Compliance Considerations for Accredited Office-Based Surgery Practices When Hiring Employees and Contractors

For New York State accredited office-based surgery practices (“OBS”), the terms of continued accreditation (varying with an OBS’ specific accrediting agency) often come with strict requirements and guidelines concerning the hiring and retention of employees and independent contractors.  Most unexpected (and often overlooked by OBS employers) are the requirements and guidelines that reach far beyond the customary licensure and/or certification requirements and expand into areas that an OBS employer might consider (understandably) to be “private business decisions” or “matters of professional judgment.” It is in these outlying areas that OBS employers must be well versed in order to avoid inadvertent compliance breaches.

When hiring new employees and/or independent contractors, OBS employers must review their accreditation manuals with a specific focus on the following categories of employees and/or contractors:

(a)          Registered Nurses: when hiring Registered Nurses, OBS employers must confirm, among other things, (i) instances of treatment requiring the presence of a Registered Nurse(s) (including pre and post operative care), (ii) licensure, continuing education and liability insurance requirements, (iii) requirements concerning maintenance of medical records and supporting documentation and (iv) reporting requirements concerning adverse events; 

(b)          Physicians’ Assistants and/or Specialists’ Assistants: with regard to Physicians’ Assistants and/or Specialists’ Assistants, special attention must be give to rules and regulations concerning (i) the presence and/or supervision of a physician at the OBS facility, (ii) availability of and/or access to a physicians upon request of the patient, (iii) maintenance of medical record, auditing and quality control initiatives, (iv) licensure, continuing education and liability insurance and (v) reporting requirements concerning adverse events;

(c)           Anesthesiologists: in addition to the state and federal laws concerning and/or affecting financial and work relationships among physicians (i.e., Stark Laws, Anti-Kickback Statutes, False Claims Act), OBS employers must review all rules and regulations concerning: (i) the Anesthesiologist’s access and availability to patients, (ii) pre and post operative care directives, (iii) directives concerning maintenance and support of Anesthesia equipment, medication and/or supplies, (iv) maintenance of medical records, auditing and quality control initiatives, (v) board certification, licensure, continuing education, and liability insurance and (vi) reporting requirements concerning adverse events;

It is important to note that most of these “employment requirements” can be outlined as conditions of employment in an employment contract or independent contractor agreement between the OBS employer and the employee/contractor.  Documenting and outlining relevant accreditation-mandated employment requirements, in addition to clarifying the potential employee/contractor’s responsibilities and obligations, demonstrates a good faith effort to comply with all applicable accreditation mandates and delegates applicable accountability.

Education Department Clarifies E-Reader Accessibility Rules

The U.S. Department of Education today released a new guide to laws and rules colleges must follow to ensure e-reading devices and other emerging technologies are accessible to all students. It focuses on students with vision problems, a group whose access issues have triggered official complaints against colleges. The document, in the form of “Frequently Asked Questions,” was published in response to the department’s “Dear Colleague” letter to college presidents on the subject last June.

If colleges use e-readers, or other emerging technologies, blind students “must be afforded the opportunity to acquire the same information, engage in the same interactions, and enjoy the same services as sighted students,” according to the department.

The department doesn’t discourage the use of emerging technologies but indicates that colleges should assess whether a new technology is accessible, or could be modified to be accessible, before using it.

Colleges can offer alternative versions of a text or technology to students with disabilities, as long as the alternative is “equally effective and equally integrated.”

This means that offering an e-text on a tablet device, such as the iPad, that has more options for the visually impaired, could be an effective alternative to an e-reader version.

An audio book might not do the trick, though.

Christopher Danielsen, a spokesman for the National Federation of the Blind, explains that the requirements of equal effectiveness and integration mean that an alternative text needs to offer all the capabilities of a traditional or e-text. This includes the ability to navigate to a particular section or page, an audio explanation or larger-font version of tables and charts, and, for e-textbooks, equivalent alternatives to interactive features, such as quizzes and note-taking tools.

“The blind student needs to be able to do all the other things that students do,” he says.

He says it is important that the department’s document makes clear that the requirements apply to all new technologies, not just e-readers.

