Regulation of Hospital - Provider Relationship

Question 1

Regulation of Hospital v. Provider Relationship

Answer 1

History:
Physicians had lots of independence and quickly moved around, now they are employed by hospitals or have contractual relationships. majority of doctors are hospital employees, and a small number are independent contractors.

Policy:
Good because attractive since structured employment under certain regulations (i.e, increased data reports, eliminated administrative burden to data quality reporting)
Bad: strips away personal autonomy in navigating heathfield, and takes away autonomy from practice.

Question 2

Hospital Privileges and Medical Staff Membership

Answer 2

Admitting: doctors admit their patients to the hospital and ability to take care of them and use hospital facilities

Practicing/Clinical: granting clinical privileges to practice in specific areas, and hospitals have a list of what the scope of practice is, controls what could be done. Individual hospitals will have scope of practicing privileges and what each doctor who has practicing privileges can do.

Medical Org Structure:
Organized Medical staff: independent associations within a hospital organization. Created by board. Governed by the bylaws (both hospital and medical staff bylaws), responsible for evaluating and creating requirements for credentials for doctors to apply. Do NOT need to be hospital employee, no need to hold privileges. Board has the final say on granting clinical privileges.

Governing board: Almost like board of directors, adopt its own set of bylaws, appointment and reappointment of medical staff, can grant, revoke, or deny privileges

Question 3

Scope of Privileges

Answer 3

Courts will be wary to modify decisions to grant, revoke or deny privileges made by the medical staff unless there is an abuse of discretion or the board’s decision was arbitrary, capricious, or unreasonable (Sokol). No taking away power from legislatures.

Question 4

Hospital Physician Contracting

Answer 4

Hospitals have broad deferential standards to reorganize their department even if it leads to exclusion of certain doctors if it’s focused on maintaining improvement of patient safety and quality of care. No chance to bylaws. (Fresno Community Hospital).

Question 5

Anti-Competitive Purposes

Answer 5

Also give very deferential position to the board to make decisions on behalf of hospital. Medical staff makes recommendations on boards, but the board has broad discretion in authority to make business decisions.