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MEDICAL STAFF BYLAWS – PREVENTION IS THE CURE

June 22, 2020

How Medical Credentialing Bylaws Set the Stage for Transparency in Provider Population Background and Current Behavior

A health care organization’s bylaws add a structure of guidance to the hiring practices of providers, leadership, and even the board and vendors. Bylaws arm the human resources staff, the medical staff services professionals, credentialing committees, the medical executive committee, and the board from being accused of using bias in hiring and privileging decisions. The assumption that a provider should be excused from background checks, drug testing, and continuous monitoring is to betray the patient population. The health care consumer innocently believes that the hospital, clinic, or surgical center has checked providers for criminal behavior, addiction, fraud, and competence. Every health care institution should include corporate statutes and bylaws that protect patients, not aberrant providers.

By Hugh Greeley, author of Hugh’s Credentialing Digest

A Historical Look at Medical Staff Services and Credentialing

Over past decades, medical staff services professionals have advanced their procedures and regulations only at the expectation of accreditation agencies or when required by law to do so.

Consider the long-forgotten medical staff controversy about adding a clause to the bylaws eliminating discrimination based upon race, religion, creed, color, or national origin. At the time, the medical staff services department fought that one tooth and nail. Hard to imagine today, but still entirely possible.

Readers may remember the great uproar surrounding requirements in the early 1970s that called for careful audits of care quality and practitioner performance. Adding a simple criminal background check to initial credentialing procedures took the nation’s medical staffs nearly a decade, slowed or stopped in its tracks by cries from within the staff that such a check was an insult to physicians. There even were some who stated categorically that physicians could not possibly have a criminal record, so why go to the trouble of checking?

One of my favorites was the suggestion that a physician at a hearing should be able to receive counsel from an attorney. Why medical staffs resisted that one escapes me.

Then came another controversy sweeping the land of the so-called “organized, self-governing, volunteer medical staff” that of implementing a substance abuse clause. With everything we know about the subject including but not limited to:

  1. Peer-reviewed articles about the prevalence of this problem and the need for early detection;
  2. Getting “burned” by a new appointee;
  3. Receipt of recommendations from physicians’ aids or impaired practitioner committees; it is surprising that knowledgeable medical staff leaders continue to listen to the few who won’t recognize the hypocrisy of not requiring a simple drug test when a new physician applies for staff appointment.

The case for such testing is clear—some physicians, like others throughout society, abuse drugs. This is without controversy. In fact, there is evidence that the drug abuse rate among some medical specialties may be higher than the overall rate in society.

Fortunately, early detection and provision of assistance (treatment) does work for physicians, just as it does for others. But the legal case is crystal clear—hospitals and their medical staffs have the right to require such testing.

Physicians are not being deprived of any constitutional right because no special constitutional right making physicians a privileged class when it comes to drug testing exists.

If some think such a requirement is insulting, how do they reconcile similar requirements for pilots, schoolteachers, NASA scientists, military personnel, and every other person working alongside them in the hospital, i.e., each nurse, physician’s assistant, therapist, employed physician, transport aide, etc.?

The logical and correct response must be that they cannot reconcile it. Physicians are human beings, albeit highly educated and spectacularly well-trained ones, but nonetheless vulnerable to the same follies as all human beings.

There is, of course, the need for careful deliberation once a staff has decided to insert a substance abuse clause into its standard procedures for applicants. Exactly what substances might the staff be interested in? Certainly not the presence of alcohol in the bloodstream, for that would identify the majority of applicants, and perhaps not the presence of THC, for marijuana reportedly is less harmful than alcohol and would, depending upon the state, identify many unnecessarily. Methamphetamine, heroin, cocaine, and other drugs of this type might be possible targets.

Additionally, the drug-testing policy must address the consequences of both refusal to submit to such a test (“It’s up to you, but your application will not be processed until the test results are received.”) and the consequences of a positive drug test.

This time around, it would be professional if medical staffs beat society to the punch and did not wait to be told that this is a good idea. In the absence of such enlightenment, the parents—read that “board of directors”—may need to step in and simply create a house rule. End of issue.

Credentialing Resources to Assist Medical Staff Services

Verisys Connect is Verisys’ self-service data search portal that provides real-time data solutions to address background information and other health care related primary source searches.

Data Insights for Health Care Best Practice outlines data sources and reveals the 360-degree view of a provider.

Also, the e-book, “Closing the Five Critical Gaps in Health Care Screening, Verification and Monitoring for Credentialing” reveals the data solutions that close the data gaps that expose health care organizations and patients to avoidable risk.

Hugh Greeley Written by Hugh Greeley
Credentialing and Healthcare Industry Expert
HG Healthcare Consultant
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