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QUESTION: What do you recommend for the composition of the Credentials Committee and the terms for service for the members?
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ANSWER: A Credentials Committee is best composed of experienced leaders, such as past chiefs of staff or other physicians who have had medical staff leadership experience. Many Medical Staffs have representation from a variety of specialties to ensure that the committee has the expertise necessary to address difficult credentialing and privileging issues. With the increasing number of advanced practice clinicians (e.g., nurse practitioners and physician assistants) providing services in hospitals, more and more Medical Staffs are appointing at least one advanced practice clinician to the Credentials Committee as a voting member and for that individual’s input and expertise on the topic of credentialing and privileging these providers.
Service on the Credentials Committee should be the primary medical staff obligation of the members and terms should be at least three years so that committee members have an opportunity to gain some experience and expertise in credentialing. The terms should also be staggered so that there is always a repository of expertise on the committee. This Credentials Committee’s primary responsibility is to review and make recommendations on applications for medical staff appointment and clinical privileges. It can also oversee the development of threshold eligibility criteria for clinical privileges.
QUESTION: Did CMS recently change its regulations on supervision of physician assistants?
ANSWER: Yes. CMS recently issued a final rule that revised its regulations on physician supervision. This rule explains that CMS will largely defer to state law and state scope of practice rules for issues involving supervision of physician assistants (“PAs”). In situations where there is no state law governing physician supervision of PA services, CMS will look for documentation of the PA’s scope of practice and the working relationships the PA has with supervising physicians (when furnishing professional services).
Crucially, you will need to check your state law to verify whether these changes will have a significant impact on your organization.
QUESTION: We heard that a new exception in the proposed Stark rules would allow a hospital to provide “recruitment” assistance to a physician who wants to employ a physician assistant. Is this true?
ANSWER: Yes. CMS recently proposed a number of changes to the Stark Regulations, among them, a new exception for payments made by a hospital to a physician to assist the physician in the employment of a “non-physician practitioner” in the geographic service area of the hospital. Under the proposed new exception, a “non-physician practitioner” includes physician assistants, nurse practitioners, clinical nurse specialists and certified nurse midwives. The non-physician practitioner must also be a bona fide employee of the physician, and the reason for employing the practitioner must be to provide primary care services to the patients of the physician. The proposed exception also includes a two-year limit on assistance and a cap on the amount given by the hospital to the physician.
However, please remember that these are proposed rules. The safest course of action is to not enter into these arrangements until the rules are final. But, if a hospital does not want to wait, it could follow the proposed rules. However, that is risky since the proposed rules may never become final, or may change before becoming final.
To help you stay on top of this very important development, join Horty Springer partners Dan Mulholland and Henry Casale as they discuss the proposed changes to the Stark Rules during a special audio conference entitled Stark Reality Check! — CMS Proposes New Stark Law Rules on August 17, 2015 at 1:00 pm ET.