Synergy - July/August 2014 - 28

NAMSS FOCUS

efficiency, quality, and patient safety at
the system and individual hospital level,
consistent with applicable state law and
accreditation requirements. NAMSS
urges CMS to reconsider and clarify its
position regarding the 'single medical staff'
requirement to permit such flexibility.
NAMSS requests that CMS' final rule better
reflect its intent to eliminate ineffective and
inefficient policies by consistently granting
individual hospitals more flexibility to enable
hands-on medical leadership at the local
level while still maintaining the benefits of a
unified, system-wide medical staff."

(3) We are requiring that the unified and
integrated medical staff is established in
a manner that takes into account each
hospital's unique circumstances and any
significant differences in patient populations
and services offered in each hospital.
(4) We are also requiring that the unified
and integrated medical staff gives due
consideration to the needs and concerns of
members of the medical staff, regardless of
practice or location, and the hospital has
mechanisms in place to assure that issues
localized to particular hospitals are duly
considered and addressed."

Hospital governing bodies are no longer
required to include medical staff members.
CMS' Final Rule (2014):

Key Takeaway:

"We are retaining the current regulatory
provision but reinterpreting it to allow for
either a unique medical staff for each hospital
or for a unified and integrated medical staff
shared by multiple hospitals within a hospital
system. We are adding four new provisions to
hold a hospital responsible for showing that it
actively addresses its use of a system unified
and integrated medical staff model.

Medical staff in multihospital systems may
integrate into a larger medical staff or
operate individually within the system. The
final rule revises the proposed mandate that
each hospital within a multihospital system
have its own medical staff and reverts to
the original and current requirement that
"the hospital must have an organized
medical staff that operates under bylaws
approved by the governing body and is
responsible for the quality of medical care
provided to patients by the hospital." The
final rule adds the above four stipulations
to the original/current requirement
to ensure that each hospital "actively
addresses its use of a unified and integrated
staff model."

(1) We are requiring that the medical
staff members holding privileges at each
separately certified hospital in the system
have voted either to participate in a unified
and integrated medical staff structure or to
opt out of such a structure, and to maintain
a hospital-specific separate and distinct
medical staff for their respective hospital.
(2) We are requiring that the unified
and integrated medical staff has bylaws,
rules, and requirements that describe its
processes for self-governance, appointment,
credentialing, privileging, and oversight-as
well as its peer review policies and due
process rights guarantees-which include a
process for the members of the medical staff
of each separately certified hospital (that is,
all medical staff members who hold specific
privileges to practice at that hospital) to
be advised of their rights to opt out of the
unified and integrated medical staff structure
after a majority vote by the members to
maintain a separate and distinct medical
staff for their hospital.
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5. Practitioners Permitted to
Order Hospital Outpatient
Services
CMS' Proposed Rule (2013):
"We propose to revise the outpatient
services CoP to allow for practitioners who
are not on the hospital's medical staff to
order hospital outpatient services for their
patients when authorized by the medical
staff and allowed by state law."
NAMSS' Comment (2013):
"NAMSS appreciates CMS' clarification
regarding outpatient orders for
practitioners who are not members of a

hospital's medical staff and the resulting
efficiencies that it affords hospitals and
MSPs. In realizing these efficiencies,
NAMSS recommends that CMS specify
the timeframe and the duration of the
verification process for such orders, as they
vary in frequency and urgency."
CMS' Final Rule:
"We are revising the outpatient services CoP
to allow for practitioners who are not on
the hospital's medical staff to order hospital
outpatient services for their patients when
authorized by the medical staff and allowed
by state law."
Key Takeaway:
Any practitioner who is responsible for the
care of the patient, licensed in the state
in which he/she cares for the patient, acts
within his/her scope of practice under
state law, and is authorized in accordance
with medical staff policy and approved by
its governing body may order outpatient
services. This applies to hospital medical
staff members who are privileged to order
applicable outpatient services, as well as
practitioners who are not medical staff
members, but meet the above criteria for
"authorization by the medical staff and
the hospital for ordering the applicable
outpatient services for their patients." These
requirements also apply to all hospital
outpatient services.

Looking Ahead
Reducing waste and increasing effective and
efficient hospital management is a constant
task that requires careful deliberation.
NAMSS appreciates CMS' consideration
of public feedback and will continue to
monitor proposed CoPs changes to ensure
NAMSS' member interests are represented.
These rules took effect on July, 12, 2014:
http://www.gpo.gov/fdsys/pkg/FR-201405-12/pdf/2014-10687.pdf. ■

Molly Giammarco is NAMSS'
Government Relations Manager.
You can reach her at
mgiammarco@namss.org.
http://www.gpo.gov/fdsys/pkg/FR-2014-05-12/pdf/2014-10687.pdf http://www.gpo.gov/fdsys/pkg/FR-2014-05-12/pdf/2014-10687.pdf
Synergy - July/August 2014

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