AHLA The Medical Staff Guidebook: Minimizing the Risks and Maximizing Collaboration (Non-Members)

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The Medical Staff Guidebook: Minimizing Risk and Maximizing Collaboration is a new Fourth Edition of the formerly titled Health Care Entity Bylaws and Related Documents. AHLA recommends this new edition of the Guidebook to all in the health care field who need to know how to ensure their medical staff bylaws cover the essential aspects to better serve both the medical staff's needs and those of the health care entity.

Medical staffs and health care entities have historically had a unique relationship of interdependence. While the governing body of the health care entity is ultimately responsible for the success or failure of the entity, it is the medical staff that provides the necessary ingredient for the success, i.e. quality patient care. In recent years, there has been an increase in direct integration between physicians and health care entities, through a number of different relationships. This change, along with increased scrutiny of the industry from regulators and the market place, means that the medical staff/health care entity relationship may become increasingly difficult to manage. At the heart of this balancing act are the medical staff bylaws. Well-drafted bylaws can help create a cohesive working relationship, leading to enhanced patient care. The publication includes discussion of the impact that the increasing number of facilities where health services are provided, and in which organized medical staffs exist, has had.

Coverage includes:

      •  An overview of the applicable regulatory matters, including conditions of participation, and the role that accreditation organizations play;
      •  The protection afforded health care entities and physicians by the Health Care Quality Improvement Act of 1986 (HCQIA);
      •  The Joint Commission's changes incorporated in MS.01.01.01;
      •  The underlying legal and business issues that will impact the drafting of appropriate bylaws;
      •  An overview of the bylaws, medical staff governance, the nature of medical staff appointment, procedures for determining clinical privileges, and fair hearing procedures;
      •  Organizational and drafting tips; and
      •  Sample language, and key clauses.

Authors / Contributors

Table of Contents

TABLE OF CONTENTS


Chapter 1 — Introduction: Historical Perspective on the Medical Staff/Hospital Relationship


1.1   Preface

1.2   Historical Background

1.3   What are Medical Staff Bylaws?



Chapter 2 — Basic Statutory, Regulatory and Accreditation Matters

2.1   Introduction

2.2   Medicare Conditions of Participation

2.3   Accreditation Requirements

2.4   Health Care Quality Improvement Act of 1986

2.5   The Americans with Disabilities Act of 1990

2.6   Potential Claims under Age Discrimination in Employment Act

2.7   State Licensure Laws

2.8  Fair Credit Reporting Act




Chapter 3 — Underlying Legal and Business Issues Impacting the Hospital/Medical Staff Relationship

3.1   Introduction

3.2   Corporate Negligence

3.3   Medical Staff Bylaws as a Contract

3.4   Compliance with Bylaws

3.5   Antitrust Concerns

3.6   Economic Credentialing

3.7   Exclusive Contracts

3.8   Board Certification

3.9   Geographic Proximity Requirements

3.10   Number of Admissions

3.11   On-Call Coverage Issues

3.12   Health Care Entity/Physician Integration Issues

3.13   Impact of ACOs and Clinically Integrated Networks on Medical Staff Credentialing

3.14   Hospitalists, Intensivists and Other Hospital-Based Physicians

3.15   Development of Medical Staff Categories without Treatment Privileges

3.16   Responding to Credentialing Inquiries




Chapter 4 — Organizational and Drafting Tips for Medical Staff Bylaws and Related Documents

4.1   Medical Staff Input and Involvement

4.2   Structure of Medical Staff Bylaws

4.3   General Organizational and Drafting Considerations



Chapter 5 — Content of Key Provisions of Health Care Entity Bylaws

5.1   Introduction

5.2   Establishment of Medical Staff

5.3   Ultimate Authority of the Governing Body

5.4   Priority Between Health Care Entity Bylaws and Medical Staff Bylaws

5.5   Approval/Adoption of Medical Staff Bylaws and Rules and Regulations

5.6   Indemnification



Chapter 6 — Overview of Medical Staff Bylaws

6.1   Governance of Medical Staff

6.2   Definitions Consistent with HCQIA

6.3   Nature of Medical Staff Appointment

6.4   Bases for Grant of Clinical Privileges

6.5   Limiting Membership in Departments

6.6   Actions Warrant Privileges and Immunities

6.7   Independent Action by Governing Body

6.8   Amendments

6.9   Dispute Resolution Provisions

6.10   Governing Law



Chapter 7 — Credentialing Procedures

7.1   Introduction

7.2   Credentials Committee

7.3   Qualifications for Initial Appointment

7.4   Pre-Application Process

7.5   Application Process

7.6   Processing the Application

7.7   Data Bank and Excluded Provider Queries

7.8   Release and Immunity Provisions

7.9   Recommendation on the Application

7.10   Governing Body Action on Application

7.11   Reappointment Procedure

7.12   Centralized Credentialing

7.13   Categories of Medical Staff Membership



Chapter 8 — Privileging: Procedures for Determination of Clinical Privileges

8.1   Introduction

8.2   Establishment of Criteria for Granting Clinical Privileges

8.3   Determination of Clinical Privileges

8.4   Non-Clinical Criteria Impacting Grant of Clinical Privileges

8.5   Granting of Clinical Privileges

8.6   Requesting Change in Clinical Privileges

8.7   Orders for Diagnostic and Therapeutic Services by Non-Medical Staff Members



Chapter 9 — Corrective Actions

9.1   Procedures for Corrective Actions

9.2   Summary Suspension

9.3   Automatic Termination



Chapter 10 — Fair Hearing Procedures

10.1   Introduction

10.2   Limited Right to One Hearing

10.3   Right to Hearing

10.4   Notification of Proposed Adverse Action

10.5   Notice of Hearing

10.6   Waiver of a Hearing

10.7   Conduct of Hearing

10.8   Decision by Governing Body

10.9   Internal Appellate Review

10.10   Reporting Under HCQIA



Chapter 11 — Conclusion

11.1   Conclusion