CMS, NPDB, Joint Commission and Peer Review Compliance: Legal Updates on Medical Staff Issues

Course Description:

Medical staff policies and procedures that do not correct for bias make for bigger problems than mere bad optics. Bad faith credentialing loses opportunities for hospitals, harms overall staff morale and jeopardizes both physicians reputations and patient care. Prejudiced peer review means huge damages in court. Bad faith peer review is a moral hazard. Diversity, equity and inclusion are often included as goals in hospital mission statements. Failure to address DEI in medical staff documents creates a disconnect.

Given the many opportunities for liability exposure, hospitals, medical staffs, physicians and other providers must be familiar with the restrictions the law places on peer review. There is relief available: federal and state laws extend immunity and confidentiality to protect both the subject of peer review and those who are conducting peer review. But those protections must be earned, and the qualifications are not necessarily obvious. Peer review mistakes, such as discriminatory practices or procedural shortfalls, are costly for all involved.

This webinar will review basic medical staff processes that need to be corrected to comply with state and federal law and regulation, and Joint Commission accreditation standards.

Learning Objectives:

Review federal legal requirements for fairness in peer review
Identify areas where peer review abuse happens
Provide examples of discriminatory peer review
Explain guardrails to use to protect peer reviewers
Help individuals measure whether their peer review processes are unfair
Explore the peer review reporting quirks of the National Practitioner Data Bank
Provide ways to comply and avoid unnecessary reporting
List resources for peer review guidance
Take questions and discuss answers

Areas Covered in the Session:

Addressing Bias in Medical Staff Credentialing & Peer Review
Defining Physician Peer Review
Peer Review is Mandatory in Hospitals
- Law
- Accreditation Standards
- Medical Staff Bylaws
Peer Review Advantages
Peer Review is Protected
- Protected by state & federal statutes
- Protected under professional liability insurance policies
- Protected by medical staff bylaw
Hospital Peer Review Actions Don’t Stay in the Hospital
- State Licensing Boards
- National Practitioner Data Bank
- Third party Insurance Contracts
- Next (if any) Employer/Partner
Balancing Interests
- Patient care quality
- Potential liability for hospitals and medical staff leadership
- Physicians’ reputation
Conflicting Interests
- Competition
- Profit
- Power
Components of Medical Staff Peer Review
Hospital Medical Staff Peer Review Processes
- Application Process
- Credentialing & Privileging
- Ongoing Professional Performance Evaluation
- Focused Professional Performance Evaluation
- Provider Wellness
- External Peer Review
- Investigation
- Corrective Action
- Hearing Rights
- Appeal Rights
- Reporting to state and federal governments
All Components Equal? Equally Protected?
The Dangers of Peer Review Abuse
- Targeting A Professional Because
- Peer Review for The Wrong Reasons
- Conditional Immunity
- Limitation On Damages for Professional Review Actions
Protect Peer Review
Warning: Federal Law Immunity Does Not Apply to AHPs, State Law Varies
- Under the federal Health Care Quality Improvement Act of 1986: Adequate Notice & Hearing
Medical Staff Documents
- HCQIA & state laws
- Notice & Transparency
- Confidentiality
- Access to All Information, Including Favorable
Avoid Weaponizing Reporting
Resources and Documents: Look for Peer Review Procedural Problems
What to Look For?

Suggested Attendees:

Hospital Administrators
Compliance Officers
Medical Staff Leaders
Medical Staff Office Managers
Chief Medical Officers
Health Care Attorneys
Medical Staff President/ Chief of Staff
Bylaws Committee
Credentialing Committee
Vice President of Medical Affairs
Director of Medical Staff
Medical Staff Attorney
Hospital Counsel
Credentialing Specialist
Human Resources Professionals

About the Presenter:

Elizabeth “Libby” Snelson, ESQ., helps medical staffs across the country with medical staff bylaws, and works for medical societies on medical staff issues. A frequent speaker on medical staff legal issues, Ms Snelson presents at medical staff leadership retreats, and in programs sponsored by state medical staff services associations and medical societies, the American Medical Association, the American Bar Association, and other organizations. She is Past President of the American Society of Medical Association Counsel, Vice President of the ABA’s Physician Issues Interest Group, and serves Of Counsel to the Minneapolis law firm of Lockridge Grindal Nauen. She was a member of the Joint Commission’s MS 01.01.01 Task Force. Her articles on medical staff legal issues have appeared in various publications. She is the author of The Physicians’ Guide to Medical Staff Organization Bylaws, published by AMA, the Massachusetts Medical Society’s Model Medical Staff Bylaws, the North Carolina Medical Society’s Model Medical Staff Bylaws, and other model medical staff documents. Ms Snelson provides expert testimony in peer review litigation.

Additional Information:

System Requirement:

Internet Speed: Preferably above 1 MBPS
Headset: Any decent headset and microphone which can be used to hear clearly

For more information, you can reach out to the below contact:
Toll-Free No: 1-302-444-0162
Email: care@skillacquire.com

Snippet From Our Previous Session:

Related Webinars You May Like:

Testimonials:

"This program on HIPAA did a great job providing actionable concepts in a way that updated our team and me, I now know how I will implement the concepts because I already did it in their online seminar, it was easy to ask questions from the speaker at the end of my 60 minutes course"

Melissa Preston, Health Information Management Staff

"David Vaughn covered the material completely and I have a new understanding of when, where and why we need to use an ABN"

Sandie Fowler, Out of Network Billing Staff

"Great presentation. Able to do during the day. Timing was great"

Tina Duffy, Compliance Officer

Buy this