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, MMS, and 80 other state and
specialty medical societies.
In a letter to CMS Administrator Marilyn Tavenner, MMS
President Richard S. Pieters, MD, said the rules could substantially reduce the
ability of local physicians to participate in hospital decision-making and
further disenfranchise community physicians.
Change #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 occur only 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.
Change #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 – twice a year
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 hospital’s patients.
Change #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 MDs and DOs should be
eligible for medical staff membership.
Change #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, 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 it would give hospitals time to make their
bylaws changes.