His organization filed a federal complaint last year against Penn State University for its “pervasive and ongoing discrimination” against blind students through its use of a course-management system, library catalog, and departmental Web sites that were not accessible.

The Dear Colleague letter last June came in part because of a lawsuit filed in 2009 by the Federation and the American Council of the Blind against Arizona State University, which was planning to offer a pilot program using Amazon’s Kindle e-reader device. Arizona State settled, promising to use only accessible e-reading devices.

This article was originally posted at  http://ping.fm/EcfQZ

The inevitability of personal digital learning

Standards-based reform began in the 1990s and was accelerated and broadened by NCLB in the naughts.   The ideal of high standards, more measurement and strong accountability didn’t work as well as hoped—in many states we ended up with low expectations, cheap tests, and weak accountability.  Done right, standards-based reform is still a good frame, but it’s hard to do well and sustain.

Many standards advocates, me included, believed that new school development would prove to be transformational.  Dozens of grant-funded networks were developed over the last 15 years, most promisingly charter management organizations.  But after twenty years, 5000 charter schools only serve 3% of total enrollment.  Half of these new schools are great but development has been slow and expensive.

A wave of thin governance reforms (e.g. site-based management), poorly constructed pay schemes (e.g. merit pay), along with waves of instructional fads all failed to produce impact at scale.

In a discussion of personal digital learning, former Massachusetts commissioner Dave Driscoll suggested that this time is different—that a shift inevitable.  Driscoll was the country’s best college-ready chief, leading the implementation of some of the best state standards.  On his watch, Tom Payzant’s steady push made Boston the best urban district in American. Driscoll is on to something—the shift to personal digital learning is different than previous waves of education reform for at least six reasons:

1. The growth of informal learning opportunities. Targeted learning capabilities like Khan Academy are building on broad learning capabilities like search and Wikipedia.  For anyone connected to broadband, it’s possible to learn almost anything.

2. The growth of online learning.  Growing at 46% annually, online learning is extending access to quality content and instruction.  Growth is concentrated where states have extended access with multiple statewide providers offering full and part time enrollment.  (The future may be inevitable but progress is lumpy.)

3. RttT assessments will drive the shift to online testing (in about 44 states).  The 2014 deadline for new state tests, which will probably be predominantly online, is causing states to consider plans for high access learning environments.

4. Online learning providers are massively scalable.  For the first time, the U.S. has a half a dozen (nonprofit and for-profit) providers capable of serving millions of students with consistently high quality.

5. The ‘new normal’ environment will continue to promote productivity seeking school models.  The press to do more with less will make this decade different than the last two decades of adding edtech to how we’ve always done school.

6. The adoption of Common Core State Standards will promote investment in the development of new engaging content libraries and learning platforms.

Commentators like Andy Rotherham worries about overhyping technology.  There will be lots of versions of tech-enabled schools and, like charters, some will work better than others.  But this is not like other reforms, it’s a phase-shift not a reform, it’s a shift from print to digital and from groups to individual students.  These shifts are irreversible historic shifts not temporal reforms.

This article was originally posted at http://edreformer.com/2011/05/the-inevitability-of-personal-digital-learning/

MassCOSH: 47 Massachusetts Workers Died on the Job in 2010; Improved Safety Oversight Needed

The report, which is produced by the Massachusetts AFL-CIO, the Massachusetts Coalition for Occupational Safety and Health (MassCOSH) and the Western Massachusetts Coalition for Occupational Safety and Health (Western MassCOSH), stressed that workplace fatalities are preventable.

“Of the 47 families who suffered the pain of losing a loved one at work this year, many have to struggle with the fact that an existing safety regulation could have saved their loved one’s life,” said Robert Haynes, president of the Massachusetts AFL-CIO. “All an employer had to do was care enough to properly implement it.”

The report called for strengthened OSHA regulations and enforcement; increased immigrant worker protections, such as additional bilingual investigators and stronger whistleblower protections; work schedules and staffing arrangements that do not promote workplace injuries or illnesses; comprehensive workplace safety programs; and more.

