CHA Model Medical Staff Bylaws and Rules –– 2014 Edition Page 4
November 2013
November 21, 2013
TO: Users of CHA Model Medical Staff Bylaws and Rules 2014
FROM: Jana Du Bois, Vice President, Legal Counsel
SUBJECT: Updated 2014 Edition of the CHA Model Medical Staff Bylaws and Rules; Summary of Key Changes; and Comparison of the CHA Model Medical Staff Bylaws and Rules to the California Medical Association’s (CMA) Model Medical Staff Bylaws
The California Hospital Association has updated its electronic edition of the Model Medical Staff Bylaws and Rules manual and related documents. This updated 2014 edition has been edited by Ann O’Connell who is a partner with the Sacramento office of Nossaman LLP.
This memorandum highlights the major changes made to the 2014 CHA Model Medical Staff Bylaws and Rules and details other useful documents that are included on the CD, most significantly a side-by-side comparison of the CHA Model Medical Staff Bylaws and Rules to the CMA Model Medical Staff Bylaws.
Importance of the CHA Model Medical Staff Bylaws and Rules
The CHA Model Medical Staff Bylaws and Rules are intended to set the framework for the Medical Staff, hospital administration and Governing Body to work together cooperatively to achieve their mutual goals. The model stresses the quality-of-care responsibilities of the Medical Staff, and gives the Medical Staff latitude to develop standards and procedures for credentialing and privileging Medical Staff members, as well as applicable standards of care and procedures for monitoring the performance of Medical Staff members.
Other organizations, including the California Medical Association (CMA), have developed model Medical Staff Bylaws. The bias that distinguishes the CHA model from the CMA model is that the CHA model is based upon a recognition that the hospital Governing Body has ultimate responsibility for the governance of the hospital, and that the Medical Staff must be accountable to the Governing Body in the conduct of Medical Staff responsibilities. Also the CHA Bylaws reflect CHA’s belief that the legal rights of individual physicians are well safeguarded by the extensive legal protections established by California law. CHA’s model recognizes and accommodates these legal rights, but does not further expand them in a way that creates unnecessary burden for Medical Staffs trying to fulfill their responsibilities for monitoring and improving the quality of care.
The CHA model also recognizes that many hospitals are part of a multi-hospital system and integrated network. The CHA model includes optional provisions that enable the Medical Staff to eliminate duplication of effort within the system and concentrate on effective peer review for the integrated entity.
Everyone involved in the Bylaws and Rules development and approval process should understand that the adopted documents could impact how effectively the Medical Staff performs. Arcane provisions can cost the Medical Staff leadership and the hospital greatly in both time and money without necessarily providing any real benefits. Medical Staff leaders should assure the Bylaws give them the tools they need to perform their responsibilities and minimize their burdens; administrative staff should assure the Bylaws provide for appropriate Medical Staff involvement in administrative decisions; and the governing board should assure the Bylaws allow the governing body to fulfill its ultimate responsibility.
The CHA Model Medical Staff Bylaws and Rules strives to balance these considerations so the Medical Staff can fulfill its role as the primary guardians of quality care and patient safety. At the same time it assures individuals (applicants and members) are afforded all legal protections consistent with California law.
Key Changes to the Model Medical Staff Bylaws
The following is a synopsis of the key changes that were made to the Bylaws:
· Revised to include provisions required for hospitals selecting DNV Healthcare accreditation standards.
· Telehealth/telemedicine provisions have been updated to reflect changes in California law and Medicare Conditions of Participation.
· An option to move informed consent provisions into policies (and out of the Bylaws) has been added.
· New provisions have clarified the role of the Medical Staff with respect to candidates and responsibilities for contract practitioners.
· Clarification of any “waiting period” for reapplication to the Medical Staff following disciplinary actions.
· The Disaster and Emergency Privileges sections have been modified, for clarification.
· The provisions relating to modifying the Medical Executive Committee’s authority have been modified.
