Joint Commission revises medical staff standard

A task force has revised a controversial Joint Commission standard governing physician-hospital relations in ways it hopes will better ensure medical staff independence.

The changes to the commission standard -- adopted in 2004 and first revised in 2007 -- were drafted by a task force of organizations representing hospitals, physicians and dentists. Doctors and others can review and comment on the draft standard until Jan. 28 (link).

Jay A. Gregory, MD, chair of the governing council for the AMA Organized Medical Staff Section, served on the task force that came up with the changes. "The key thing is that we maintained the medical staff's independence and self-governance," he said.

Physician organizations, such as the AMA and the American College of Physicians, wanted to ensure that a hospital's medical staff had a mechanism, under the commission standard, to confront a medical executive committee that does not represent its views.

"There are two main times when we see this perceived balance of power get out of whack," Dr. Gregory said. "One is when the medical executive committee is controlled by [hospital] employees. The other is when there just happens to be some strong competitors on the committee and they manipulate the system to their advantage, and that does happen. The medical staff needs to have the ability to address these issues."

The intent behind the draft standard, according to a frequently-asked-questions document posted at the commission's Web site, is to enable a hospital's medical staff, governing body and executives to agree on rules and procedures that will guide their relations.

Under the draft standard, the medical staff and the medical executive committee must notify each other when they want to change a hospital rule, regulation or policy. The proposed standard also lays out a process for resolving conflicts between the two bodies.