“Physicians may find it’s not much fun in dealing with medical staff bylaws, but they are your bill of rights to deal with hospital administration,” said Shannon Hunter, MD, an otolaryngologist who practices in Clyde, NC.

Dr. Hunter was chief of staff when physicians at Haywood Regional Medical Center (HRMC) learned the hospital had lost its Medicare certification in early 2008, causing the 190-bed facility to temporarily lose Medicare and Medicaid payments. While physicians had tried to address concerns with hospital administration for several months, they were not informed about the looming crisis that led to decertification. As the news quickly spread throughout the western North Carolina community, physicians scrambled to find alternatives to help their patients while the hospital evaluated its management and operations.

As the hospital worked to regain Medicare certification, Dr. Hunter and her colleagues began working on getting physicians more involved and having a greater voice in hospital affairs. During the recertification process, she recalls that many patches had to be made to an antiquated set of bylaws, “but it was clear that an overhaul of the entire document was necessary when we were out of our reactionary phase to regain certification.”

“We wanted honest guidance and to build trust,” Dr. Hunter said. “We wanted to make sure we had bylaws that were friendly for the medical staff—not just the administration.” She contacted the North Carolina Medical Society for assistance.

 “We looked to NCMS for guidance. NCMS made recommendations that helped us meet guidelines. This included hiring an outside attorney to review what we had developed. The process went very well and helped to build the level trust we wanted,” she said.

Today, HRMC is part of the Charlotte-based Carolinas Healthcare System. In reflecting on her experience, Dr. Hunter stressed the importance of reviewing medical staff bylaws to ensure that physicians have a strong voice in hospital management and operations.

“It’s important for medical staff to meet regularly. Some may not see the need for medical staff bylaws, but they must understand that bylaws protect doctors. With good bylaws in place, physicians can better respond to changes in rules and laws and make adjustments in the ever-changing medical environment,” Dr. Hunter said.

“Today, we have a comfortable relationship between the medical staff and hospital administration,” said Robin Matthews, MD, an obstetrician/gynecologist in Waynesville, NC, who continues to chair the committee that reviewed and revised the Medical Staff Bylaws as the hospital regained certification and underwent administrative changes.

“Dr. Matthews and the Bylaws Committee are to be commended for the completion of our revision,“ Dr. Hunter said. “They were constructed by the medical staff for the medical staff and reflect our commitment to stay involved in our own self-governance.”

Currently, the Bylaws Committee is working on rewriting the Rules and Regulations. Dr. Matthews describes medical staff relations as very healthy, with physicians asking questions, seeking accountability and avoiding complacency.

To keep the medical staff engaged, Dr. Matthews believes physicians need to:

• Meet regularly
• Stay involved
• Be aware of necessary changes and avoid resisting those changes
• Be assertive and engaged.

The NCMS encourages physicians to regularly review their medical staff bylaws and make changes to maintain a strong voice and ensure quality care for their patients. For assistance, please contact Melanie Phelps at mphelps@ncmedsoc.org or 919-833-3836.

Links to Helpful Resources:

Physician-Hospital Resource Area

Model Medical Staff Bylaws (Members Only)

Related stories:

Are Your Medical Staff Bylaws in Compliance? (Bulletin, 1-14-11)

Revised Model NCMS Medical Staff Bylaws Now Available (Bulletin, 1-7-11)

“We are continually assessing how we can better serve the people and communities of eastern North Carolina,” said Dave McRae, CEO of UHS. “We want to simplify our name and our system naming structure to communicate directly and plainly who we are, what we offer and the value we bring to the communities we serve.”

UHS was created in 1997 and has grown to include eight hospitals that serve 29 counties and provided access to care for more than 1.4 million people. About 60 percent of PCMH patients travel to the Greenville-based hospital from outside of Pitt County. The System also has added physician groups and incorporated home health, hospice and wellness to the services offered.

Employment Contract Review: The NCMS has partnered with Poyner Spruill, LLP to offer NCMS members substantial savings on expert review of employment contracts. This expert review service helps members avoid risks such as unfair non-compete clauses, unfavorable scheduling, and inadequate liability protection.

