Anesthesiologists' Relationships with Their Hospitals

Anesthesia Business Consultants, LLC Confidential Presentation Materials

Your Relationship to Your Hospital

Karin Bierstein, JD, MPHVice President for Strategic Planning & Practice

Affairs, Anesthesia Business Consultants, LLC

Anesthesiology Residency ProgramUniversity of California – San Diego

May 27, 2009


Disclosure

• VP at Anesthesia Business Consultants, LLC,

• ABC is footing my expenses• I’m here only to give you an

introduction to hospital-anesthesiologist relationships


Objectives

1. Understand the rules that will govern your relationship with your hospital.

2. Discuss some ways to protect your own and your Group’s relationships with the hospital.


http://www.ASAhq.org

> Members Only


The Rules of Engagement

1. The Organized Medical Staff (OMS) : SELF-GOVERNANCE, via

The Medical Staff Bylaws • Quality & safety of patient care• Define med. Staff organizational

structure & governance processes• Create rights & responsibilities between

1. OMS and governing body2. OMS and individual members of the medical

staff

2. Contract between anesthesiology group and hospital


1. Hospital Privileges

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.


Why the “Organized Medical Staff?”

• Medicare Conditions of Participation for hospitals (federal regulations)

• Reg. Section 48212(a)(2):– The governing body must appoint

members of the medical staff after considering the recommendations of the current medical staff.

• TJC accredits hospitals if they are in compliance with the CoPs


Privileges/Medical Staff Membership

• TJC Medical Staff Standard – MS.1.20– Element of Performance EP 11

• Basic requirements:– Current licensure– Relevant training or experience– Current competence– Ability to perform requested

privileges

• I.e., privileges, not a right


Hospital Privileges cont’d

• Process described in Medical Staff Bylaws

• Privileges must be– Granted, and– Renewed

• Credentialing process– Required of & protects the hospital

• Checks the validity of the credentials• Basic quality screening mechanism

(initial and ongoing)


Credentialing cont’d

• The initial appointment to the Medical Staff is cumbersome– Neither you nor the Group can do

much to speed up the process:• Hospital requirements come from The

Joint Commission + payers + its malpractice carrier etc.

– But you could slow it down by not cooperating100% with requests for documentation (medical education, residency, state licenses, DEA certificate, work history, references….)


Ongoing Medical Staff Membership Requirements

• Some required by TJC; some local• Some are really obvious:

– No criminal record; no exclusion from Medicare

• Call response requirements– consider the distance of your home

from the hospital• Maintaining malpractice insurance• Board certification/recertification• Compliance with hospital policy

– Conduct/behavior


Medical Staff Bylaws 2009: A Struggle for Control

• Hospitals want more say over who obtains and who keeps hospital privileges

• Medical Staff standards are in flux MS.1.20.

• Codes of conduct• The only one applicable to MDs

should be the Medical Staff Code of Conduct


More TJC MS Standard shenanigans

• LD 3.10 requires Code of Conduct and Process for managing “disruptive behavior”– Define “disruptive behavior”

• “adding to the workload of hospital staff” – would include admitting a patient!

• Economic credentialing in another form

• The only process for managing physician behavior should be in the Med Staff Bylaws for another reason:


Peer Review

• Health Care Quality Improvement Act of 1986

• Properly conducted peer review is protected (presumption of immunity)– “Reasonable” (good faith) evidence

gathering, presentation, decision-making

– Due process protections– Not subject to discovery in litigation– Not “defamation” or “restraint of trade”


Peer Review cont’d

• Confidentiality so important that Medical Staff Bylaws often set higher standards than HCQIA

• National Practitioner Data Bank– Must be queried as part of

credentialing process• ASA

– Hospital Consultation Program– Expert Witness Testimony

reporting program


2. Hospital-Anesthesiology Group Contracts

• Principal purpose is to structure the working – and financial – relationship between the Group and the Hospital – Exclusive v. non-exclusive

• Clean sweep provisions tying privileges to the term of the contract

• The hospital contract may require Group to remove an anesthesiologist “upon request.”


Beware Subjective Performance Standards in Contracts

• “Group is required to promote and not denigrate the reputation of the Hospital….”

• Bar Group communications that would tend to impugn the reputation of the Hospital....”


Your Best Protection: Good Citizenship

• Excellent outcomes and service (the surgeons are the customers too)

• Mutually respectful, trusting relationship with hospital leadership

• Active participation and leadership / committees, TFs, special projects

• Quality and efficiency measurement• Openness to new concepts, methods

Anesthesiologists' Relationships with Their Hospitals

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