“OSHA lacks funding, staff and tools to deter violations,” the report stated. “Fatal and serious workplace injuries in 2010 continued to occur because Massachusetts employers ignored OSHA regulations and failed to institute basic safety measures. Strong government regulations and enforcement – including criminal prosecution – is essential, but often lacking.”

Report Highlights:

• Ten worker fatalities, or 21 percent, occurred in the construction industry;


• Transportation (12 fatalities), falls (9 fatalities), commercial fishing (four fatalities) and workplace violence (three fatalities) otherwise accounted for the majority of worker deaths in Massachusetts;


• Fatally injured workers ranged in age from 18-77, with an average age of 50;


• Just over half of workers who died on the job were age 50 or older;


• Temporary workers and Latino employees may face an increased risk for workplace injury, illness or death;


• Approximately 440 additional workers in Massachusetts died from occupational diseases in 2010.

The 47 fatalities showed a decline compared to the 62 on-the-job deaths that occurred in the commonwealth in 2009. Even so, the report explained that worker deaths in Massachusetts have fluctuated in recent years, and declines in worker deaths typically have been followed by an increase the following year.

“Dying for Work in Massachusetts” was released in conjunction with Workers’ Memorial Day on April 28. Download a copy of the report here.

This article was originally posted at  http://ping.fm/KBldO

Repeat, Fall Hazards Add Up to $125,818 Fine for Aluminum Finishing Firm

OSHAhas issued Aluminum Finishing LLC in Adel, Ga., 18 safety citations for a variety of hazards, including a lack of fall protection and dangers from the corroded components of the facility's structural integrity. Proposed penalties total $125,818. OSHA opened an inspection in October 2010 as a follow-up to an April 2010 inspection and a complaint alleging the hazards.

Aluminum Finishing, which anodizes aluminum products, was issued one willful citation with a penalty of $53,900 for exposing employees to fall hazards while walking on top of a steel beam without proper fall protection.

The company was issued six repeat citations with $43,120 in penalties for failing to have employees use fall protection while working above dip tanks, ensure emergency lighting is operational, guard live electrical equipment, cover open troughs to prevent tripping, and provide sanitary conditions for workers. The company was cited for similar violations in October 2008 and April 2010.

Eight serious citations with $28,798 in penalties were issued for allowing employees to work near a dip tank without the proper eye or face protection; exposing workers to shock, electrocution and burn injuries; not properly adjusting the work rest on the floor grinder; and having an emergency eye wash unit with inadequate water pressure. The inspection also revealed that workers were exposed to struck-by hazards from corroded ceiling objects, including sprinkler system pipes, metal wall sheathing, and light fixtures.

The company received three other-than-serious citations with no proposed penalties for failing to establish or implement a written respiratory protection program, anchor the floor grinder to the floor, and mount a portable fire extinguisher.

"This company has disregarded the safety of its employees and repeatedly allowed them to be exposed to struck-by hazards from structural failure, electrocution hazards and falls," said Robert Vazzi, OSHA's area director in Savannah. "Immediate action needs to be taken to protect employees from these workplace hazards."

Boosting productivity in US higher education

The United States needs more college graduates. Opinions vary on exactly how many, but McKinsey estimates that the nation will need an additional one million each year by 2020 to sustain its economic health. That would mean increasing today’s annual total—2.5 million—by 40 percent.

To meet this goal, universities and colleges would have to increase their output of graduates by 3.5 percent a year over the next decade. That’s a daunting task for two reasons. First, it would cost an additional $52 billion a year, based on 2008 costs to produce a graduate. Yet many states, plagued by fiscal woes, have recently lowered spending on higher education, a trend that’s unlikely to be reversed. Second, to achieve this increase, colleges would need to enroll many more than 3.5 percent more freshmen each year, because today, on average, only 40 percent of students who enroll go on to graduate.

To meet the target without spending more, colleges would simultaneously have to attract additional students, increase the proportion of them who complete a degree, and keep a tight lid on costs. Gaming the target by lowering the quality of the education or granting access only to the best-prepared students obviously wouldn’t count. Not surprisingly, many people within and beyond higher education say that colleges can’t possibly do all these things at once.

