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Right call on governance

February 8, 2013
When the Centers for Medicare & Medicaid Services (CMS) issued a final rule last May that tried to implement an under-theradar Medicare regulation requiring a physician to serve on a hospital's governing board, the AHA and other hospital leaders pushed back.

We pointed out that the measure was not part of the proposed rule revamping the 'conditions of participation' that hospitals must meet to qualify for Medicare and Medicaid reimbursement, and was never vetted publicly. We made the case that the medical staff requirement could conflict with state and local laws for hospital governance - andthat CMS would have known that had it solicited public comment on the policy.

Heeding those concerns, the agency put the regulation on hold. On Feb. 4, CMS issued a proposed rule rescinding this regulatory provision and making a number of welcome changes to reduce burdensome regulatory requirements -particularly as they related to small and rural hospitals (see our story on page 1).

Under the proposed rule, CMS would require a hospital's governing body to consult periodically with a member of the medical staff on patient care quality.

For multi-hospital systems with a single board, that governing body would need to consult with a member of the medical staff from each hospital in the system.

This new requirement for routine conversations about patient care between the board and the medical staff puts appropriate focus on effective communication rather than trying to dictate a particular governance structure. Chalk one up to smart rulemaking.

We can't say the same about CMS' decision to move forward with a provision from last May's regulations that prevents a multihospital system from opting for a single organized medical staff.

Not allowing a single organized medical staff can stymie integration efforts under way at health systems. Many of these organizations have a unified medical staff in place, and, as a result, are able to more reliably and completely standardize high-quality, safe care across their systems.

Building a better health care system means eliminating outdated rules and regulations and ensuring that new ones are coordinated, efficient and effective. CMS has proposed a number of changes in the proposed rule that take us in that direction.

Unfortunately, its single medical staff proposal is an example of rulemaking that lets traditional organizational structures stand in the way of efforts to better coordinate patient-centered care.