Volume 28
No. 9

N E W Sx I T E M S

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Membership categories evolve


When I look back at columns I've written for the Medical Staff Update, I'm sometimes struck by how yesterday's innovations can become today's launching pad for change. (I'm also struck by how many things remain consistent through the years, but I'll get to that later.)

Recently, as I prepared this article, I pulled out my December 1996 column entitled Benefits and Responsibilities of Medical Staff Membership. At that time eight years ago I discussed a new innovation, "affiliate" staff membership. This category differentiated those physicians who wanted to maintain a connection with the hospital from those "active" physicians who admitted patients to the hospital, treated patients in the clinic, or served as consultants.

We had created the new category to accommodate practitioners who wanted to continue on the staff for a variety of reasons, especially those staff members who reported to us that they needed a medical staff membership to participate in certain insurance plans.

Even since that relatively recent point in time, medical practice has become more compartmentalized. Some of us are spending more and more time practicing in the hospital, while others of us rarely or never come to the hospital professionally, except perhaps, for courtesy visits to patients. In light of this evolution, the National Committee on Quality Assurance (NCQA), the accrediting body for many health maintenance organizations, no longer requires hospital privileges for all physicians who participate in HMO's. The NCQA finally realized that "...admitting privileges may not be applicable to certain physicians who practice exclusively in ambulatory settings."

At the same time, it has become increasingly clear that our legal and ethical responsibilities to validate those who carry the Stanford Hospital mantle have crystallized. Several accrediting bodies and laws - including JCAHO, NCQA, IMQ and Title 22 - mandate us to assess a provider's competence. As an institution we cannot do this objectively and fairly until after individual caregivers have conducted at least some inpatient or outpatient care activity within our institution. Furthermore, we are increasingly integrating our assessment efforts with our overall quality enhancement programs. It is no secret that a proactive quality improvement program involves participation - including evaluation - of the professionals who provide that care. Therefore, physicians on our medical staff must effectively and comprehensively participate in our quality assurance and peer review programs. This is a process that is reasonable and productive for those who practice at SHC, but surely onerous and perhaps irrelevant for those who don't come to our hospital.

To account for this enhanced role of physicians in quality assurance, the credentials committee in May 2003 acted with the direction of the Medical Board, Hospital Administration and the Hospital Board of Directors to eliminate the "affiliate" medical staff category and only reappoint and credential those practitioners who have at least minimal patient activity at this facility.

So from now on, when medical staff members are slated for reappointment after two years of no patient activity, we will give them an opportunity to "voluntarily resign" or simply let their membership be terminated because of inactivity. (We will review explanatory circumstances, such as leave of absence, sabbatical, etc.).

Please take note that a resignation or termination resulting from inactivity is not regarded as a disciplinary action reportable to any other health care organization. And it's equally important to note that we provide many opportunities for patient activity other than direct admissions. Opportunities that might be appealing to some of you include inpatient or outpatient consultations, or attending in one of the Stanford Clinics. Another opportunity that many of you might wish to consider is to participate in our teaching programs. Physicians who come to Stanford periodically to teach our students or house staff may transition to a "courtesy teaching" category, contingent on the medical school's need and the support of the departmental chair of the cognizant service.

Also, we have a "retired" medical staff membership category that offers a hospital connection for physicians who are no longer seeing patients.

Another change in our credentialing process gives me a brief opportunity to highlight nurse practitioners, physician assistants, etc. who have become so essential to medical care at our facility. The credentials committee has recently taken responsibility for overseeing the appointment and reappointment of allied health professionals (AHP's). The professionals in this category will be reappointed and reviewed similarly to the processes we use to review active medical staff members.

While our policies must account for the evolution of medical practice from hospital-centric to health care and patient centered, I'm reassured that our decisions are driven by quality of care, patient safety and fairness. The details change, but the commitment remains the same.

And even some details remain the same.

When I re-read my column from 1996 I was struck by the fact that our dues for medical staff membership have not increased - $150.00 per year for SHC and $225.00 per year for those who practice at both SHC and LPCH. Nevertheless, the rising costs of everything haven't left us completely unscathed: staff application fees have risen to $300.00 per year and the credentialing fees are now at $62.50 per year/per hospital.

On a much broader scale, I hope you'll read several articles in this issue on the decision by the Board of Hospital Directors to continue our medical staff structure as it is now constituted. I'm sure I'll be saying more about this in future columns, but for the moment, I'd like to say how pleased I am that we have such a clear mandate to continue our status as both a community and university hospital. While medicine has evolved, the underlying philosophy and values of our medical community have endured for nearly 40 years.

Another reassuring constant I noted is that vascular surgeon Walter Cannon is still doing an outstanding job as chair of the Credentials Committee, a post he accepted after completing a two-year-stint as medical staff president in 1989. Walter, a long-time leader in many areas of our medical community, is leading the effort to maintain the outstanding quality of our medical staff in a fair, evenhanded and impeccably thorough and professional manner. I wish to acknowledge all the fine work he has done for this institution in credentials and many other capacities over the years.

I welcome a dialogue with you as we face growth, challenges and evolution in our professional lives. Should you have any questions regarding these matters of medical staff categories and requirements, feel free to contact me at lshuer@stanford.edu, or Sandi Edgar, director of Medical Staff Services, at sedgar@stanfordmed.org.