Hospitals could claim a slight victory after the Joint Commissions decision to delay implementation of the revised MS 1.20 standard, the contentious medical staff standard providers have found reason to dislike.
After a status report from the task force established to review the standard, the commission announced June 2 it would push back its July 2009 implementation deadline to give the review process more time. No new deadline is scheduled yet.
Hospitals can breathe a little easier now that they dont have to rush through what would have been a lot of work to meet that deadline, said Jeff Micklos, senior vice president of business operations and general counsel for the Federation of American Hospitals.
The FAH, along with several other organizations, had protested elements of the revised standard, saying it undermines collaborative leadership efforts between hospital executives and medical staff. The Joint Commission has considered various forms of the standard since 2004. As it stands now, MS 1.20 does not dictate what hospitals must include in their bylaws vs. procedural manuals, but that would change if the new draft is implemented (See chart).
That is only one component of the new wording hospitals dislike, and the continued delay indicates the commission recognizes the problem, said Catherine Ballard, a partner with Cleveland-based Bricker & Eckler who covers medical staff and patient-care issues.
The debate around the standard sheds light on the sometimes tricky relationships among medical staff, the medical executive committee that votes on its behalf and hospital governing bodies. The executive committee is elected by its medical staff to manage time-consuming bylaw process changes that doctors dont want to be burdened with as they practice medicine, Ballard said. Even with the occasional problems between doctors and hospital executives, the bylaws and manuals used to govern the practice of medicine are working, she added. The standard the commission wants to implement would unravel that process by making the entire medical staff vote on all bylaw changes.
In addition, the standard renders the executive committee ineffective by allowing individual doctors to circumvent it if they have a problem, and there should be something in place for physicians to try to resolve problems with the executive committee first, she said.
The Joint Commission said MS 1.20 aims to ensure medical staff feel that they are being represented on quality and safety issues in the hospital. The task force is trying to reconcile some of the issues raised by hospitals and doctors, primarily about the level of detail the standard should include in regards to bylaws, said Chuck Mowll, an executive vice president at the Joint Commission.
The commissions decision to delay was made to ensure hospitals at least 12 months for the implementation process, Mowll said. Pending a final report from the task force, the commission also wants to conduct a field review of the standard in August and September. The task force recommendations and results from the field review will be discussed at the commissions November board meeting, where the board will be asked to approve changes to the standard. Given that schedule, the current implementation date didnt make sense, he said.