Physician-Hospital Integration in the 21 st Century. Hoyt J. Burdick, MD, FACHE. Physician-Hospital Integration in the 21 st Century. Background and perspectives Economic integration and alignment Employment doesn’t assure engagement Dual track physicians.
Hoyt J. Burdick, MD, FACHE
Hospital-Employed Physicians: How Medical Staffs are Coping with the New Reality
Janice Dinner, Esq., Associate General Counsel, Banner Health
Karen Owens, Esq., Partner, Coppersmith Schermer &Brockleman PLC
American Health Lawyers Association 2013 Meeting
The management of medical care has become too important to leave to doctors,
who, after all, are not managers to begin with.
FORTUNE Magazine, 1970
Source: Changing Demographics, Competencies and Physician Leadership
Peter Angood, MD, presentation, July 27, 2013
Be willing to share leadership and work collaboratively with one another
Be willing to deal with each other as true partners
Make changes in our behaviors that get in the way
Clarify what changes in the patient care process are needed
Understand what our patients need from us
Encourage the community to use our local physician and hospital services
“Review by one’s peers within a hospital is not only time consuming, unpaid work, it is also likely to generate bad feelings and result in unpopularity.”
Scappatura v. Baptist Hospital, Arizona, 1978
Until 1986, physicians performing peer review still faced potential extremely serious federal liability, particularly under the anti-trust laws.
Health Care Quality Improvement Act
- adequate fair hearing
- qualified good faith immunity
“Hospitals resisted claims that physicians were their employees simply by virtue of being medical staff members.
Most courts found that simple medical staff membership did not equate to an employment relationship because physicians operated with too much autonomy to satisfy legal standards for employment.”
Diggs v. Harris Hosp. Methodist, Inc., 1988
St. Luke’s Health System v. State, 1994
Under the traditional model, hospitals typically could not be held directly liable for physician negligence.
- Ostensible agency – plaintiff led to believe that the physician was
controlled by the hospital
- Negligent credentialing – hospital failed to adequately credential
or oversee the quality of the physician through the peer review
CMS, in its Conditions for Medicare Participation, requires hospitals to delegate peer review responsibilities to the medical staff (42 C.F.R. 482.12) and these requirements are incorporated into Joint Commission Medical Staff Standards.
- Revisions to Final Rule May 12, 2014
- Hospital Governing body to consult periodically with medical staff
- Enables unified medical staff for multi-hospital systems
The Incidental Economist
Contemplating health care with a focus on research,
an eye on reform
Hospitals are employing more physicians: what it means for the rest of us
The changing health care environment, and what it means for health IT
Posted on August 15, 2012 by Robert Rowley
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