AHA: CMS pulls surprise switcheroo in medical staff rules

Under a recent final rule from the Centers for Medicare & Medicaid Services, a medical staff member must serve on the hospital board, and hospitals (even if part of a multiple-hospital system) must each have an independent medical staff--two changes that the American Hospital Association has staunch objections to.

The CMS language "surprised and greatly concern hospitals," the American Hospital Association said in a letter to the federal agency yesterday.

AHA suggests CMS snuck in two changes in the May final rule not included in the October 2011 proposed rule, which could greatly affect hospitals and critical-access hospitals under the Conditions of Participation (CoP).

The last-minute changes didn't give enough time for hospitals to comment, in violation of the Administrative Procedure Act, which requires public participation on final rule-making, AHA said.

"Had these substantive changes been proposed properly, they would have generated significant opposition from hospitals during the public-comment process," AHA President and CEO Rich Umbdenstock said.

The Administrative Procedure Act, however, notes that only "interested parties" must be addressed in the rulemaking.

AHA strongly criticized the two revised medical staff rules. The surprise switcheroo "dictate[s] the specific composition of a governing board," AHA noted.

In some cases, hospitals cannot have a medical staff member on their board either by choice or by law, AHA noted. For instance, elected officials deciding who will serve on public hospital boards may not choose a physician on the medical staff.

In addition, previous assumptions were that the CMS rule would allow for a single governing body within a multi-hospital system. In an effort toward integration, many multiple-hospitals have moved toward a unified medical staff model. However, the rule could be interpreted to mean that multiple, independent medical staffs for each hospital would have administrative burdens to face.

The fallout of hospitals not compiling with the CoPs could mean losing Medicare status, and with it, the reimbursements.

For more information:
- read the AHA letter (.pdf)
- see the AHA News Now brief

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