But McKinsey research suggests that many already are, using tactics others could emulate. In fact, the potential to increase productivity across the varied spectrum of US higher education appears to be so great that, with the right policy support, one million more graduates a year by 2020, at today’s spending levels, begins to look eminently feasible. The quality of education and access to it could both improve at the same time.

Good education, good management

How a college manages its resources shows up in its cost per degree, found by dividing the institution’s total annual costs by the number of degrees awarded. The measure sounds simple, but it captures the two key components of higher education’s productivity: cost efficiency and completion rates. Some colleges have a high cost per degree because they produce many graduates, but their overall costs are excessive. Others graduate relatively few students, though keep their costs in check. Some struggle on both counts. Institutions become more productive by increasing graduation rates while controlling overall costs.

To understand what makes institutions more productive, McKinsey examined the education and management practices of eight colleges with productivity levels up to 60 percent greater than average, measured by the cost per degree (see sidebar, “About the research”). These highly productive colleges are a mix of private and public, for profit and nonprofit, with more or less competitive entry. All perform highly on measures of educational quality and openness of access, and all belong to the groups of colleges that award associate’s or bachelor’s degrees after two or four years of study, respectively. We chose schools from these groups because they represent the bulk of higher education: similar segments of institutions educate 51 percent of all college students in the United States.

The eight colleges share some organizational and cultural features that facilitate high productivity. These features notably include smooth-running operational and managerial systems, a policy framework that encourages their ongoing improvement, and, above all, leaders and staff dedicated to combining good education and good management. The schools achieve high productivity largely through five strategies: two that increase the number of students completing their degrees and three that keep costs under control.

Helping students to graduate

The eight highly productive institutions design their education systems expressly to help as many students as possible achieve degrees. Indiana Wesleyan University’s College of Adult and Professional Studies (IWU–CAPS), for example, achieves a six-year graduation rate of 65 percent—19 percentage points above its peer average—by constructing clear-cut pathways to degrees and encouraging students to support one another. Early assignments have the dual purpose of helping students get together and learn how they can succeed academically at college, whether on campus or online. With few pathways to a degree, students generally move through the sequence of classes as a single cohort, keeping each other up to the mark.

Similarly, in Florida, Valencia Community College’s three-year graduation rate—35 percent—is 15 percentage points above that of peer institutions, partly because the college provides students with support and tools for planning their path to graduation. It also tailors support to its different student segments and has redesigned support services to improve their quality.

Reducing nonproductive credits

Up to 10 percent of all credits taken by US students are in excess of the number required to graduate. True, such credits may expand students’ minds, but they add cost to a degree. Tracking students’ progress and skillfully intervening when necessary can help reduce that cost. Southern New Hampshire University (SNHU), for instance, has a monitoring system that discourages students from embarking on redundant credits altogether: no bachelor’s graduate at SNHU completes more than 150 credits en route to a degree, while 20 percent of graduates at similar institutions have upward of 150. Better preparation for college work and a policy of allowing transfer students to conserve credits help reduce redundant credits too.

Failed courses and courses from which students withdraw account for an additional 7 percent of all credits taken. Targeted policies can help institutions to cut this waste. Brigham Young University–Idaho (BYU–Idaho) has implemented policies to prevent redundant teaching and learning, including strict guidelines on course withdrawal and academic progress. Partly as a result, BYU–Idaho’s rates of failure and withdrawal are as much as 32 percent lower than its peer average. In addition, BYU–Idaho insists that students gain at least 75 percent of their intended credits each semester or risk suspension. By contrast, many colleges review a student’s rate of credit completion only once a year.

Redesigning instruction

Using new teaching technologies can lower costs substantially and raise quality at the same time. Rio Salado College, in Arizona, substitutes part- for full-time faculty. Western Governors University (WGU), in Utah, uses course mentors—one for academic and one for life-coaching purposes—to augment online teaching materials. Both schools develop “master courses” centrally instead of asking individual professors to create their own material. High-tech teaching systems are understandably controversial, but their results have been verified. Since 1999, the National Center for Academic Transformation (NCAT) has helped 150 institutions make the best use of technology in their teaching. NCAT found that costs at its partner institutions decreased, on average, by 37 percent in redesigned courses. Learning outcomes improved after 72 percent of the redesigns, and the other 28 percent produced learning of a quality comparable to that of traditional formats. NCAT has six alternative redesigns ready and waiting for colleges to introduce.

