Cms Issue Final Rules Affecting Medical Staff Membership, Hospital Governing Bodies, And Hospital Outpatient Orders

On May 7, 2014, the Centers for Medicare & Medicaid Services (CMS) issued a final rule that brings important revisions and clarifications to the Conditions of Participation (CoP) affecting hospitals and other healthcare providers. Some of the most important changes, which will take effect July 11, 2014, are highlighted below. It is expected that the final rule will lead to intense discussion as hospitals and medical staffs work to implement the new requirements and/or make structural changes.

Unified Medical Staffs Now Permitted in Multi-Hospital Systems
Perhaps the change with the most far-reaching implications is the reinterpretation of § 482.22, which previously required multi-hospital systems to maintain unique medical staffs for each hospital. Having concluded that “it is in the best interest of hospitals, medical staff members, and patients to modify our proposed prohibition on the use of a unified and integrated medical staff for a multi-hospital system,” CMS now allows for one unified and integrated medical staff shared by multiple hospitals within a hospital system with the voluntary majority approval of these medical staffs. If unification is approved by the Medical Staffs, this reinterpretation requires hospital accountability through the creation of integrated medical staff bylaws, and consideration of hospital- and practice-specific issues.

Hospital Boards Need Not Include Physicians But Must Consult Medical Staff Leaders
CMS has also revised its “Medical Staff” standard at § 482.12(a)(1), and no longer requires hospitals to include at least one physician on their board. Rather, hospitals are now required to consult directly with the medical staff leader or his or her designee periodically throughout the year in a face-to-face or telephone discussion of matters related to the quality of medical care provided to patients of the hospital. While hospitals may still include medical staff members or leaders on their boards, this does not satisfy the direct consultation requirement without periodic, direct consultation with the medical staff leader. In commentary accompanying the CoP revision, CMS stated that it expects that this direct consultation would occur at least twice during each hospitals’ calendar or fiscal year. Hospitals with multiple medical staffs must consult directly with leaders in each medical staff.

Other Changes: Medical Staff Membership and Non-Medical Staff Outpatient Orders
-Medical staff membership requirements at § 482.22(a) are clarified: medical staffs must be composed of doctors of medicine or osteopathy, but may also include other categories of physicians (such as dentists, podiatrists, chiropractors and optometrists) and non-physician practitioners (such as APRN’s, PA’s, RD) as permitted by State law.

– Changes to § 482.54(c) new permits Practitioners who are not members of the hospital’s medical staff to order hospital outpatient services for their patients, if and as authorized by the medical staff and allowed by State law.

Date Published: March 1, 2017

Written by: Cooper Levenson, P.A.

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