:32:16] I'm like, I'm going to court after Nyleen. All right. Well, you say it was your confession. Okay. It's my confession. So one of the things I guess I can confess to is being in court. I won't even take it to the CVO. Before CVO, when I was still in corporate America. Okay. We did some mass recredentialing, which I know all y'all do, right? We mass recredential at a time.

[00:32:43] And so some of our players didn't have all of the documents that were required to be in the file to do a recredentialing. Okay. Okay. But the medical staff manager had just left. I was new on the job. I wanted to make sure that everything went through. It went through. And I didn't upset everybody. And, you know, there was every specialty had its own medical supervisor, medical director. And so I was appeasing them as well as the board of directors.

[00:33:13] And so, you know, you guys know. You guys know. And so, yeah. So we put some things, you know, together and made it all work. And we shouldn't have done that. And we all passed it. Again, this was very young in my career. So before I left that facility, I actually became the medical staff manager of that facility. And, you know, we recredentialed. And never did that again. Well, no.

[00:33:39] We recredentialed everybody again outside of the period because I had learned standards. I had learned a lot more in that time. And so those files were even better than going. And, you know, the mistake never came out or anything. But, again, it's the pressure that you feel from your CEO, from the board of directors. And, you know, I understand the big players, right, you guys? But it's really, truly the medical director when they're in your room and they're like, we need this OB on.

[00:34:07] And they're already scheduled and five patients are coming in today to see that. And you're just like, what do I do, right? I mean, you're under that type of pressure. And I don't think a lot of people understand that type of pressure. And it's like you're the only one that can make it work out. I mean, have you ever been like that? Absolutely. Absolutely. Okay. All right. Another question. One more. Let's go. Let's go. Everybody wants to have some. Am I reading or are you reading? No. Let's go with provider. Oh. Oh. Because you were dancing. So I thought you were going to dance with me. Yeah.

[00:34:37] You're looking at my head. Yeah. So I'm ready for some. Okay. So it's provider tied to the facility with known compliance issues. Yeah. Okay. So here's the caveat. Is it documented compliance issues within your facility or is it just known in the community? Confession session. I do have a confession on this one though. Okay. Should we? We just. Yeah. We just approved a file. With known compliance issues? With known issues. Okay.

[00:35:06] But there was nothing documented so I couldn't prove it. Mm. The chair of credentials went to the other hospitals and the answer he got is like, hey, we're credentialing this doctor. But the first thing out of the other doctor's mouth was, don't let him in your hospital. But how do you prove that at a credentials committee and then legally deny? And when nobody wants to say it. And then nobody wants to say it.

[00:35:30] So my question to you is, again, known compliance issues, but is it documented? So with that caveat, do you pass the file? So are we saying is it documented or undocumented? How are we giving it to them? Documented? Documented compliance? Documented. Okay. Let's say documented. Okay. Let's say they're a good hospital because Iowa's been doing a good job. They've been doing a great job. And Nebraska's doing a great job. Nebraska's doing a great job. Okay. So if you know that there's compliance issues and it came on their FPPE. Documented.

[00:36:01] Documented. Do you pass the file, stop the file, need more time to investigate, or you escalate? Stopping the file? Yeah. Oh, y'all ain't even letting it get through. Okay. Passing the file? Oh, y'all some good MSPs. Okay. Need more time to investigate? Put it all together, maybe do another FPPE? Okay. Are you guys, do you guys have a physician wellness council or a physician wellness committee

[00:36:28] at your hospitals to address disciplinary issues? Or are you putting all your disciplinary issues through peer review? Peer review. So the hospital that I'm at, I keep talking about my hospital, but poor things. I mean, we're trying. Well, I think it's a good example of the hospital you're at because the hospital Nyleen's at right now, not to speak on you professionally, but is a rural hospital with provider shortages in Georgia in a rural part. So I mean, I think it has a lot of comparisons.

[00:36:58] Relevance and comparisons. They never had a peer review committee ever. It did not exist in 60 years that the hospital was open. So when I implemented it and I said, okay, now we have new bylaws. There's this thing called the peer review committee. Everybody looked at me like they had big heads, big eyes. They were just like, oh, what is that? And I'm like, oh Lord. So we had to go through, you know, that training. So the doctor that decides that he's going to help us out with his peer review as the peer review chair, he's like, well, I don't do disciplinary issues. Oh my goodness.

[00:37:28] So, I mean, a lot, a lot of training. So glad to hear that. But at our other hospital where we had 1,200 doctors, we actually implemented a physician wellness council after our third physician who committed suicide. We had three doctors. Yeah, and I think it's something that is becoming more and more prevalent. One of the physician leaders that we talk a lot with, you know, has, you know, at his facility down in Florida, they've implemented a physician wellness program. But they need to in Florida. Oh, yeah.

