Four New Medicare Rules Could Undermine Your Hospital Medical Staff

The Centers for Medicare and Medicaid Services has finalized controversial new regulations that could undermine the power of hospital medical staffs throughout Massachusetts.

The rule was implemented in July over the strenuous objections of the American Medical Association, the MMS, and 80 other state and specialty medical societies.

In a letter to CMS Administrator Marilyn Tavenner, MMS President Richard S. Pieters, M.D., said the rules could substantially reduce the ability of local physicians to participate in hospital decision-making and further disenfranchise community physicians.

The four rule changes of particular concern are as follows:

  1. CMS removed the requirement that each hospital must have its own independent medical staff.Hospital systems may now ask each hospital medical staff if it wants to integrate into a unified medical staff for the entire system. However, this integration can only occur if a majority of the hospital medical staff votes to join the unified staff. “Majority” is defined by the bylaws of each respective medical staff.

    If medical staffs of various hospitals are unified into a single body, the unified medical staff is required to take into account each member hospital’s unique circumstances, including the unique characteristics of their patient populations. The unified staff must also develop policies to address the concerns of the medical staff of each individual hospital.
  2. CMS removed the requirement that a medical staff member must serve on the hospital system’s governing body. Instead, the governing body is required only to consult with the leader of the medical staff periodically throughout the year — bi-annually at a minimum. This consultation must be a face-to-face or telephone/video meeting that is immediate and synchronous. This consultation must include a discussion of the quality of care delivered to the respective hospital’s patients.
  3. Medical staff membership may include non-physicians.This is not a new rule, but a clarification of a 2012 rule that some critics found ambiguous. The new rule states that medical staff must  consist of doctors of medicine and osteopathy, and may include podiatrists, optometrists, chiropractors, dentists, and other non-physician practitioners, if permitted by state law. The AMA argued that only M.D.s and D.O.s should be eligible for medical staff membership.
  4. Outpatient services may be ordered by practitioners not on the medical staff. This must be approved by the medical staff and the hospital’s governing body, and permitted by state law.

Concerns

The AMA, the MMS, and 80 state and specialty medical societies asked CMS to delay the implementation of the rule until next year, but CMS refused. However, it suggested that it might give hospitals time to make their bylaws changes.

AMA Resources

The AMA has developed a checklist of specific issues that medical staff should consider. Visit www.massmed.org/hospitalstaffing to review the checklist.

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