Model Medical Staff Bylaws: The Medical Staff bylaws, including the fair hearing plan, is the key agreement establishing the relationship between Physicians and the Hospital, and between the Medical Staff and its individual members. The Model Medical Staff Bylaws includes provisions that comply with the Joint Commission Medical Staff Standard MS.01.01.01 that went into effect on March 31, 2011.

Legal Analysis of Medical Staff Bylaws: Clear, comprehensive, well-balanced bylaws are important to the success of a hospital medical staff. How well do yours stack up? NCMS partner Poyner Spruill, LLP offers members analysis and comment on existing medical staff bylaws. Basic, Expanded, Full analysis arrangements are offered at discounted hourly rates, with optional services such as expedited review and presentation to the Medical Staff.

Discounts on legal fees: NCMS Members receive 20% off legal consultation with Poyner Spruill, LLP on all NC Medical Board and hospital medical staff issues.

Individual Consultation from PractEssentials: The NCMS PractEssentials staff is available to consult with physicians on various career decision points–whether a physician is considering an employment situation, entering private practice, compensation packages, and other employment-related issues.

Other Resources Available at NCMS Online include:

• Additional information about MS .01.01.01
• AMA Model Medical Staff Code of Conduct
• Links to Joint Commission, CMS Conditions of Participation, NC Statutes referencing hospital privileges and responsibilities, and Power Point presentations on employment issues.

To access these member services, visit www.ncmedsoc.org or call the NCMS Member Resource Center at (800) 722-1350.

Contract review:  Contract negotiation is critical to a successful Physician-Employer relationship.  But often physicians don’t know their obligations and underestimate their negotiating power. The NCMS has partnered with Poyner Spruill, LLP to offer NCMS members substantial savings on expert review of employment contracts. This expert review service helps members avoid risks such as unfair non-compete clauses, unfavorable scheduling, and inadequate liability protection. 

Model Medical Staff Bylaws: The Medical Staff bylaws, including the fair hearing plan, is the key agreement establishing the relationship between physicians and the hospital, and between the Medical Staff and its individual members. The NCMS has published the Model Medical Staff Bylaws for NCMS members, which includes provisions that comply with the Joint Commission Medical Staff Standard MS.01.01.01 that went into effect on March 31, 2011.

Legal Analysis of Medical Staff Bylaws: Clear, comprehensive, well-balanced bylaws are important to the success of a hospital medical staff.  How well do yours stack up?  NCMS partner Poyner Spruill, LLP offers members analysis and comment on existing medical staff bylaws. Basic, Expanded, Full analysis arrangements are offered at discounted hourly rates, with optional services such as expedited review and presentation to the Medical Staff. Click here for details.

More information on these documents and preferred pricing is available at NCMS Online. Other resources on the NCMS site include additional information about MS .01.01.01, the AMA Model Medical Staff Code of Conduct, and links to Joint Commission, CMS Conditions of Participation, NC Statutes referencing hospital privileges and responsibilities, and Power Point presentations on employment issues. For assistance, contact the NCMS Member Resource Center.

Dan “Trey” Blazer, III, MD, Durham, Duke University Hospital

David Eddleman, MD, Raleigh, Rex Healthcare

Marc DeMason, MD, Eden, Morehead Memorial Hospital

The ACSCC involves a national network of 1600 volunteer physicians who are responsible for providing leadership and direction in establishing, maintaining and supporting their facilities’ cancer program.

The NCMS has developed the Revised Model Medical Staff Bylaws for NCMS members, which is available at http://www.ncmedsoc.org/members/pages/physician_hospital/medstaff_bylaws.html.

The revised version includes changes made by the NCMS Physician Hospital Issues Committee to address MS.01.01.01, as well as new or revised NCMS House of Delegates policy and AMA policy. In addition, the revised version covers DNV (Det Norske Veritas Healthcare) standards, for those hospitals that are accredited by that organization.

