Anesthesiologists' Relationships with Their Hospitals
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Anesthesiologists' Relationships with Their Hospitals



Presentation to senior residents on medical staff bylaws, anesthesia group contracts, privileging, etc.

Presentation to senior residents on medical staff bylaws, anesthesia group contracts, privileging, etc.



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Anesthesiologists' Relationships with Their Hospitals Anesthesiologists' Relationships with Their Hospitals Presentation Transcript

  • Your Relationship to Your Hospital Karin Bierstein, JD, MPH Vice President for Strategic Planning & Practice Affairs, Anesthesia Business Consultants, LLC Anesthesiology Residency Program University of California – San Diego May 27, 2009
  • Disclosure
    • VP at Anesthesia Business Consultants, LLC,
    • ABC is footing my expenses
    • I’m here only to give you an introduction to hospital-anesthesiologist relationships
  • Objectives
    • Understand the rules that will govern your relationship with your hospital.
    • Discuss some ways to protect your own and your Group’s relationships with the hospital.
  • http:// > Members Only
  • The Rules of Engagement
    • The Organized Medical Staff (OMS) : SELF-GOVERNANCE, via
    • The Medical Staff Bylaws
      • Quality & safety of patient care
      • Define med. Staff organizational structure & governance processes
      • Create rights & responsibilities between
        • OMS and governing body
        • OMS and individual members of the medical staff
    • Contract between anesthesiology group and hospital
  • 1. Hospital Privileges
    • Permission to provide medical or other patient care services in the granting institution, within well-defined limits, based on the individual’s professional license and experience, competence, ability and judgment.
  • Why the “Organized Medical Staff?”
    • Medicare Conditions of Participation for hospitals (federal regulations)
    • Reg. Section 48212(a)(2):
      • The governing body must appoint members of the medical staff after considering the recommendations of the current medical staff.
    • TJC accredits hospitals if they are in compliance with the CoPs
  • Privileges/Medical Staff Membership
    • TJC Medical Staff Standard – MS.1.20
      • Element of Performance EP 11
    • Basic requirements:
      • Current licensure
      • Relevant training or experience
      • Current competence
      • Ability to perform requested privileges
    • I.e., privileges , not a right
  • Hospital Privileges cont’d
    • Process described in Medical Staff Bylaws
    • Privileges must be
      • Granted, and
      • Renewed
    • Credentialing process
      • Required of & protects the hospital
        • Checks the validity of the credentials
        • Basic quality screening mechanism (initial and ongoing)
  • Credentialing cont’d
    • The initial appointment to the Medical Staff is cumbersome
      • Neither you nor the Group can do much to speed up the process:
        • Hospital requirements come from The Joint Commission + payers + its malpractice carrier etc.
      • But you could slow it down by not cooperating100% with requests for documentation (medical education, residency, state licenses, DEA certificate, work history, references….)
  • Ongoing Medical Staff Membership Requirements
    • Some required by TJC; some local
    • Some are really obvious:
      • No criminal record; no exclusion from Medicare
    • Call response requirements
      • consider the distance of your home from the hospital
    • Maintaining malpractice insurance
    • Board certification/recertification
    • Compliance with hospital policy
      • Conduct/behavior
  • Medical Staff Bylaws 2009: A Struggle for Control
    • Hospitals want more say over who obtains and who keeps hospital privileges
    • Medical Staff standards are in flux MS.1.20.
    • Codes of conduct
      • The only one applicable to MDs should be the Medical Staff Code of Conduct
  • More TJC MS Standard shenanigans
    • LD 3.10 requires Code of Conduct and Process for managing “disruptive behavior”
      • Define “disruptive behavior”
        • “adding to the workload of hospital staff” – would include admitting a patient!
        • Economic credentialing in another form
    • The only process for managing physician behavior should be in the Med Staff Bylaws for another reason:
  • Peer Review
    • Health Care Quality Improvement Act of 1986
    • Properly conducted peer review is protected (presumption of immunity)
      • “Reasonable” (good faith) evidence gathering, presentation, decision-making
      • Due process protections
      • Not subject to discovery in litigation
      • Not “defamation” or “restraint of trade”
  • Peer Review cont’d
    • Confidentiality so important that Medical Staff Bylaws often set higher standards than HCQIA
    • National Practitioner Data Bank
      • Must be queried as part of credentialing process
    • ASA
      • Hospital Consultation Program
      • Expert Witness Testimony reporting program
  • 2. Hospital-Anesthesiology Group Contracts
    • Principal purpose is to structure the working – and financial – relationship between the Group and the Hospital
      • Exclusive v. non-exclusive
    • Clean sweep provisions tying privileges to the term of the contract
    • The hospital contract may require Group to remove an anesthesiologist “upon request.”
  • Beware Subjective Performance Standards in Contracts
    • “Group is required to promote and not denigrate the reputation of the Hospital….”
    • Bar Group communications that would tend to impugn the reputation of the Hospital....”
  • Your Best Protection: Good Citizenship
    • Excellent outcomes and service (the surgeons are the customers too)
    • Mutually respectful, trusting relationship with hospital leadership
    • Active participation and leadership / committees, TFs, special projects
    • Quality and efficiency measurement
    • Openness to new concepts, methods