The American Health Lawyers Association Regulatory Accreditation and Payment Practice Group (RAPPG) has issued an email alert regarding the issuance of a final rule by CMS intending to streamline Medicare regulatory requirements.  Two aspects of that rule which are a great concern to physicians are:

• Allowing hospital systems with more than one hospital to use a single medical staff provided the medical staffs of each hospital vote to approve the structure, and
• The leading their proposal that there be a physician member of the medical staff based upon complications with regulatory requirements of non-profit and government owned hospitals.

Below are quoted portions of the AHLA email alert regarding those two issues, as follows:

• Hospital medical staff-related changes:  reinterpreting 42 C.F.R. Section 482.22 to permit either a unique medical staff for each hospital or a unified and integrated medical staff shared by multiple hospitals within the same system.  In the case of the latter, each hospital must demonstrate that it actively addresses its use of a system unified and integrated medical staff model by a vote of the medical staff of each hospital to participate in such model and the unified staff adopting integrated policies and procedures (including advising medical staff of the ability of members to opt out), among other requirements.

The Final Rule also clarifies that, subject to state law requirements and governing body discretion, hospitals have the option to appoint other categories of physicians (as set out at Section 482.12(c)) and non-physician practitioners to their medical staff.  It also permits hospitals to grant limited privileges to registered dietitians and qualified nutritionists to order patient diets directly.

Additionally, the Final Rule permits non-staff practitioners to order hospital outpatient services for their patients when authorized by the medical staff and as permitted by state law;

• Medical staff participation on hospital governing board: eliminating the requirement that a member of the medical staff sit on the hospital governing board.  Instead, the governing board is only required to consult periodically throughout the year with the individual responsible for the organized medical staff of the hospital, or his or her designee.  For multi-hospital systems using a single governing body to oversee multiple hospitals within its system, this provision requires the single governing body to consult directly with the individual responsible for the organized medical staff (or his or her designee) of each hospital within its system

I believe this is further diminution of physicians impact on the operation of the medical staff.  I would suggest it would have been just as easy to require physician membership except when prohibited by non-profit or government regulations.  That physician membership requirement has been replaced by a requirement to “consult” with appropriate medical staff representatives.

I have attached the following:

1. A link to the entire regulation;
2. A scan of the actual regulations dealing with the composition of the governing body and the single medical staff; and
3. The CMS discussion of both.