CASA Ambulatory Surgery Center Leadership Medical Staff Law, Credentialing and Peer Review Seminar
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1 CASA Ambulatory Surgery Center Leadership Medical Staff Law, Credentialing and Peer Review Seminar MEDICAL STAFF FUNCTIONS: Understanding Roles and Responsibilities Presented by: Erin Muellenberg, J.D LA / NY / SF / DC / arentfox.com
2 Overview Governing Body Medical Staff Laws & Regulations Mandated Functions Bylaws or Policies and Procedures Footer Text 2
3 Footer Text 3
4 Governing Body Accountability for all functions Documentation of requirements Not in operating agreement Identifies role and authority of GB Identifies any delegation Footer Text 4
5 Documentation Organized Medical Staff = Bylaws No Organized Medical Staff = Policies and Procedures Footer Text 5
6 Medical Staff Responsibilities Credentialing Peer Review Process Improvement Infection Control Medical Records Footer Text 6
7 Licensing and Accreditation Health & Safety Code Must be CMS certified to operate as ASC Footer Text 7
8 State Requirements Health and Safety Code System for quality assessment and improvement Appropriate credentialing Privileges determined within scope of license Reappraisal of medical staff Professional with ACLS certification on site when patient is on site Footer Text 8
9 CMS Conditions for Coverage Medical Staff Organization is at discretion of GB Bylaws or policy indicating accountability to Governing Body Granting of privileges to physician and non physicians scope of license training and experience Footer Text 9
10 TIP Be sure medical staff members sign a statement agreeing to abide by the Bylaws/Policies Initial application Reapplication Footer Text 10
11 CMS Conditions for Coverage Medical Staff Credentialing/Privileging Elements GB grants privileges Privileges must be specific Practitioner is legally and professionally qualified Current license Demonstrated competence Peer opinions considered Footer Text 11
12 CMS Conditions for Coverage Medical Staff (a) Process for granting privileges documented Use of outside resources if expertise not available in-house (coalition) Criteria for credentialing and privileging Rationale for granting privileges against recommendation Footer Text 12
13 CMS Conditions for Coverage Medical Staff (b) Bylaws/Policy includes: Reappraisal standards Current credentials Past performance QI/PI profile Emergency transfers Surgical complications Post surgical infection rate Footer Text 13
14 CMS Conditions for Coverage Medical Staff (b) Bylaws/Policy includes Requests for expanded privileges Limitations of privileges Consideration of outside physician assessment Footer Text 14
15 CMS Conditions for Coverage Medical Staff (c) Bylaws/Policies address Mid level practitioners System for overseeing and evaluating quality Specific clinical activities for each practitioner (NP, PA, CRNA) Oversight process (standardized procedures, supervision) Process for credentialing and privileging Periodic evaluation Footer Text 15
16 CMS Conditions for Coverage Medical Records Bylaws/Policy Confidentiality Completion Pre-operative evaluation H&P Elements Footer Text 16
17 CMS Conditions for Coverage Medical Staff QI/PI Process includes Medical record evaluation Patient identification H&P Pre operative diagnosis Operative findings Allergies & reactions Anesthesia administration Informed consent Discharge diagnosis Footer Text 17
18 Infection Control Nationally recognized guidelines Directed by professional with training Integrated in QA/PI program Ongoing Actions to prevent, identify and manage infections and communicable disease; Mechanism for corrective action Footer Text 18
19 CMS Conditions for Coverage Medical Staff (a) Physician order Administration of Drugs Administration supervised by nurse Appropriately stored Avoiding advance drug preparation Pre filled syringes initialed Infection control standards followed Footer Text 19
20 Lab or Radiology Policies must address Procedures for obtaining routine and emergency tests Services provided by ASC Reports included in patient record Footer Text 20
21 Disclosure Conflict of Interest Disclosure of financial interest or ownership Operating Agreement Bylaws Policy Footer Text 21
22 Informed Consent Informed consent policy includes Description Indications Risks and benefits Alternatives Consequence of declining Surgeon and anesthesiologist Non surgeon or anesthesiologist involvement. Footer Text 22
23 Adverse Event Policy Business and Professions Code (eff. 1/1/14) Reported within 5 days Defined Health & Safety Code Wrong site Wrong patient Wrong procedure Retained FB Death w/in 24 hours Produce or device failure Air embolism, etc. Footer Text 23
24 Transfer Agreements Health & Safety Code Policy requires transferring provider to cooperate in medical staff peer review process Inappropriate care reported to accrediting agency Permits surgery only by licensees with admitting privileges or must have written transfer agreements with licensees with admitting privileges Footer Text 24
25 TIP All Bylaws/Policies, Privileges, New Applicants, Reapplicants APPROVED BY GOVERNING BODY Footer Text 25
26 Footer Text 26
27 Code of Conduct Elements Examples of Inappropriate Behavior Verbal abuse Non communication Physical abuse Threatening behavior Expected behaviors Reporting Consequences Footer Text 27
28 Impairment
29 Questions? Footer Text 29
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