Think early and often about fair hearings

When a concern with a pracititoner surfaces, always think, "What if this goes to a fair hearing?" Keep the following tips in mind throughout all professional review activities, even if a concern is not currently present. Issues sometimes surface much later, so you want to be confident that looking back, everything was compliant with the bylaws.

Refer to the bylaws early and often

It’s common for medical staffs to begin managing a situation as it slowly unfolds. Before you know it, you may unintentionally:

• Trigger a part of the corrective action process
• Miss key steps outlined in the bylaws, which allows the practitioner in question to claim he or she was not afforded procedural due process

“When you find yourself dealing with an incident or problematic provider, pull out your bylaws right away and review them. Understand where you are in the process and what your options are for proceeding,” says Jon Kammerzelt, partner and chair of the health & life sciences practice group at Quarles & Brady LLP in Madison, Wisconsin.

Additionally, keep the bylaws and relevant policies close by during peer review, credentialing, and MEC meetings, and constantly check whether medical staff leaders are following them. Also bring the bylaws with you to any meeting regarding the formal corrective action and fair hearing process.

Always speak up when members of your committee overlook the steps set forth in the bylaws, even if you feel like you’re being a pest, says Catherine Ballard, Esq., a partner in the healthcare practice group at Brickler & Eckler in Columbus, Ohio.“The physicians can talk a good talk, but they don’t necessarily know what the walk is,” she says. “A good MSP knows what the walk is.”

Be the conflict-of-interest police 

Remember, one reason all of these processes are in place is to provide the practitioners in question procedural due process, and that includes having a fair review of the concerns raised about them. If a peer or committee member involved in the review has a conflict with the physician, it shoots a hole in the credibility of the organization’s process, Ballard says.

“In this situation, perception is reality. You might think the peer can be fair, but would an outsider looking in feel the same way?” she asks.

Just like it’s your job to raise concerns if the bylaws are not being followed, it’s also the MSP’s responsibility to make sure conflict of interest is top of mind for medical staff leaders.

“She [or he] can prompt the chair of the committee, ‘Don’t forget you need to see if anybody has a conflict of interest,’ ” Ballard says.

Remember, it is up to the committee to decide whether an individual should be recused—not the person with the potential conflict, she says.

Additionally, MSPs are often the only person working in a medical staff services department long enough to know whether physicians have conflicts of interest. If someone should raise a conflict and does not, alert the committee chair of your concerns.

Consult legal counsel

According to Ballard, it is a best practice to have in-house legal counsel attend credentials, peer review, and MEC meetings to weigh in, just in case the committee enters legal waters.

If that’s not possible, be sure to involve legal counsel before:

• A peer review committee places a practitioner on FPPE
• The credentials committee recommends denying privileges to a practitioner
• A recommendation to initiate corrective action is brought before the MEC
• The MEC issues an adverse recommendation
• Summarily suspending a practitioner’s privileges

The earlier you can involve legal counsel, the better. “You might be taking the right action, but if you have had a number of procedural missteps along the way, that right action can be jeopardized,” Ballard says.