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AMA, AHA at Odds Over 'Surprise' Medicare Final Rule

Cheryl Clark, for HealthLeaders Media, June 18, 2012

The medical staff must be specific to each hospital, he wrote, to serve "as a vital resource for real-time clinical feedback regarding what does and does not work.  For these efforts to be successful, it is essential that a locally organized medical staff oversee care delivery and provide a primary perspective regarding how that hospital's care coordination efforts are working for that local patient population."

Governing boards
Umbdenstock says that CMS' new requirement that each hospital's governing body must include at least one medical staff member caught the AHA by surprise as well because it was not in the proposed rule, violating the Administrative Procedure Act.

If it had been in the proposed rule, CMS would have heard five essential reasons why many hospitals can't comply.

  1. Since governing boards of many hospitals are elected, those hospitals "would not meet the requirement unless a physician decides to run for the hospital's board/commission and is successful in that campaign."
  2. Publicly owned hospitals may have trustees whose members are appointed by the county council or another elected official, and are limited to choosing "individuals who best fulfill the fiduciary responsibilities for these important public hospitals."
  3. In some states, such as Iowa, the law specifically prohibits a person or a spouse of a person with medical or special staff privileges" from serving as a trustee.
  4. Public university boards of regents serve as governing boards of university hospitals.
  5. Investor owned hospitals have governing boards selected by their investors, and it's "not appropriate for an agency to interfere with the choices made by investors in a privately held company."
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