· The effect of loss of Medicare or Medi-Cal provider status on emergency call activities has been clarified.
· The Notice of Action provisions have been modified to assure notification of the mediation option, and the timing for requesting mediation has been clarified.
· Hearing Officer selection provisions have been updated to reflect implementation of the Hearing Officer Selection services offered by the California Society for Healthcare Attorneys.
· The requirement to notify of attorney participation in hearings has been added, and the roles of attorneys representing the parties in a Medical Staff fair hearing have been further clarified.
· Cross-references have been updated throughout the Bylaws.
· Comments have been updated throughout the Bylaws (these changes are not specifically annotated as such).
Key Changes to the Model Medical Staff Rules
Key changes to the Rules include:
· Revisions to the Telemedicine Staff appendix to reflect changes in California law and CMS/TJC/DNV accreditation requirements.
· Primary source verification requirements for Disaster Privileges have been updated.
· The comment accompanying the Nurse Anesthetist Appendix regarding the Governor’s opt-out from the Medicare supervision requirements has been updated to reflect the outcome of the California appellate court ruling upholding the opt-out.
Comparison of the CHA Bylaws to the CMA Bylaws
Hospital and Medical Staff executives have asked CHA to identify the distinctions between the CHA Model Medical Staff Bylaws and Rules to the model Bylaws developed by the CMA. A detailed side-by-side comparison of the two different documents, along with relevant comments regarding key distinctions of importance, has been developed. This comprehensive document is included as an electronic file.
The document is in table form, comparing CHA’s Model Medical Staff Bylaws and Rules 2014 and CMA’s Model Medical Staff Bylaws 2013. This comparison illustrates a generally similar approach to the substance of Medical Staff Bylaws — in that both are similarly organized and contain a similar level of detail — yet it also illustrates a number of respects in which the two organizations significantly differ in their approach to certain key issues.
In a nutshell, these appear to be the most significant distinctions:
· In recognition of the Governing Body’s ultimate responsibility for all hospital operations, the CHA Bylaws preserve more discretion for the Governing Body than do the CMA Bylaws.
· Correspondingly, the CMA Bylaws provide more autonomy for the Medical Staff than do the CHA Bylaws. There are some significant CMA provisions in this regard, including Medical Staff participation on hospital and system Governing Bodies, participation in hospital strategic planning and budgeting activities and review of financial operations, and review and oversight of exclusive and medical director contracting decisions.
· The CMA Bylaws include an extensive role for the Medical Staff in the hospital’s contracting decisions, including exclusive contracts for ancillary services, medical directorships and chief medical officers.
· The CMA Bylaws provide for Medical Staff sole management of “Medical Staff Funds,” and require the hospital to contribute to those funds.
· The CMA Bylaws include extensive conflict of interest provisions affecting all levels of Medical Staff activities, and preclude Governing Body-promulgated conflict of interest provisions (except for Governing Body members).
· The CMA Bylaws provide significant protections, over and above those provided by statute, to individual members of the Medical Staff who may be facing investigation and/or disciplinary action.
A more detailed summary of these and other key differences between the CHA and CMA models is provided.
Files on the CD
Enclosed is a CD that contains electronic files that readers will find useful. Each file serves a unique purpose. The files on the CD include:
· Annotated versions of the CHA Bylaws and Rules. These versions allow you to see the revisions (as compared to the 2011 Edition).
· Non-annotated versions of the Bylaws and Rules. These versions include all of the revisions in a clean format and allow you to customize each section to meet your facility’s needs.
· Summary of key differences between CHA and CMA’s models
· Comparison document showing the differences between the CHA Model Medical Staff Bylaws and Rules 2014 and the CMA Model Medical Staff Bylaws 2013.
CHA members with questions regarding this memorandum or the content of the CHA Model Medical Staff Bylaws and Rules 2014 may contact Jana Du Bois at (916) 552-1636 or .
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Enclosures