Anesthesiologists' Relationships with Their Hospitals


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

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Anesthesiologists' Relationships with Their Hospitals

  1. 1. 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
  2. 2. Disclosure <ul><li>VP at Anesthesia Business Consultants, LLC, </li></ul><ul><li>ABC is footing my expenses </li></ul><ul><li>I’m here only to give you an introduction to hospital-anesthesiologist relationships </li></ul>
  3. 3. Objectives <ul><li>Understand the rules that will govern your relationship with your hospital. </li></ul><ul><li>Discuss some ways to protect your own and your Group’s relationships with the hospital. </li></ul>
  4. 4. http:// > Members Only
  5. 5. The Rules of Engagement <ul><li>The Organized Medical Staff (OMS) : SELF-GOVERNANCE, via </li></ul><ul><li>The Medical Staff Bylaws </li></ul><ul><ul><li>Quality & safety of patient care </li></ul></ul><ul><ul><li>Define med. Staff organizational structure & governance processes </li></ul></ul><ul><ul><li>Create rights & responsibilities between </li></ul></ul><ul><ul><ul><li>OMS and governing body </li></ul></ul></ul><ul><ul><ul><li>OMS and individual members of the medical staff </li></ul></ul></ul><ul><li>Contract between anesthesiology group and hospital </li></ul>
  6. 6. 1. Hospital Privileges <ul><li>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. </li></ul>
  7. 7. Why the “Organized Medical Staff?” <ul><li>Medicare Conditions of Participation for hospitals (federal regulations) </li></ul><ul><li>Reg. Section 48212(a)(2): </li></ul><ul><ul><li>The governing body must appoint members of the medical staff after considering the recommendations of the current medical staff. </li></ul></ul><ul><li>TJC accredits hospitals if they are in compliance with the CoPs </li></ul>
  8. 8. Privileges/Medical Staff Membership <ul><li>TJC Medical Staff Standard – MS.1.20 </li></ul><ul><ul><li>Element of Performance EP 11 </li></ul></ul><ul><li>Basic requirements: </li></ul><ul><ul><li>Current licensure </li></ul></ul><ul><ul><li>Relevant training or experience </li></ul></ul><ul><ul><li>Current competence </li></ul></ul><ul><ul><li>Ability to perform requested privileges </li></ul></ul><ul><li>I.e., privileges , not a right </li></ul>
  9. 9. Hospital Privileges cont’d <ul><li>Process described in Medical Staff Bylaws </li></ul><ul><li>Privileges must be </li></ul><ul><ul><li>Granted, and </li></ul></ul><ul><ul><li>Renewed </li></ul></ul><ul><li>Credentialing process </li></ul><ul><ul><li>Required of & protects the hospital </li></ul></ul><ul><ul><ul><li>Checks the validity of the credentials </li></ul></ul></ul><ul><ul><ul><li>Basic quality screening mechanism (initial and ongoing) </li></ul></ul></ul>
  10. 10. Credentialing cont’d <ul><li>The initial appointment to the Medical Staff is cumbersome </li></ul><ul><ul><li>Neither you nor the Group can do much to speed up the process: </li></ul></ul><ul><ul><ul><li>Hospital requirements come from The Joint Commission + payers + its malpractice carrier etc. </li></ul></ul></ul><ul><ul><li>But you could slow it down by not cooperating100% with requests for documentation (medical education, residency, state licenses, DEA certificate, work history, references….) </li></ul></ul>
  11. 11. Ongoing Medical Staff Membership Requirements <ul><li>Some required by TJC; some local </li></ul><ul><li>Some are really obvious: </li></ul><ul><ul><li>No criminal record; no exclusion from Medicare </li></ul></ul><ul><li>Call response requirements </li></ul><ul><ul><li>consider the distance of your home from the hospital </li></ul></ul><ul><li>Maintaining malpractice insurance </li></ul><ul><li>Board certification/recertification </li></ul><ul><li>Compliance with hospital policy </li></ul><ul><ul><li>Conduct/behavior </li></ul></ul>
  12. 12. Medical Staff Bylaws 2009: A Struggle for Control <ul><li>Hospitals want more say over who obtains and who keeps hospital privileges </li></ul><ul><li>Medical Staff standards are in flux MS.1.20. </li></ul><ul><li>Codes of conduct </li></ul><ul><ul><li>The only one applicable to MDs should be the Medical Staff Code of Conduct </li></ul></ul>
  13. 13. More TJC MS Standard shenanigans <ul><li>LD 3.10 requires Code of Conduct and Process for managing “disruptive behavior” </li></ul><ul><ul><li>Define “disruptive behavior” </li></ul></ul><ul><ul><ul><li>“adding to the workload of hospital staff” – would include admitting a patient! </li></ul></ul></ul><ul><ul><ul><li>Economic credentialing in another form </li></ul></ul></ul><ul><li>The only process for managing physician behavior should be in the Med Staff Bylaws for another reason: </li></ul>
  14. 14. Peer Review <ul><li>Health Care Quality Improvement Act of 1986 </li></ul><ul><li>Properly conducted peer review is protected (presumption of immunity) </li></ul><ul><ul><li>“Reasonable” (good faith) evidence gathering, presentation, decision-making </li></ul></ul><ul><ul><li>Due process protections </li></ul></ul><ul><ul><li>Not subject to discovery in litigation </li></ul></ul><ul><ul><li>Not “defamation” or “restraint of trade” </li></ul></ul>
  15. 15. Peer Review cont’d <ul><li>Confidentiality so important that Medical Staff Bylaws often set higher standards than HCQIA </li></ul><ul><li>National Practitioner Data Bank </li></ul><ul><ul><li>Must be queried as part of credentialing process </li></ul></ul><ul><li>ASA </li></ul><ul><ul><li>Hospital Consultation Program </li></ul></ul><ul><ul><li>Expert Witness Testimony reporting program </li></ul></ul>
  16. 16. 2. Hospital-Anesthesiology Group Contracts <ul><li>Principal purpose is to structure the working – and financial – relationship between the Group and the Hospital </li></ul><ul><ul><li>Exclusive v. non-exclusive </li></ul></ul><ul><li>Clean sweep provisions tying privileges to the term of the contract </li></ul><ul><li>The hospital contract may require Group to remove an anesthesiologist “upon request.” </li></ul>
  17. 17. Beware Subjective Performance Standards in Contracts <ul><li>“Group is required to promote and not denigrate the reputation of the Hospital….” </li></ul><ul><li>Bar Group communications that would tend to impugn the reputation of the Hospital....” </li></ul>
  18. 18. Your Best Protection: Good Citizenship <ul><li>Excellent outcomes and service (the surgeons are the customers too) </li></ul><ul><li>Mutually respectful, trusting relationship with hospital leadership </li></ul><ul><li>Active participation and leadership / committees, TFs, special projects </li></ul><ul><li>Quality and efficiency measurement </li></ul><ul><li>Openness to new concepts, methods </li></ul>