Creating a Unified Medical Staff

By: Jenna Downey, Esq., director and corporate counsel, Premier Health

The evolution and growth of Premier Health has raised the question: is it time to create one, unified medical staff? From the physician perspective, there are a range of benefits to a unified medical staff. The consolidation of medical staff functions and obligations would reduce redundancy and decrease the burden on physicians. A unified medical staff would also increase efficiencies in approval processes when implementing policies, safety initiatives and clinical protocols, and facilitate information sharing between peers. However, the perceived loss of local autonomy resulting from a unified medical staff is a valid concern. In this article, we will explain the proposed structure of a Premier Health medical staff that seeks to preserve a local presence of physician leadership at each site and ensure meaningful representation at the system level.

Backgroundloc

Similar to the recent standardization of the Medical Staff Bylaws, Dr. Mary Hoppa of the Greeley Company facilitated two three-hour sessions to discuss what a unified medical staff could look like for Premier Health. Twenty-four physicians from Premier Physician Network, Miami Valley Hospital, Atrium Medical Center and Upper Valley Medical Center were invited to participate, including variety in both independent and employed physicians as well as primary care and specialists. Issues concerning governance, leadership, and departments were thoroughly vetted and ultimately voted on by these participating physicians.

The Proposed Premier Medical Staff

Medical Executive Committee (MEC)

The MEC structure resulted from a compromise between facility size and equity of representation. As such, the MEC’s 15 voting members would include the president and president-elect of each facility (to ensure equal representation) as well as the newly created at-large members for each facility, with MVH having four, AMC having three and UVMC having two (to account for facility size). This MEC would be the recommending body and voice of the medical staff to the Premier Board of Trustees on system medical staff matters, including system initiatives/policies, corrective action, credentialing, and privileging.

Medical Staff Operating Council (MSOC)

The MSOC at each facility preserves the importance of local physician leadership in addressing site-specific issues. These councils include the officers of each facility (president/president-elect), site department chairs, a Credentials Committee representative, the MSQC chair, and a School of Medicine representative (MVH only). The MSOC would oversee the medical staff functions at its own facility as well as monitor and recommend action to the MEC concerning quality, patient safety, and the competency and professional conduct of its medical staff members.

Medical Staff Leadership

As it is a regulatory requirement that a medical staff has one leader, there will be a chief of staff for the Premier Medical Staff. Each facility would still have a president and president-elect. The new chief of staff position would be selected from the presidents of each facility by the MEC, and the president-elect would be nominated by each facility’s MSOC and voted on by the active members of the facility. Other new leadership positions, referred to as “at large” positions, will be created to provide facility representation at the system MEC. These positions will be nominated and elected by each site’s MSOC.

Departments; System Committees versus Site Committees

The departments of the medical staff would reflect the current structure at MVH. If the facility has the specific department, then it will have a facility department chair. Each department will have a System Department Chair who will be elected from the facility department chairs. Both the Credentials Committee as well as the Practitioner Wellness and Behavior Committee will become system medical staff committees. However, the Medical Staff Quality Committees will remain specific to each facility.

What’s Next

Each independent medical staff at each hospital must decide to come together to form one Premier Health medical staff. This means that each medical staff must vote, by majority, either to accept a unified and integrated medical staff structure or to opt out of such structure and to maintain a separate and distinct medical staff for their respective hospital. Once a unified medical staff is approved, it is required that the medical staff bylaws have appropriate procedures for opting out of the unified structure as well.

Back to the December 2019 issue of Premier Pulse.