Synchronize your medical staff processes and exclusive contracts
In addition to employment, many organizations utilize a contract to better align and integrate the parties involved. Such contracts can run the gamut from a relatively simple agreement to interpret EKGs, to an exclusive contract with a cardiology group to provide all cardiac services at the hospital. Some understanding of the nuances is useful for medical staff leaders.
Sometimes one specialty has an exclusive contract that allows only physicians who are party to that contract to be eligible for privileges protected by it. Specialties traditionally covered by such exclusive contracts include radiology, pathology, anesthesia, and emergency medicine. Over time, more hospitals are expanding the scope of specialties that are covered by exclusive contracts, such as pain management, hospitalists (adult and pediatric), intensivists, neonatologists, cardiothoracic surgery, cardiology, surgicalists, and laborists.
Decisions regarding which specialties will be provided under an exclusive contract, and the scope of that exclusivity, are the purview of the governing board, usually with significant management input. Once approved by the board, the hospital enters into an exclusive contract with a staffing company vendor to provide that service. This might be a local or regional physician group or a national company that has expertise in providing the clinical service.
All contracted physicians must still successfully go through the medical staff credentialing and privileging process. There are no exceptions to this because of the exclusive contract. On the other hand, only physicians coming in under the vendor awarded the exclusive contract can be considered for privileges in that specialty. You might think that medical staff leaders and the medical staff services department (MSSD) would always be informed about these exclusive contracts, particularly because their existence ultimately affects who may apply for privileges in the areas that the contracts cover. However, it is not at all unusual to hear that the MSSD has never been informed about some contracts, especially those beyond the traditional radiology-pathology-anesthesia-emergency medicine ones.
As for employed physicians, determination of competency for requested privileges remains the purview of the medical staff. The MSSD needs to know that no other individual or group may apply for privileges in an area that is covered by an exclusive contract. Communicating this fact can alleviate any embarrassment for a practitioner who may not be privy to the exclusive contract and who is told after applying for the privilege that he or she is ineligible.
Also like employed physicians, contracted physicians are held to the same performance standards as any other physician. But once again, there may be different routes for handling nonconformance.
Another major feature of exclusive contracts is that medical staff privileges are tied to the contract. If a physician leaves the group providing the exclusive contract service, then his or her privileges are automatically terminated. Although this is not a medical staff defined process but is instead a contractually defined one, it is still important for medical staff leaders to understand this co-terminus provision (individual contract terminated = no medical staff privileges). Again, loss of privileges tied to an exclusive contract does not entitle the physician to a fair hearing under the medical staff bylaws.
The other feature of such agreements is that the hospital may terminate an exclusive contract with one vendor and contract with another vendor. Under this scenario, the medical staff privileges of the entire group will terminate with the termination of the exclusive contract. The new exclusive contract group will then have to establish individual contracts with new or existing providers. Again, only those physicians who are part of the approved vendor can apply for those privileges.