A fight for authority between physician and hospital groups continued to escalate as doctors contemplated taking a strong stance against hospitals apparent bid for more oversight of medical staff bylaws.
As part of that fight, the American Medical Association is considering a resolution to drop out of the Joint Commission over ongoing revisions to MS 1.20, which physicians say are weighted in favor of hospital control. The move follows an unexpected decision by the Joint Commission to delay implementation of that rule for one year, under pressure from hospitals led by the American Hospital Association (June 9, p. 12).
Hospitals have taken what amounts to an undemocratic approach to the standard that oversees medical staff bylaws, according to physicians who would prefer the commission implement the MS 1.20 draft approved last year. We are very unhappy with their conduct, said Arthur Palamara, a surgeon in Hollywood, Fla., and patient-safety advocate, who was part of the delegation that submitted the resolution during the AMAs House of Delegates conference. Doctors are pushed out of self-governance.
The resolution calls for the AMA to use all available negotiation tools up to and including nonparticipation if the commission allows MS 1.20 to be significantly altered in favor of more hospital control over medical staff. The MS 1.20 draft approved in July 2007 for implementation assures doctors rights to self-governance and ensures the full medical staff participates in fostering a patient-safety culture within hospitals, the delegation wrote in a resolution submitted to the AMA. Doctors are asking the AMA to adopt a policy of support for the 2007 draft, in addition to calling for action while the task force studies the draft.
The resolution was referred for decision to the AMA board of trustees, which will have to consider it because the issue is important for doctors, said Brian Johnston, a physician and a delegate of the Organized Medical Staff Section of the AMA. They want the board of trustees to seriously think about it, he said.
The AMA will consider it as its representatives appointed to the Joint Commission continue to review the work the MS 1.20 task force conducts. The AMA understands there are valid concerns on both sides about the standard, said James Rohack, a physician and president-elect of the AMA. Our hope, our plan is to create something everyone can agree with, said Rohack, who is one of the seven commissioners who represent the AMA on the Joint Commission board.
Contention around MS 1.20 hasnt settled much in the nearly five years the commission, doctors and hospitals have been debating how to best structure the standard so that everyone is satisfied with the framework. Hospitals claim the 2007 draft undermines collaborative leadership efforts between doctors and hospitals. Now that the commissions MS 1.20 task force has been given more time to evaluate the standard and possibly rewrite parts of it, doctors are concerned the final draft will leave them with weakened autonomy. Rohack said the self-governance of the medical staff is a bedrock principle of the relationship to a hospital. I really dont believe the standard is going to be rewritten to take away authority of the medical staff, he said. However, if changes to that effect do come out of the task forces work, wed draw the line in the sand, Rohack added.
Hospitals are not trying to run roughshod over doctors in the MS 1.20 negotiation process, said Nancy Foster, vice president for quality and patient-safety policy at the AHA. Hospitals around the country recognize the function of a well-working medical staff, she said.