“This document is a valuable resource for our members as we strive to ensure that physicians have a viable  voice in medical staff governance in hospitals,” said William M. Johnstone, Jr., MD, JD, Chair of the NCMS Physician Hospital Issues Committee. “I urge members to review the Revised Model Medical Staff Bylaws to ensure that their local bylaws are in compliance with the Joint Commission standard.”

If you have questions or need more information, please contact Melanie Phelps at mphelps@ncmedsoc.org or call 800-722-1350.

The revised NCMS Medical Staff Bylaws include provisions that comply with the new Joint Commission Medical Staff Standard MS.01.01.01, which take effect on March 31, 2011. The revised version also includes changes recommended by the NCMS Physician Hospital Issues Committee, new or revised NCMS HOD policy, new AMA policy, and references to the DNV (Det Norske Veritas Healthcare) standards.

For additional information, please contact Melanie Phelps at mphelps@ncmedsoc.org or call 800-722-1350.

George H. West, MD, was recognized for his vast medical knowledge, “dry wit,” teaching skills, staff support, and taking excellent care of his patients. Dr. West earned his medical degree from Bowman Gray School of Medicine (Wake Forest). He began a solo practice in internal medicine in 1973 and later founded Kinston Diagnostic Group with partner, Roy Everett, MD.

Walter Sabiston, MD, was honored for introducing the day surgery concept at Lenoir Memorial and for pioneering new approaches to outpatient surgery in the eastern North Carolina community.  Dr. Sabiston received his medical degree from the UNC-CH School of Medicine and founded Kinston Head and Neck Physicians and Surgeons.

The forum will be held on Thursday, October 14, 2010 from 3:30pm-5pm ET.  To participate dial Dial: 1-800-837-1935 Conference ID 13795147.

The 2010 Hospital-Physician Relations Survey will examine the state of relations between hospitals and their employed physicians and how those relations may change. The survey is now open and is available to all readers of Modern Healthcare and sister publication Modern Physician. Readers can find the survey at http://modernhealthcare.com/surveys. The participation deadline is September 20, 2010.

Modern Healthcare and Press Ganey will analyze the results and report the findings in the November 8 issues of Modern Healthcare and Modern Physician.

One provision of the Patient Protection and Affordable Care Act that takes effect at the end of this year is the restriction on physician ownership of hospitals in the Medicare program.  The health reform law also places major limits on the expansion of existing physician-owned hospitals.

New physician-owned facilities that are not certified as Medicare participants by December 31, 2010 will no longer be allowed into the program after that date.  Other changes to the law include capping levels of physician ownership, ending some exceptions to Stark self-referral bans and mandating more disclosure of physician owners’ potential conflicts of interest, if they send their patients to their own facilities.

Past legislative attempts to limit physician ownership of hospitals often targeted specialty hospitals such as orthopedic, cardiac and other surgical facilities.  However, limitations enacted by the PPACA will also impact acute care facilities, even some community hospitals that may have been financially supported by their physicians in the past.

Until many pending federal lawsuits are settled, existing plans for new or expanding physician-owned hospitals are in a holding pattern.  The new law caps ownership levels to where they were at the bill’s passage (March 23, 2010).  According to the Physician Hospitals of America, there are currently 265 physician-owned facilities in 34 states that employ more than 75,000 workers with an average bed size of 233 general acute care beds that will be negatively impacted by the restrictions.

ACO Summit attendees heard presentations offering perspectives on ACOs from the Brookings Institute, Crescent PPO, Community Care of North Carolina, Poyner and Spruill, LLP, and Smith Anderson.  Participants discussed how new business models can improve the delivery of health care and how physician participants can use existing successful programs as a foundation for ACOs.  The Summit also reviewed the NCMS current draft policy on Accountable Care Organizations, to be considered by the NCMS Board of Directors in September.

Presentations and materials from the ACO Summit can be found on the NCMS Health System Reform page http://www.ncmedsoc.org/healthreform. If you would like to offer feedback on the draft policy on ACOs or provide information on ACOs being developed in your area, please complete and submit the feedback form also found on the Health System Reform page.  Please submit feedback regarding the draft policy by August 30, 2010.

