Did you know that, hidden away in the CMS Conditions of Participation (CoP), there is an often-overlooked requirement that is ideal for increasing medical staff involvement and improving practice evaluation?
In a recent article, we discussed some of the compliance issues that may arise when attempting to implement an FPPE/OPPE process within a laundry list or fragmented privileging system, even when it includes both core/bundle privileging and/or modified laundry list privileging.
Are you auditing your physicians to determine whether they actually show up to the CME programs that they attest to attending? If not, you are likely among the majority of healthcare organizations across the country. But an argument could be made both in favor and against the...
One of the most common myths regarding medical staff governance is that only active staff can vote. The reality is there is no restriction as to who can vote: not from the CMS Conditions of Participation (CoP), not from The Joint Commission, not from any other national regulatory or...
The Joint Commission was scheduled, on paper, to arrive in first quarter 2013-which was why, in October 2012, John H. Stroger, Jr. Hospital of Chicago's Cook County was a little surprised to see Joint Commission surveyors at their door one Tuesday morning. Although the arrival...
The CMS Conditions of Participation (CoP) and The Joint Commission are in complete agreement on this one: Medical staff departments are not required. The CoPs require a "well organized" medical staff. The Joint Commission requires an "organized self-governed medical staff." The Joint Commission...