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Systems allowed to have unified, system-wide medical staff; understand the new rule

The Centers for Medicare and Medicaid Services (CMS) issued a final rule in May regarding the Medicare conditions of participation for hospitals that includes a new option for hospital medical staffs. The rule became effective July 11, 2014.

Under the new regulations, a hospital’s medical staff can opt to be under the umbrella of a unified, system-wide medical staff, but only if that hospital’s medical staff affirmatively votes to do so. A medical staff that votes to join a system-wide medical staff still retains the right to later “opt-out” and restore a separate, individual hospital medical staff.

A second change requires each hospital’s governing body to meet with an “individual assigned responsibility for the medical staff,” such as the president of the medical staff or someone elected in a leadership role, at least two times per year. This replaces the previous requirement of having a representative from the medical staff be a part of the hospital’s governing body.

During the American Medical Association (AMA) Interim Meeting last week, the Organized Medical Staff Section (OMSS) hosted a special session highlighting two key issues to consider when implementing the new requirements:

  • Update medical staff bylaws. The bylaws should specify the person to meet with the hospital governing board twice a year.
  • Be familiar with the rule. Weigh the pros and cons of uniting medical staffs within one system or keeping individual hospital staffs separate.

The AMA also highlighted some of the advantages and disadvantages of joining a unified, system-wide medical staff. According to the AMA, “a unified, system-wide medical staff could mean a stronger, organization, with clinical standards developed across a greater number of peers and patients. On the other hand, unification could reduce each medical staff’s connection with or representation on the governing body.”

Physicians can e-mail the AMA-OMSS with questions about the new regulations.

Back to November 20, 2014 Medigram