内容

目次

Chapter 1 — Introduction: Historical Perspective on the Medical Staff/Hospital Relationship 1.1 Preface 1.2 Historical Background 1.3 What are Medical Staff Bylaws? Chapter 2 — Basic Statutory, Regulatory and Accreditation Matters 2.1 Introduction 2.2 Medicare Conditions of Participation 2.3 Accreditation Requirements 2.4 Health Care Quality Improvement Act of 1986 2.5 The Americans with Disabilities Act of 1990 2.6 Potential Claims under Age Discrimination in Employment Act 2.7 State Licensure Laws 2.8 Fair Credit Reporting Act Chapter 3 — Underlying Legal and Business Issues Impacting the Hospital/Medical Staff Relationship 3.1 Introduction 3.2 Corporate Negligence 3.3 Medical Staff Bylaws as a Contract 3.4 Compliance with Bylaws 3.5 Antitrust Concerns 3.6 Economic Credentialing 3.7 Exclusive Contracts 3.8 Board Certification 3.9 Geographic Proximity Requirements 3.10 Number of Admissions 3.11 On-Call Coverage Issues 3.12 Health Care Entity/Physician Integration Issues 3.13 Impact of ACOs and Clinically Integrated Networks on Medical Staff Credentialing 3.14 Hospitalists, Intensivists and Other Hospital-Based Physicians 3.15 Development of Medical Staff Categories without Treatment Privileges 3.16 Responding to Credentialing Inquiries Chapter 4 — Organizational and Drafting Tips for Medical Staff Bylaws and Related Documents 4.1 Medical Staff Input and Involvement 4.2 Structure of Medical Staff Bylaws 4.3 General Organizational and Drafting Considerations Chapter 5 — Content of Key Provisions of Health Care Entity Bylaws 5.1 Introduction 5.2 Establishment of Medical Staff 5.3 Ultimate Authority of the Governing Body 5.4 Priority Between Health Care Entity Bylaws and Medical Staff Bylaws 5.5 Approval/Adoption of Medical Staff Bylaws and Rules and Regulations 5.6 Indemnification Chapter 6 — Overview of Medical Staff Bylaws 6.1 Governance of Medical Staff 6.2 Definitions Consistent with HCQIA 6.3 Nature of Medical Staff Appointment 6.4 Bases for Grant of Clinical Privileges 6.5 Limiting Membership in Departments 6.6 Actions Warrant Privileges and Immunities 6.7 Independent Action by Governing Body 6.8 Amendments 6.9 Dispute Resolution Provisions 6.10 Governing Law Chapter 7 — Credentialing Procedures 7.1 Introduction 7.2 Credentials Committee 7.3 Qualifications for Initial Appointment 7.4 Pre-Application Process 7.5 Application Process 7.6 Processing the Application 7.7 Data Bank and Excluded Provider Queries 7.8 Release and Immunity Provisions 7.9 Recommendation on the Application 7.10 Governing Body Action on Application 7.11 Reappointment Procedure 7.12 Centralized Credentialing 7.13 Categories of Medical Staff Membership Chapter 8 — Privileging: Procedures for Determination of Clinical Privileges 8.1 Introduction 8.2 Establishment of Criteria for Granting Clinical Privileges 8.3 Determination of Clinical Privileges 8.4 Non-Clinical Criteria Impacting Grant of Clinical Privileges 8.5 Granting of Clinical Privileges 8.6 Requesting Change in Clinical Privileges 8.7 Orders for Diagnostic and Therapeutic Services by Non-Medical Staff Members Chapter 9 — Corrective Actions 9.1 Procedures for Corrective Actions 9.2 Summary Suspension 9.3 Automatic Termination Chapter 10 — Fair Hearing Procedures 10.1 Introduction 10.2 Limited Right to One Hearing 10.3 Right to Hearing 10.4 Notification of Proposed Adverse Action 10.5 Notice of Hearing 10.6 Waiver of a Hearing 10.7 Conduct of Hearing 10.8 Decision by Governing Body 10.9 Internal Appellate Review 10.10 Reporting Under HCQIA Chapter 11 — Conclusion 11.1 Conclusion