Anesthesiologists' Relationships with Their Hospitals
Upcoming SlideShare
Loading in...5
×
 

Anesthesiologists' Relationships with Their Hospitals

on

  • 587 views

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.

Statistics

Views

Total Views
587
Views on SlideShare
587
Embed Views
0

Actions

Likes
0
Downloads
7
Comments
1

0 Embeds 0

No embeds

Accessibility

Categories

Upload Details

Uploaded via as Microsoft PowerPoint

Usage Rights

© All Rights Reserved

Report content

Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
  • Full Name Full Name Comment goes here.
    Are you sure you want to
    Your message goes here
    Processing…
  • it can be tough
    Are you sure you want to
    Your message goes here
    Processing…
Post Comment
Edit your comment

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:// www.ASAhq.org > 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
  •