The Centers for Medicare &
Medicaid Services (“CMS”)
published a Final Rule on May 12, 2014, making
modifications to the Medicare Conditions of Participation (“CoP”).
Specifically, updates were published
to revisit the CofP with respect to the medical staff of multiple
hospital systems. Under the Final Rule, CMS will no longer prohibit a multi-hospital system from establishing a unified and integrated medical staff after
receiving numerous comments and agreeing that a unified system may be best for
standardization of practices in some hospital settings. CMS provided the following guidelines for such integration while recognizing the related parameters and limitations should
be left to the hospitals.
(1) Medical Staff Members Must
Vote
All
medical staff members practicing at each separately certified hospital must
have voted by majority to either accept and incorporate a unified and
integrated medical staff structure or to reject such structure and maintain a
separate and distinct medical staff.
(2) Opt-Out Provisions Must be
Included in Bylaws
Bylaws,
rules, and requirements must exist to document several processes, including the
ability for members of the medical staff to opt-out of the unified and
integrated structure after a majority vote by the members and, conversely, to
maintain a separate and distinct medical staff for the respective hospital.
(3) Medical Staff Must
Acknowledge Unique Circumstances, Populations, and Services of Hospitals
The
unified and integrated medical staff must be established to consider each
hospital’s unique circumstances, including differences in patient populations
or services offered in each hospital. Examples of patient population
differences include, among others, low income or minority populations and rural
populations. Furthermore, services offered include, among others, emergency,
psychiatric, pediatric, long term acute care, organ transplant, and dialysis.
(4) Hospitals Must Give Due
Consideration
Each
hospital must give consideration to the needs and concerns of each medical staff member and mechanics must be created to
ensure issues are considered and addressed.
Please note that hospitals may
choose to exercise this flexibility only after determining such decision is in
accordance with all applicable state and local laws. Additionally, please note
that these modifications become effective on July 11, 2014.
For additional information, or to
obtain a complete summary of all modifications, please consult the Federal
Registry at http://www.gpo.gov/fdsys/pkg/FR-2014-05-12/pdf/2014-10687.pdf or contact Susan Ziel at sziel@kdlegal.com.