CMS expands medical staff definition to include APRNs, PAs

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Among a raft of changes the Centers for Medicare & Medicaid Services issued this week, the agency controversially expanded its definition of the medical staff, allowing nonphysician practitioners to have privileges like other medical staff members. In an effort to cut some outdated requirements, CMS changed rules about medical staff oversight and roles.

"We have broadened the concept of 'medical staff' and have allowed hospitals the flexibility to include other practitioners as eligible candidates for the medical staff with hospital privileges to practice in accordance with state law," CMS said in the final rule. The explicit change now allows hospitals to give nonphysician practitioners, such as advanced practice nurses, physician assistants and pharmacists, the power to perform duties that they are trained for and allowed to do within their scope of practice and state law. If hospitals choose to do so, nonphysician practitioners could free up physicians to work on more medically complex patients, CMS said.

The practitioners still must gain approval by the governing body that grants privileges.

CMS said there was overwhelming support to broaden the concept of the medical staff to include all types of healthcare professionals. But critics worried that the rule would allow certain practitioners to circumvent medical staff bylaws, risking patient safety.

CMS responded to comments and said the goal of the final rule is to allow hospitals to explore new approaches to care, thereby increasing the number and the types of practitioners granted hospital privileges.

"We encourage physicians and hospitals to enlist qualified nonphysician practitioners to fully assist them in taking on the work of overseeing and protecting the health and safety of patients. This applies not only to the 'work' of the medical staff--such as quality innovation and improvement, best practices application and establishment of professional standards--but also to the everyday duties of caring for patients," CMS said in the final rule. "We also believe that an interdisciplinary team approach to patient care is the best model for patients. However, we also agree that physicians, owing to their training and expertise, must be the leaders in overall care delivery for hospital patients." 

CMS also eased up on rules for medical staff leadership, in which podiatrists can now be responsible for the medical staff.

Also included in the rule, one governing board now can set the policy for the entire health system rather than the previous requirement that one body oversee each hospital. It thereby increases flexibility for the health system, CMS said.

The U.S. Department of Health & Human Services (HHS), it said, is cutting the "red tape," HHS Secretary Kathleen Sebelius and CMS Acting Administrator Marilyn Tavenner both called it in Wednesday's announcement. Eliminating obsolete or burdensome regulations will save $1.1 billion across the healthcare system in the first year and more than $5 billion over five years.

To learn more:
- read the HHS announcement
- see the final rule (.pdf)

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