[00:37:57] I'm just saying. But, you know, PBI Education, who we just, you know, interviewed on Credentialing Chronicles this last Tuesday that dropped, they advocate a lot for that because, you know, again, I mean, I'm just going to advocate for this. We need an MSP wellness program. You know, I mean, I feel like. Hey, that's a great idea. Shannon always has the best ideas. I feel like we just put that up under the physician wellness program and you guys take

[00:38:26] care of each other at the same time, you know. I think that would be bailed because, you know, truly all of these physicians, 1,400, 300, no matter what the roster at your facility is, you as the MSP are expected to know the behaviors, know that, track the trends, look at the patterns and be able to see things that are happening through the OPPE process, peer review process, peer reference process.

[00:38:51] All of those processes, you know, that, I mean, are true and proven to hospital and joint commission credentialing. I mean, because I'll advocate peer references should be done on the NCQA spectrum all day long and, you know, we are NCQA certified, but peer references, you find so much out about a provider. I mean, I found out all kind of things. So, over on Nebraska, y'all are doing pretty well. Yeah.

[00:39:20] We couldn't find too much tea on you guys. Iowa was a little juicier. A lot of legislative, that's what you found. Yeah. I mean, you did a deep dive. A lot of changes, but I think they're doing a pretty good job. No, great job. So, I think y'all win the corn race. Sorry. Ah! No! No, Lylee! I'm going to be designing. Yeah, it's okay. And so, um, so, sorry. Okay.

[00:39:47] So, Nebraska, really, you showed us that, uh, really when the system slips, you know, everything, everything else follows. Um, telemedicine, at least they took action on that once they found out that the nurse practitioner wasn't doing anything. So, that was really good. And that's the biggest thing, I think, what we have learned from, from being in your state, and from really deep diving in your state the last two, three weeks, is that Iowa and Nebraska board, honey, they are going to take action. They are. And that is an amazing thing.

[00:40:15] And, you know, that really comes down to the MSPs in the community. It really comes down, you know, to the, the processes that you all are making. And, I mean, I just have to say, give y'all a round of applause. Yes, round of applause. Yes, great job, guys. The true superheroes of medicine. Yes. So, let's do our quick PSA. PSA for Nebraska. We have some stuff to tell you guys, and then we're going to get ready for this. Well, I just got, does anybody want to come in and help us with the PSA? Yeah. Anybody have anything to say? We, we, it's three categories.

[00:40:44] You can say something to a doctor. You can say something to the, the patient. Or you can say something to a fellow MSP. Come on. Come on. Come on, guys. Help us. I thought we liked to have fun. I know. I thought we were having fun. Y'all were fun. Yes. Okay. Go ahead. Tell me. In the sexy shirt. You're looking good. This is a PSA to a doctor. Yes. If you want your file done on time, you must sign.

[00:41:13] If you're not going to sign, I can't do anything with it. And say it again for the people in the back. Anybody, anybody have one for a patient or a fellow MSP? Yeah. What do you guys want to say? What should we tell people? We, we, we, come on. This is our live. I would say two things to fellow MSPs. Being the nurse, I think having someone clinical in your medical staff office is huge. Absolutely. For small rural area hospitals. Yes.

[00:41:40] And then the other thing, I will just pick back off the credentialing resource center. I've been in the office for seven years and I've had a subscription for all seven years. Good. And I use the white papers and I check them for updates yearly. Great job. It's a great resource. Great job. So abstracts for the AORN are open. I've submitted three. I need you to help me. We need to get into the nursing realm to assist nurses, to understand, love our MSPs, respect our MSPs.

[00:42:09] Because although we do respect our nurses, you know, I do make fun and have, you know, little banter and stuff like that. But yes, you guys are an integral part of our process. But we need you guys to respect us as much as we respect you. And you have nothing. Well, sometimes it's scary. My tea is that I worked as a bedside nurse for eight and a half years and literally had no idea what happened with credentialing and privileging. I would have never stopped. I would have been like, oh, you're a doctor here? Great. Yes. I would have never stopped. Because you came in through our HR process.

[00:42:39] Well, I would have just stopped in the hallway and thought, somebody checked you in. Right. Right. Yeah. But this, unfortunately, is the situation. Let's go ahead and let the MSP go that has all the knowledge. It's been with us forever because she costs so much and let's hire somebody in the clinical that could just come up and take it easy. But I mean, truly, it doesn't work that way, you know, or we have a surgery center and it's like, we really don't need an MSP. Let's just have a nurse do it. Right. And then the nurse is like, I know nursing.

[00:43:08] I know nothing MSP. Yes. Yeah. Yes. And so, and it's, it's really, really scary. So if I could just say anything is your knowledge is invaluable. Invaluable. Many, many, many, many, many, many organizations. And the organizations, I can't do this alone, guys. And I really am trying really, really hard. I mean, I'm at like 12 conferences this year just because I am so passionate to just talk to you guys and tell you guys, and not only you, but get to every OR leader because to me,

[00:43:37] that's the most sacred, sacred location to do it. So, yeah, I have to say Nyleen's passion is, is surgery centers all day. OR surgery centers. Yeah. My passion is the CVO area. You know, the credentialing, the privileging, the contracting, all the headaches that y'all got on y'all plates every day. But again, we truly wanted to come together and had this idea to just bring credentialing out. I mean, it's just something that you hear about on conferences, but we want it to be

[00:44:07] something that everybody talks about. Everybody should be talking about credentialing. When we see providers, nurses, everybody, you know, things that come on the news, right? All these crimes. I mean, she is the credentialing crime junkie, you know? I love it. So, when we're seeing it now, it's like we want patients immediately to be like, oh my God, there's a credentialing person in that hospital. Yeah. What did they do wrong? Why don't they, or what did they do right? How did they catch that person? You know? And they just don't know.

