The Centers for Medicare & Medicaid Services (CMS) recently issued a Final Rule, which serves to reduce several burdensome requirements on hospitals and other health care providers. Among the changes, CMS will now permit flexibility in the structure of hospital medical staffs, and will no longer require that a hospital’s governing board include a member of the medical staff.

 

The final rule does not incorporate the proposal to require each hospital within a multi-hospital system to have its own medical staff. Rather than prohibiting multi-hospital systems from having a unified and integrated medical staff, the final rule permits multi-hospital systems to have either a medical staff for each hospital or a unified and integrated medical staff shared by the hospitals within the system. If the unified and integrated medical staff approach is used, the final rule requires, for example, that the medical staff members holding privileges at each separately certified hospital in the system vote by majority either to participate in a unified and integrated medical staff structure or to opt out of such a structure. The unified and integrated medical staff must have bylaws, rules and requirements that describe its processes for self-governance, appointment, credentialing, privileging and oversight, among other requirements.

 

The final rule eliminates the requirement that a member of the medical staff sit on the board of the hospital. Rather, the governing board need only seek consult from time to time with the person responsible for the hospital’s medical staff. In the case of a multi-hospital system that has an integrated governance model to oversee multiple hospitals within its system, the final rule requires the single governing body to consult directly with the individual responsible for the organized medical staff (or his or her designee) of each hospital within its system.

 

The reaction to these two particular aspects of the final rule has been positive. For systems looking to transform their structures to better integrate and operate as a unified whole especially in this era of transformation from volume to value based reimbursement, they may wish to take advantage of these changes as part of their overall strategic planning.