Cardiologists Seek Supreme Court Review of Economic Credentialing Case

Three cardiologists have petitioned the US Supreme Court to review an appellate court decision finding that they did not have a claim against a hospital that had allegedly terminated their privileges based on their refusal to refer patients to the hospital's only cardiac surgeon. (Gaalia v. Citizens Medical Center).

The cardiologists claimed that in 2007, they refused to refer patients to Citizens Medical Center's cardiac surgeon because the surgeon's mortality rate exeeded that of other surgeons in the area. They claimed that CMC took action against them, imposing an on-call duty requirement that they were unable to fulfill, essentially leading to the termination of their privileges. They claimed that under the federal Anti-Kickback Act, the hospital wrongfully terminated their privileges under a practice of economic credentialing.

The U.S. Court of Appeals for the Fifth Circuit ruled that CMC had a rational basis for terminating the cardiologists' privileges and that the hospital committed no violation. The cardiologists are seeking review of the decision by the Supreme Court, stating that the healthcare industry needs clarification on when the federal anti-kickback statute applies.


Source: BNA

Arkansas Court Strikes Down Economic Credentialing

The Arkansas Supreme Court upheld a 2009 decision stating that a hospital could not deny staff privileges to physicians with an ownership stake in competing hospital based on financial concerns because this policy violates state laws.

Baptist Health in Little Rock, Arkansas denied staff privileges to 12 physicians stating that its conflict of interest policy permitted the hospital to do so because of the economic interests of the facility.

Organizations such as the American Medical Association joined the physicians as plaintiffs, stating that restricting physician practice through economic credentialing restricts patient choice and that physicians should be evaluated on performance, not financial factors.

This is the highest court decision issued on the subject of economic credentialing. The AMA states that it is an issue that if challenged again, will be determined on a state-by-state basis.


Source: amednews.com
http://www.ama-assn.org/amednews/2010/10/18/prsc1018.htm

Peer Review: Federal Court Says Credentialing Documents Not Covered by Colorado Statutory Privilege

Recently a ruling was made that a Colorado peer review privilege statute does not apply to documents generated by a hospital's credentialing committee and sought by a physician alleging he was wrongfully terminated (Ryskin v. Banner Health Inc., D. Colo., No. 09-cv-1864, 7/9/10).

The U.S. District Court for the District of Colorado said the state law did not bar Dr. Michael Ryskin from seeking documents from the Sterling Regional MedCenter credentialing committee because he provided sufficient allegations that the hospital failed to follow provisions of professional review and fair hearing plans that guaranteed him certain due process rights in the event of adverse actions affecting medical staff privileges.

Of greater importance, the court said, was the fact that the hospital did not appear to have followed its applicable practices for professional review and credentialing activities in Ryskin's case. Because compliance with the statutory procedural requirements is a prerequisite to asserting the privileges, they were not available.

Although the hospital argued that Ryskin may have been entitled to some due process rights if the credentialing committee had made an adverse recommendation against his medical privileges, and although it also argued that no adverse determination was ever made, the court rejected those arguments

The court concluded that, while the state law privileges are designed primarily to shield peer review materials from production in medical malpractice cases, Ryskin's action was not concerned with quality of care issues but was, rather, focused on determining the motives behind his termination.

In a conclusive decision from the court: “Plaintiff seeks not the conclusions of the relevant committees, but their motives. To shield the documents in this lawsuit would be to frustrate the search for truth."

Source: BNA's Health Care Daily 7/19/2010: Federal Court Says Credentialing Documents
Not Covered by Colorado Statutory Privilege

Report Calls for Improved Oversight over Credentialing and Privileging in VA Medical Centers

The Government Accountability Office (GAO) conducted a review of six Veterans Affairs medical centers (VAMCs) to determine if VA policies on credentialing and privileging were being properly implemented. A report detailing this review was released this month.

The report shows that staff at the VAMCs studied were inconsistent in meeting credentialing standards. Some of the issues highlighted in the report include: improper verification of state licensure, failure to document physician performance information, and the failure to detect malpractice information that was not disclosed by physicians.

The VA has accepted the findings of the GAO report and has already taken steps to implement improved policies and oversight over the credentialing and privileging processes. Some of these improvements include: updating the VetPro system by September 2012, working with state medical boards to see if they will provide additional information for credentialing and privileging purposes, and amending the current VA policy so that written verification is not required for states that provide information that can be verified online or over the phone.

To read the full report, click here:
http://www.gao.gov/new.items/d1026.pdf.

TJC Releases Telemedicine Revisions to Hospital Standards

The Joint Commission (TJC) has released revisions to the Leadership and Medical Staff chapters of the Hospital Standards in order to comply with CMS requirements for deeming authority.

Currently, TJC accepts credentialing and privileging by proxy. CMS currently requires that telemedicine providers be credentialed by both the originating and distant sites. TJC would have allowed the originating site (where the patient is located) to accept the credentials and privileges granted by the distant site (where the provider is located) if the distant site is TJC accredited and complies with the appropriate Medical Staff standards.

TJC has revised its telemedicine standards to comply with the CMS rule, but continues to work with CMS and Congress to accept credentialing by proxy by the distant site.

The revised standard is effective July 15, 2010 and can be found here:
http://www.jointcommission.org/NR/rdonlyres/73A1C766-37B6-4EB2-BEB3-2A59C2BE841E/0/CMS_ChangestoCMSHospitalStandards_EPs_July15_20090929.pdf.


Source: The Joint Commission

Doctor Sues Georgetown University for Defamation and Breach of Contract

Dr. Carlos F. Gomez, medical director of the D.C. Pediatric Palliative Care Collaboration is suing Georgetown University for $1.25 million after he was denied staff privileges.

Gomez claims that Georgetown sought him to become a member of the medical staff despite the known fact that he had a past history of substance abuse. Gomez's complaint states that Georgetown rejected his credentialing application in August 2008 "imput[ing] that Dr. Gomez's history of substance abuse had caused harm to his patients." Gomez denies the claim and said that he had been sober for five years and had no malpractice or disciplinary actions against him when he applied to Georgetown.

The two parties settled in January, with Georgetown agreeing to keep his file confidential and to report that privileges were denied based on questions of Dr. Gomez's clinical competency due to his time away from practice.

Gomez claims that Georgetown violated this agreement by reporting to the NPDB that his privileges were denied due to a "diversion of controlled substances."

From an MSP perspective, it will be interesting to see how this case is ruled. We deal with denied applications all the time, but it is surprising to see the alleged settlement reached between the parties and the subsequent NPDB report that stems from this case.


Source: Washington Business Journal
http://washington.bizjournals.com/washington/stories/2009/08/31/story5.html

Anesthesiologist’s Drug Dependency not Protected under ADA

An anesthesiologist who was terminated by a practice group in Oregon failed to show that a chemical dependency problem rendered him disabled under the Americans with Disabilities Act or that his termination was improper, a federal trial court ruled June 6 (Tyson v. Oregon Anesthesiology Group PC, D. Ore., No. 03-1192, 6/6/08).

The U.S. District Court for the District of Oregon ruled that Dr. Geoffrey Tyson failed to demonstrate that he qualified, because of his drug dependency problem, as disabled under the ADA or that the practice group that terminated him, Oregon Anesthesiology Group PC (OAG), regarded him as disabled.

In reaching these conclusions, the court found there was insufficient evidence that his chemical dependency, which allegedly led him to divert patient medications and compromised patient care, constituted a condition that limited his ability to work or carry out another major life activity. He also could not show that he was otherwise qualified for the anesthesiology position he held or the other positions he sought while his privileges at an Oregon hospital were suspended.