The new commissioner is a lawyer who works at a plaintiffs’ firm that has represented numerous clients against the hospital and local physicians. Having a lawyer, who works at a medical malpractice plaintiffs’ firm involved in all of the health system’s credentialing, peer review, and quality management activities, caused grave concerns among the medical staff and hospital administration. We believe this is the first time a lawyer practicing in a medical malpractice plaintiffs’ firm has been placed on a hospital’s governing body.

The medical staff held an emergency meeting to address the issue. At that meeting, several actions were taken to ensure the obvious conflict of interest was properly addressed. Among them, the medical staff decided to retain counsel to ensure that any confidentiality agreements or conflict of interest policies formulated to address this situation provided adequate protection for the individual physicians on the medical staff. David Sousa, general counsel for Medical Mutual Insurance Company, and Stephen Keene, general counsel for the NC Medical Society, attended the medical staff meeting, as well. Mr. Sousa announced at the meeting that Medical Mutual would assist in indentifying counsel with appropriate expertise and cover the costs of the representation. Dan McLamb, of Yates McLamb & Weyher in Raleigh, was hired to represent the medical staff in the negotiations.

Ultimately the commissioner signed a confidentiality agreement and conflict of interest policy  that, among other things, requires the commissioner to recuse himself from all performance improvement, quality assessment, peer review and liability claims during his tenure. Earlier this week, the new commissioner lost in a four-way primary for the Democratic nomination for the commission seat.

The work done by the medical staff and their counsel provides excellent guidance to medical staffs that confront this issue in the future. The NCMS appreciates the leadership and prompt action of Medical Mutual Insurance Company to assist the medical staff with this issue.

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The Board considered the draft proposal at their January meeting and the item was tabled to allow for further review by the NCMB’s Policy Committee.  The proposed policy on telemedicine will be revisited at the next committee meeting in March.  You can view the draft being considered here.

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The proposed rule issued by CMS outlines provisions governing the EHR incentive programs, including defining the “meaningful use” of EHR technology. The rule also outlines the proposed payment methodologies for the Medicare and Medicaid EHR incentive programs.

An interim final regulation issued by ONC sets initial standards, implementation specifications, and certification criteria for EHR technology.  Under federal statute the interim final regulation will go into effect 30 days after publication, with an opportunity for public comment and agency refinement for 60 days following publication.

The CMS proposed rule and fact sheets may be viewed at http://www.cms.hhs.gov/Recovery/11_HealthIT.asp

ONC’s interim final rule may be viewed at http://healthit.hhs.gov/standardsandcertification.

In early 2010 the ONC intends to issue a notice of proposed rulemaking related to the certification of health information technology.

“We believe it is crucial that physicians who are members of a medical staff understand their rights and obligations and are engaged in medical staff matters.  The proposed standard and related elements of performance advance this goal.  The proposed standard engages staff members more fully by requiring a heightened level of involvement for medical staff members in the approval and implementation of bylaws, rules and regulations, and policies.”

According to the Joint Commission, the American Hospital Association, American Medical Association, American College of Surgeons, American College of Physicians, American Dental Association, and other interested organizations believe this revised version appropriately articulates the elements of a productive relationship between a hospital and its medical staff.  It also allows as much flexibility as possible in how and where a hospital and its medical staff choose to articulate these responsibilities. Do you agree?  Review and Comment.

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The Model Medical Staff Bylaws provide approaches for medical staffs to consider when faced with the challenges of compliance with the many laws, regulations, and standards governing medical staff bylaws.

This document will only be available online through the Members-only section of the website and will also be accessible through the Physician Hospital Resource Area.  These Model Bylaws will be updated as laws, rules, standards, policies, etc. change, and we will alert members to substantive changes in the NCMS weekly Bulletin.

For more information on the Model Bylaws, contact Melanie Phelps, mphelps@ncmedsoc.org.

Click here to access the Model Bylaws now.

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