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CMS agrees to reconsider new medical staff requirement included in final CoP regulations

June 25, 2012


Heeding concerns raised by the AHA and others, the Centers for Medicare & Medicaid Services (CMS) has put a hold on plans to require a physician to serve on a hospital’s governing board, and said it will reconsider the requirement in future rulemaking.

The requirement was included in a May 16 final rule revising the Medicare and Medicaid con­ditions of participation (CoP) for hospitals. The AHA, in recent comments to CMS on the rule, strongly objected to the medical staff requirement, as well as another provision that prevents a multi-hospital system to elect to have a single organized medical staff. The final CoP rule takes effect July 16.

The AHA said both policy changes violate the “Administrative Procedure Act,” since CMS did not include either of these changes in the regulation it pro­posed in October. The AHA’s comment letter called on the agency to “immediately rescind” the two requirements.

CMS signaled it was hedging on the hospital governance requirement in a June 15 memo to state survey agencies. CMS said it decided to revisit the requirement due to concerns about the provision’s conflict with other laws and the complexity of the issues raised by critics of the plan. In the memo,

 

CMS said surveyors should not assess compliance with the requirement or cite related deficiencies without receiving instructions from the agency. In addition, the agency said CMSapproved hospital accreditation programs are not expected to revise standards or survey processes related to the requirement “until we have addressed the issue completely.”

Gary Yates, M.D., chief medical officer of Sentara Healthcare and an AHA Center for Healthcare Governance physician expert on governance issues, said CMS should not be “prescriptive in these sorts of matters.” He said the agency should allow each system “to select those options around governance they feel are most appropriate for their community.”

Sentara Healthcare, a not-for-profit health system that operates more than 100 sites of care serving residents across Virginia and northeastern North Carolina, includes medical staff on its governing boards. Yates is a member of the AHA’s Physician Leadership Forum.

In its comments to CMS, the AHA said there are a number of reasons some hospitals do not have a physician on their governing boards. Some hospitals are prevented by law from doing so, and others seek to avoid a potential conflict of interest in cases where medical staff members serve as employees of the hospital or enjoy privileges at compet- ing hospitals.

Some hospital leaders, like Scott Malaney, president and CEO of Blanchard Valley Health System in Findlay, OH, are concerned that the medical staff requirement could stymie integration efforts under way at health systems. “If you make us have separate and distinct medical staffs even though there are patients flowing back and forth, that doesn’t help integration,” said Malaney, who heads a nonprofit, integrated regional health system.

The former AHA board member said unnecessary duplication, especially in meetings and costs, would likely occur if the requirement takes effect.


 

By Pete Davis