Synergy - July/August 2014 - 26

NAMSS FOCUS

CMS Issues Final Rules on Hospital
Medical Staff Conditions of Participation
By Molly Giammarco, NAMSS Government Relations Manager

I

n early 2013, NAMSS provided comment
to the Centers for Medicare & Medicaid
Services' (CMS) proposals to the Medical
Staff Conditions of Participation, RIN
0938-AR49, Medicare and Medicaid
Programs; Regulatory Provisions to Promote
Program Efficiency, Transparency, and Burden
Reduction; Part II. These proposals addressed
several areas of interest to NAMSS
members: dietitian privileging, hospital
medical staff membership composition,
hospital governing body representation,
medical staff within multihospital systems,
and outpatient hospital orders. CMS
published its final rule on these measures on
May 12, 2014.
To help you understand CMS' final rule, we
have highlighted CMS' proposed rule to the
above topics, NAMSS' 2013 comments on
these proposals, CMS' final rules, and key
takeaways below.

1. Hospital Registered
Dietitian Privileges
CMS' Proposed Rule (2013):
"We propose to include qualified dietitians
as practitioners who may be privileged
to order patient diets under the hospital
conditions of participation (CoPs)."
NAMSS' Comment (2013):
"NAMSS appreciates that CMS recognizes
the role that allied healthcare providers play
in delivering quality and competent patient
care. The proposal recognizes changes that
are occurring at the state level through
scope of practice laws that allows dietitians
to operate as independent practitioners
and write patient orders. Enabling dietitians
to sign off on patient orders without the
physician's approval streamlines this process.
NAMSS requests clarification to affirm that
the proposal only provides hospitals the
option to credential and privilege dietitians.
Many hospitals use contractors to supply
dietitians. In these instances, there is not
26

/

S Y N E R G Y J U LY / A U G U S T 2 0 1 4

a consistent roster of dietitians on staff.
If the proposal requires such hospitals to
credential dietitians, MSPs in such settings
would need to constantly credential new
dietitians and the aforementioned high
turnover rate would generate additional
expenditures. NAMSS encourages CMS to
consider these costs and to keep flexibility
in the final rule by not requiring hospitals to
credential and privilege dietitians."
CMS' Final Rule (2014):
"We are permitting registered dietitians
and other clinically qualified nutrition
professionals to be privileged to order
patient diets under the hospital conditions
of participation (CoPs).
In order for patients to have access to
the timely nutritional care that can be
provided by RDs, a hospital must have the
regulatory flexibility either to appoint RDs
to the medical staff and grant them specific
nutritional ordering privileges or to authorize
the ordering privileges without appointment
to the medical staff, all through the hospital's
appropriate medical staff rules, regulations,
and bylaws."
Key Takeaway:
CMS permits, but does not require,
hospitals to allow qualified dietitians to
join their medical staff. The final rule
acknowledges that granting dietitians
privileges to order patient diets may not
work for all facilities.

2. Hospital Medical Staff
Composition
CMS' Proposed Rule (2013):
"We propose to clarify the requirement that
a hospital's medical staff must be generally
composed of physicians but that it may
also include, in accordance with state laws,
including scope-of-practice laws, other
categories of non-physician practitioners
who are determined to be eligible for
appointment by the governing body."

NAMSS' Comment (2013):
"NAMSS appreciates this clarification to
grant states and hospitals the flexibility to
deem non-physician practitioners eligible for
medical staff membership."
CMS' Final Rule (2014):
"We are clarifying the requirement that a
hospital's medical staff must be composed of
doctors of medicine or osteopathy but that
it may also include, in accordance with state
laws, including scope-of-practice laws, other
categories of physicians and non-physician
practitioners who are determined to be eligible
for appointment by the governing body."
Key Takeaway:
Medical staff composition may include
physicians and certain non-physician
practitioners (such as advanced practice
registered nurses, physician assistants,
registered dietitians, and doctors
of pharmacy), but facilities are not
required to include these non-physician
practitioners on their medical staffs.

3. Hospital Governing Body
CMS' Proposed Rule (2013):
"We are proposing to add a new provision
to the 'medical staff' standard of the
governing body CoP. This new provision
would require a hospital's governing body
to directly consult at least periodically
throughout the calendar year or fiscal year
with the individual responsible for the
organized medical staff of the hospital, or his
or her designee. For a multihospital system
using a single governing body to oversee
multiple hospitals within its system, this
provision would require 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 in addition to the other
requirements proposed here. We are also
proposing to remove the requirement for a
medical staff member, or members, to be on
a hospital's governing body."
Synergy - July/August 2014

Table of Contents for the Digital Edition of Synergy - July/August 2014