Technology isn’t the only way to cut teaching costs. More conventionally, BYU–Idaho revamped the academic calendar to include a third (full spring) semester, serving the same number of students as the fall and winter semesters. The college increased faculty pay somewhat but hired only a handful of new staff members. As a result, BYU–Idaho cut teaching costs per student by 32 percent while paying its faculty more than peer institutions do.

Improving efficiency in core support and services

Introducing leaner processes is one way to reduce the cost of core support and services, such as management functions, student services, academic support services, and plant operations. Organizational redesign and better purchasing also help. BYU–Idaho, Rio Salado, and DeVry University, for example, succeeded in bringing down costs in this area by converting paper-based systems to electronic ones, cross-training to eliminate staff downtime, and using self-service online portals to administer financial aid. BYU–Idaho and IWU–CAPS have markedly lower ratios of administrative staff to students than their counterparts, but with no outsourcing of operations. On the contrary, these schools spend less than peers do buying goods and services but pay their staffs as much as or more than peer institutions.

Running noncore services and other operations efficiently and selectively

Top-performing institutions also continually check to ensure that any noncore service and other operation they must offer to fulfill their missions are run efficiently. Many aren’t. Although some noncore services—catering, for instance—generate revenues and are self-supporting, 49 percent of all US higher-education institutions report that noncore-service revenues are too low to cover related costs.

DeVry University, SNHU, and WGU, as part of their effort to control total costs, offer almost no noncore services. Of course, many institutions must offer some, notably research, to fulfill their missions. But even these institutions can drive down costs by paying closer attention to mandatory operations while improving efficiency across all noncore services.

Doing better

Could other schools raise their productivity by adopting these strategies? The good news is that many appear to be using them already. Laying the cost-per-degree yardstick across all US higher-education institutions shows an average gap of 34 percent between the most productive quartile and the mean level of productivity. This difference doesn’t exist solely because some types of higher-education institutions—private universities, say—are more productive than others: there are big gaps between the average and the best in every cohort of peer institution. While we don’t know if schools in the highest quartile are using exactly the same tactics as the highly productive eight in our sample, the former too are achieving measurable improvements in all five areas targeted by the five strategies (exhibit).

This article was originally posted at http://ping.fm/tOxaA

The "Pedagogy of Poverty" in the Learning Age

This impassioned op-ed by Alfie Kohn exposes how school is very different for poor children than it is for their more affluent counterparts. Education for low-income students is rooted in and aims for compliance. Drills and worksheets, tests and recitations make up the “pedagogy of poverty," a term first used by Martin Haberman of the University of Wisconsin to describe the kind of teaching he saw in inner city public schools.

The "pedagogy of poverty" and everything that goes with it should be no shock to anyone who has read a newspaper in the last decade. It is not shocking that mostly young, inexperienced teachers with little support or meaningful professional development opportunities are more likely to be in the toughest schools. It is not shocking that there is the highest rate of teacher turnover in these same schools. But what is shocking, and what this piece highlights very effectively, is how current “reform” efforts are reinforcing and even extending in new ways these damaging inequities. Kahn states that “[i]t is possible for the accountability movement to simultaneously narrow the test-score gap and widen the learning gap.”

We are in the learning age. Information is everywhere 24/7, and we have to prepare our students to process and recombine it. Yet our education system does not facilitate the openness and fluidity of our current reality and downright prevents it in many our nation’s poorest schools. Khan rightly urges us to think long and hard about the road to reform we’re currently barreling down.

Test results. Student achievement. These are mainstays of the conversation about what education “reform” is trying to achieve. But are they useful proxies for teaching and learning?

Testing cannot be the sole aim of education because test scores don’t tell the whole story of what is going on in classrooms around the nation. Higher test scores do not equate to deeper learning, which goes beyond “competence” to synthesis and analysis across disciplines. And deeper learning is not a luxury in the learning age; it’s a necessity and a right.

Tell us what you think.