CMS: Hospitals wont need to retain medical staff on governing boards
February 8, 2013
The AHA welcomed the Feb. 4 proposed rule by the Centers for Medicare & Medicaid Services (CMS) to streamline Medicare and Medicaid regulations, calling it “an important step forward in further reducing burdensome requirements to hospitals.”
The proposed rule seeks to ease hospital staffing requirements at critical access hospitals, rural health clinics and federally qualified health centers, and would rescind a regulation requiring hospitals to retain a member of the medical staff on their governing boards.
The proposal would only require a hospital’s governing body to consult periodically with a designated member of the medical staff over issues that include patient care quality. For multi-hospital systems with a single governing body, the governing body would need to consult with a member of the medical staff from each hospital in the system.
The proposal continues the effort that began last May when CMS issued a final rule for revamping hospitals’ Medicare and Medicaid “conditions of participation” (CoP) under an executive order to modify and streamline regulations. CMS said this latest round of regulations would save $676 million annually and $3.4 billion over five years.
Hospitals heard on medical staff requirement. The medical staff requirement was included in the May regulations, but was put on hold following protests from the AHA and other hospitals leaders. The AHA argued that the medical staff requirement was not part of an earlier version of regulations revamping CoP standards, and was never vetted publicly. The AHA and other hospital groups pointed out that the medical staff requirement could conflict with state and local laws for hospital governance – and that CMS would have known that had it solicited public comment on the policy.
The AHA expressed strong support for the change in medical staff policy. “While most hospitals have physicians on their governing boards, CMS recognized that the requirement was not feasible for all hospitals,” AHA President and CEO Rich Umbdenstock said. “CMS revamped the requirements to focus on the need for good communication between governing boards and medical staff members about patient care.”
Single medical staff. But the AHA expressed disappointment in the agency’s decision not to allow a health system to have a single, integrated medical staff, if that is how it chooses to organize. When the provision first surfaced in the May regulations, the AHA told CMS that a single organized medical staff can help spur on integration efforts under way at health systems. The association said that many of these organizations have a unified medical staff in place, and, as a result, are able to more reliably and completely standardize highquality, safe care across their systems.
“Hospitals are delivering more coordinated, patient-centered care and CMS should not let antiquated organizational structures stand in the way,” Umbdenstock said.
Rural health care. The proposed rule would eliminate a requirement that physicians be on site once every two weeks at critical access hospitals – those hospitals with no more than 25 acute-care beds – rural health clinics and federally qualified health centers. CMS called the regulation burdensome and outdated.
Among other changes, the proposed rule would:
permit trained nuclear medicine technicians in hospitals to prepare radiopharmaceuticals for nuclear medicine without the supervising physician or pharmacist constantly being present, which helps speed services to patients, particularly during off hours;
• allow registered dietitians to order patient diets without a physician’s approval; and
• classify swing-beds as an optional service. This change would enable accrediting organizations to assess a hospital’s compliance with swing-bed requirements during a routine accreditation survey, rather than requiring a separate survey.