Hospital standards worth your attention

Strong medical staffs are key to patient safety.

Posted Dec. 18, 2006.

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It's easy to let one's eyes glaze over in boredom when stumbling upon news about the Joint Commission on Accreditation of Healthcare Organization's proposed revisions to Standard MS.1.20.

But that's a mistake.

The Standard MS.1.20 title may sound like bureaucratic hooey to the average physician. Something that someone else will handle while you tend to patients. Maybe it even sounds like something that really isn't going to matter in the everyday practice of medicine.

Behind that dull, flat-sounding title, though, lie words that could give hospitals the power to take away a medical staff's independence and to interfere with the medical staff's effectiveness -- two items that are key to protecting patient care and patient safety.

The Joint Commission has proposed changing this standard so certain items such as credentialing and medical staff structure don't have to be included in the medical staff bylaws that doctors vote on and approve. Instead, the commission would allow hospitals to include items like these in the administrative rules, regulations and policies that hospital board and medical executive committees control. It would more easily allow rules to be manipulated.

In turn, that creates an even bigger problem when disputes between medical staffs and physicians wind up in court because the courts are more likely to view medical staff bylaws as binding contracts instead of the administrative rules. And landing in court is not a stretch. Disputes that pit medical staffs against their hospitals are increasingly common.

Only 155 of the nation's hundreds of thousands of physicians responded to the Joint Commission's call earlier this year for responses to the proposed rule, a process known as the field review. The comment period closed in late October. The Joint Commission is reviewing the comments before it takes a final vote on proposed Standard MS 1.20.

Physicians who gathered at the AMA's Interim Meeting last month were concerned enough about the proposal that they passed policy directing the AMA's seven representatives on the Joint Commission's 29-member board to introduce and support language stating that there is a single document known as the "Medical Staff Bylaws" that must be approved by the medical staff's voting members.

The House of Delegates also directed the AMA commissioners to introduce language to make certain things an integral part of the medical staff bylaws, including the fair hearing and appeals process; medical staff structure; the right to develop and adopt medical staff policies, procedures, rules and regulations; application, reapplication, credentialing and privileging and selection, election and removal of medical staff officers.

Time will tell the outcome on this standard. But physicians should be on the lookout to comment on future proposed standards, as the Joint Commission has promulgated an increasing number of standards in recent years.

The House of Delegates has called on the Joint Commission to provide at least six months to openly comment on proposed standards and to establish a process for any physician to provide feedback about commission programs that affect that physician's practice.

For its part, the commission has noted that it has improved communication between the two sides by creating a physician engagement advisory committee, a link specifically for physicians on its Web site and other tools designed to engage physicians in the process.

The AMA's Organized Medical Staff Section Governing Council also has been actively involved with reviewing proposed standards during the field review and making recommendations to the AMA on what comments may need to be made.

But it's up to individual doctors also to keep an eye on what changes are being proposed and speak up if they disagree.

So load up on some caffeine if it seems hard to get past the title of these and other Joint Commission standards. What's in them could have a serious and lasting impact on patient safety and the way doctors practice medicine in the hospital setting.

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