Last month, the Centers for Medicare and Medicaid Services (CMS) amended its Conditions of Medicare & Medicaid Participation to recognize the increasing movement of hospitals into multi-hospital systems and to facilitate both governance and medical staff organization on a systemwide basis.
CMS first allowed systemwide governance two years ago, under its "Reform of Hospital & Critical Access Hospital Conditions of Participation." So the amendment of governance rules is more a technical adjustment than a major change. Basically, the new rules are intended to eliminate unanticipated problems with the two-year-old rule and to facilitate systemwide governance in practical ways. The major change is elimination of the requirement that a medical staff member serve on the board and replacement of that requirement with a requirement that the board regularly and directly consult with the individual responsible for the medical staff (or that person's designee).
The changes in the medical staff requirements are more fundamental. The essential change is elimination of the long-standing requirement that each separately licensed hospital have its own, separate medical staff, in favor of authorization of a single, systemwide medical staff.
The basic requirement is that the system first makes a determination in favor of a single, systemwide medical staff. Then, in order for the medical staff of any particular hospital to join the system medical staff, its members must vote "by majority, in accordance with medical staff bylaws," either to opt in or opt out of the systemwide medical staff.
In practice, the quoted language may turn out to be something of a paradox, because medical staff bylaws typically require a super majority rather than a simple majority for something as fundamental as movement into a systemwide medical staff. That poses the question, "Which is it—‘majority' or ‘in accordance with medical staff bylaws'?"
In any event, for many systems, persuading each medical staff within the system to vote to opt in will be a tall order, and the result for some systems may be that some hospitals opt in while others remain separate.
The preamble to the new rules indicates CMS's recognition that a single medical staff affords enhanced opportunities for improving patient care and outcomes through systemwide standardization and sharing of knowledge, better on-call coverage for specialties and consistency with the movement toward accountable care organizations and modern care delivery systems.