The Enduring Value of the Medical Staff Organization

Transcription

1 The Enduring Value of the Medical Staff Organization Session Code: MN07 Date: Monday, October 23 Time: 12:45 p.m. - 2:15 p.m. Total CE Credits: 1.5 Presenter(s): Arthur Snow, MD

2 The Enduring Value of the Medical Staff Organization Arthur D. Snow Jr., MD Immediate Past Chair American Medical Association - Organized Medical Staff Section About the AMA Organized Medical Staff Section Through education, advocacy, best practices, and collaboration, the OMSS empowers medical staffs to effect positive change in their practice environments. Visit us at ama-assn.org/go/omss Join us on acebook: facebook.com/groups/amaomss 1

3 Agenda Beginnings of the medical staff organization (MSO) The MSO & today s health care environment The MSO as a provider of value Beginnings of the Medical Staff Organization (MSO) Originated with a set of principles developed by the American College of Surgeons (ACS) in 1919 known as the Minimum Standard Document. 2

4 The Minimum Standard Document was the result of six years of work by Dr. Ernest Amory Codman and the ACS s Committee on Standardization to address:» Lax record keeping» Significant systemic variation» Poor clinical outcomes The Standard Document required that the medical staff initiate and adopt rules governing professional work at the hospital, including:» Regular monthly meetings» Regular analysis of the clinical care provided» Accurate and complete records for all patients» Availability of competently supervised diagnostic and therapeutic facilities ACS model evolved into the Joint Commission on Accreditation of Hospitals (now The Joint Commission) Federal government requires that hospitals have an organized medical staff in order to receive payments from Medicare & Medicaid 3

5 The traditional medical staff structure was founded on the ideals of autonomy, independence, and selfaccountability» Hospital served as the physician s workshop The medical staff was viewed as a professional, political and social forum for physicians to:» Discuss clinical issues» Define professional perspectives» Address professional concerns» Form a network for communicating with each other and with external parties » The three legged stool of governance Governing board Medical staff Hospital admin. 4

6 » Two legal rulings established the hospital s direct accountability for patient outcomes Bing v. Thunig (1957) Darling v. Charleston Community Memorial Hospital (1965)» Hospitals responsible for the care delivered by physicians within their institution Now required cooperation from medical staff for quality assurance » The emerging role of the medical staff professional (MSP) Medical staff coordinators, manager, director, vice president» The National Association Medical Staff Services Certification programs Education Resources The MSO and Today s Health Care 5

7 The MSO and Today s Health Care » HMOs penetrated 1/3 of the large commercially insured market» Consolidation The MSO and Today s Health Care The community institution transformed into a business enterprise» Hospitals forced to focus on cost management and increasing market share in their dealings with physicians The MSO and Today s Health Care Business transformation included:» Hospital service lines and co-management agreements» Economic credentialing» Salaried physician employment Hospitals cut back on in-house services and uses of technology, while developing networks of remote facilities and services 6

8 The MSO and Today s Health Care The impact on the MSO: the unengaged medical staff» Hospital employed specialists covering 24/7 services» Community-based physicians no longer wishing to spend time rounding and/or treating patients in the hospital» Independent physicians in direct economic competition with the hospital The MSO and Today s Health Care The impact on the MSO: The generational gap» Older members tend to be more traditional, autonomous and intrinsically motivated to work long hours» Younger (many employed) physicians are benchmarking their income expectations based on the 80 hour a week work norms of older physicians; may not attend meetings after hours The MSO and Today s Health Care The traditional medical staff organization has lost its relevancy; it is a dinosaur from a reimbursement and legal system that is being replaced by a system demanding value and collaboration. Pershing Yoakley & Associates, P.C. Medical Staff 2.0: Revolutionizing the Hospital-Physician Relationship 7

9 The MSO and Today s Health Care MSO processes are detailed in hundreds of pages of regulations, accreditation standards and staff bylaws» Conflicts over shared responsibility with hospital leadership» Time spent defining rules/respective roles rather than pursuing opportunities for organizational improvement hinders efforts to transform care The MSO and Today s Health Care Maintaining traditional, bureaucratic, legalistic organized medical staff activities is an expensive resource for hospitals» Medical staffs are finding that they must make do with less support from financially strapped hospitals The MSO and Today s Health Care 2010 and beyond» MSO prerogatives developed 100 years earlier have changed Traditionally small physician practice units has contributed to failures in organizing effectively MSOs struggle with a confusing matrix of officers, committees, departments, as well as levels of hospital leaders with responsibility to the medical staff 8

10 The MSO and Today s Health Care Hospitals are left to organize MSOs and work out patterns of collaboration within and across specialties, distribution of shared fees, and shared savings New/proposed payment methodologies now require hospitals and MSOs to work together in ways for which they have little historical preparation or a poor historical track record The MSO as a Provider of Value The MSO as a Provider of Value Provides key levers to promoting provider quality Conducting credentialing and privileging Establishing the criteria for new and ongoing membership Defining acceptable care standards Monitoring providers ongoing performance 9

11 The MSO as a Provider of Value Renewed investment in the MSO is necessary for positioning both hospitals and physicians for long-term success The MSO as a Provider of Value Lead with quality-related medical staff reform to enhance: Population health Physician satisfaction Patient experience Bodenheimer T, Sinsky C. From Triple to Quadruple Aim: Care of the Patient Requires Care of the Provider. Annals of Family Medicine. 2014;12(6): doi: /afm Cost reduction The MSO as a Provider of Value Foster Engagement The MSO promotes medical staff connectivity, professional satisfaction, and overall well-being Sweat out burnout 10

12 The MSO as a Provider of Value The MSO aligns quality and medical staff services functions Redesign peer review Reduce impact of MSO meetings Develop FPPE/OPPE processes Adopt the right mindset We study the past to understand the present; we understand the present to guide the future. Originally proposed by physicians as a mechanism for overseeing patient safety and clinical quality, the MSO is equipped to govern itself, conduct peer review, credentialing and privileging, and quality oversight functions. 11

13 The MSO & Today s Health Care In today s value-based world, the effectiveness of the MSO continues to be called into question and the prospect of increasing accountability for the cost and quality of care delivered has heightened the imperative for a high-performing MSO. The MSO as a provider of value While many hospitals are exploring new physician partnership models that advance quality goals, the medical staff organization provides a quality foundation that should be refined rather than recreated. Thank You! 12