Medical Staff Credentialing & Peer Review Law
As members of a profession, physicians and other health care providers have long embraced an obligation to not only provide care that meets professional standards, but to evaluate and, if necessary, take steps to improve the practices of colleagues. These professional undertakings provide the foundation for the credentialing, peer review, and quality improvement programs that are at the core of the modern medical staffing.
As a result of ever more demanding legal and accreditation standards, medical staffs have been assigned even more responsibility for — and are more accountable to — rigorous credentialing, meaningful peer review, and continuous steps toward quality improvement.
Arent Fox attorneys are known for their broad experience guiding hospital medical staffs. We have advised on questions of:
- Medical staff organization
- Governance and leadership
- Bylaws, rules, and policies
- Peer review
- Investigations and formal hearings
- Appellate reviews
- Practitioner well-being and behavior
- Allied health professionals
- Standards of the Joint Commission on Accreditation of Health Care Organizations
Our team has extensive experience in providing key advice and representation to the medical staff leaders in formal hearings and subsequent governing body appellate reviews, and we have been counsel of record in a number of precedent-setting appellate court decisions. Our experience and background allow us to educate medical staff about their rights and responsibilities, and thereby assist them in reaching the “quality of care” goals that are vitally important to physicians, hospitals, and patients.
Physician Employment and Contracting
The experience we have gained through advising hospitals and medical staffs has positioned us to provide the necessary guidance for medical group employment, physician contracting, accountable care organizations, physician practice in ambulatory care settings, and numerous other comparable new practice arrangements.
As society and the legal system have come to appreciate the importance of the physician’s access to practice settings outside hospital medical staff, the courts, accreditation agencies, and other powerful organizations have extended the requirements of fair procedure and due process to the credentialing and peer review activities of these other entities.
Further, as society transitions from traditional fee-for-service and reimbursement models to various at risk and pay-for-performance schemes, effective health care provider credentialing and peer review not only remain ethically important, but become the keys to medical group, surgery center, and accountable care organization (ACO) sustainability.
In assisting provider groups to create employment relationships or other contracting models, we draw upon our experience in the practice of law as well as our decades of close, collegial working relationships with physicians. We guide groups as they both acknowledge the newer requirements of employment and other contracting relationships, while retaining all that is worthy in traditional physician credentialing and peer review programs.
Medical Staff and medical center leaders, and those who advise them, often view the Medical Staff Bylaws as Holy Writ, or very close thereto. When the Bylaws specifically and directly speak, for example, in matters of credentialing criteria, peer review processes, and Medical Staff hearing procedures, the pronouncements are not viewed as suggestions or hints. Rather, the Medical Staff Bylaws set forth requirements.
For almost 30 years, hospitals and certain other health care organizations have been required to report to the National Practitioner Data Bank (NPDB) specified “adverse actions” regarding physicians and dentists that they employ, contract with, or have on staff.
Earlier this month, Arent Fox Health Care partner Lowell C. Brown published an article in California Healthcare News that provides insight into a key peer review case involving legal principles and individual behaviors that provide critical lessons for hospitals.
ABOUT ARENT FOX LLP
Arent Fox LLP, founded in 1942, is internationally recognized in core practice areas where business and government intersect. With more than 350 lawyers, the firm provides strategic legal counsel and multidisciplinary solutions to clients that range from Fortune 500 corporations to trade associations. The firm has offices in Los Angeles, New York, San Francisco, and Washington, DC.