[00:44:34] Like my beautiful nurse from Iowa said, she just did not know that credentialing, and now you do credentialing. So, look at you. It's like learning a whole job. Exactly. Learning a whole job. Okay, I need one more, please. Don't make me and Nailene do it. P.S.A. for doctors? No, P.S.A. for patients. She did the doctors. Remember, she said sign that app, baby. She said sign it. She said don't bring that app without sign that app. Okay, so we're going to do our P.S.A. One more for patients? Come on. Who's going to do it for patients? Help us out. You're an MSP. We'll just tell patients. Oh, wait. Hold on. I got a story real quick. Oh, no. Jasmine.

[00:45:04] She's cutting into y'all contact. I mean, my God. They're not engaging. So, listen, I'll tell the story for you. So, my daughter is Jasmine. We got a 15-minute. We got a 15-minute. Okay, we're almost done. Listen, so we can get finished early. She said she's at 15 minutes. She said you talking too much. All right. Love Iowa. So, we got my daughter Jasmine. She's nine. She'll be 10 in three weeks. She's so cute. She's so cute. And so, now we've officially made one year with Credentialing Chronicles. So, thank you guys.

[00:45:33] One year is our first year. We're in over. Yes. We are officially in over 45 countries. We've been over 1,500 cities. And we've just reached our 14,000 download mark, which is absolutely astronomical. And so, thank you so much for the support and the engagement. But anyway, so, our first episode, we were so excited, right? Second chances, red flags about our ER doctor that beat his girlfriend or whatever. And so, anyway, my daughter's listening to... Whatever happens. Yeah.

[00:46:02] My daughter's listening to... Oh, I got another good story to it. Just one. Just one. We don't need that. We don't need that. We don't need that. We don't need that. We don't need that. So, my daughter... So, she's listening to it. And here's the PSA. So, she's a patient, right? We're all patients, but she's a patient. She says, Mom, I got a dermatologist appointment tomorrow. I don't think I should be listening to this before my appointment. She goes, did you check their license?

[00:46:31] I said, oh, my... So, was he being his wife before checking my pimples? I need to know. I need to know. Yes. I know. And I was like, this is from a nine-year-old. So, imagine. We get our kids listening, right? Yeah. And just learning. So, what's our... I think our PSA... Yeah. I mean, I have to tell... I have a funny story, but... Oh, okay. When we talk to people, because that's what I... I mean, once I get out, I'm okay. I'll talk to you all day.

[00:46:55] But when we talk to people, honey, if you heard the amount of bad provider stories that we hear, we're like, yeah, we talk about credentials of the doctors. The doctors? Let me tell you what the doctor did to my mother the other day. Yeah. Yeah. That's the first thing. Because I went in there, and he wasn't playing, and I told him the medicine five times, and I'm like, can I be on your show? Because I want to let them know. And I'm like... Yeah.

[00:47:22] I don't think the doctors would listen if we had let you on the show. So, I don't think we can... You know, I... But, I mean, it's truly a way, again, for the patients to be able to kind of see this back. So, PSA for Patients, tell them... Tell them... PSA for Patients. And... Yes. And I had one lady, and she's like, who the heck wants to listen about credentialing? I said, because we're fun. We're very fine. We're making fun. Yeah. And we used to color pink. Hello. I mean... Yeah, exactly. So, yeah.

[00:47:52] Yeah. That's it. Our Nebraska show? Yes. Okay. Yes. So... Let's wrap it up. They're telling us to wrap it up. We gotta wrap it up. Okay, you go. Me? Yeah. What do I have to say? I just told a story. Oh, okay. No, you just told a story. Okay. Oh, you just told a story. I did. Your turn. It's my turn. Okay. Okay. So, thank you for Iowa and Nebraska. Julie. Julie, thank you so much. We love you. You did an amazing job. Batman, Robin, everybody. Yeah. Yes, all of you guys. Thank you so much.

[00:48:22] Thank you. For allowing us to come and spill some tea with you guys. We do have... We love you. Thank you. Please subscribe, comment, follow. Subscribe for your phones. We're on all the platforms. We've learned how to do some of this. So, whether you like to watch the video, we're on YouTube. We have the people that do that. And then we're on the Spotify, the Apple, the Amazon. Oh, God. Yeah. And unfortunately, guys, in case you didn't know, we don't get credit if you just stream it. That's it, guys. All right. Stay credentialed.

[00:48:51] Stay credentialed, not canceled. That was a lot of tea. Honey. But have they subscribed yet to hear it next week? On all of these platforms, please subscribe, like, and follow us. Bye. Bye. Bye.