Let’s think of medical care as a football game. The “win” is a good outcome for the patient. Success depends on excellent performance by multiple players, and they have a variety of specialized roles, as nurses, pharmacists, clerks, transport teams, etc. The owners sell the tickets, build the stadiums, write the payroll, and supervise their employees. The referees (regulators) make sure that the play follows the rules.The physician is both quarterback and coach. The physician both directs the plays and brings unique skills to execute the play.
The team will not function if other players choose their own game plans. Or if the owners step in to call the plays. Or if the owners forget that they need to have a player that can throw the ball. Or forget that collecting dollars is irrelevant if patient care suffers.
The practice of medicine has always required complex, multifactorial decision making. But in recent years, the economic power of healthcare corporations (hospitals, and others) has grown, and created a new array of pressures which are sometimes conflicting.
Because of our community’s unfortunate litigation history, Yakima County Medical Society is committed to promoting successful physician work through physician friendly initiatives to protect physician decision-making from corporate pressures. Physicians are not always right, nor are attacks on physicians always right. But we can apply the rules of science so that judgment of physician performance in Peer Review, MQAC, employment law, and malpractice law can more incisively differentiate what is safe vs. unsafe for patients
Current Washington State Medical Association policy on hospital medical staff peer review comes from a YCMS resolution passed in 2012:
The WSMA will continuously advocate for state law which will protect the right of physicians to a fair and professional peer review process as a necessary condition for hospital immunity from physician suit.
1) Medical Staff and Hospital Bylaws must be followed. RCW 70.41.200 and 2007 c 273 s 22 and 2007 c 261 s 3 have been amended to include this provision, but RCW 7.71 should also be amended.
2) The legislative intention of HCQIA and WA RCW 7.71 is to “foreclose federal antitrust actions” which were the basis of 1988 US Sup Ct decision, Patrick v. Burgets, but the intention was not to endorse “economic credentialing” in the absence of substandard physician performance. Financial biasis a prohibited motive in physician peer review.
3) “Fairness” is unbiased case selection in the peer review process. Cases that fall out of standard medical practice shall be handled in a uniform and standard way between all members of the department.
4) “Professionalism” requires that peer review body decisions conform with standard medical practice and outside expert review. WSMA will continue to develop resources for unbiased expert review.
5) Peer review procedures must allow the protections afforded in other statutes that recognize and protect health care providers and facilities from participating in, or refraining from participating in, actions or practices to which they object on the basis of conscience or religion.
6) When “disruptive physician behavior” is cited in peer review sanction, quality of care complaints that are not disruptive must be excluded. This is defined in the amendment written by the Senate Law & Justice Committee.
At the WSMA House of Delegates meeting in Spokane on Sept. 27, 2015, YCMS presented three more physician friendly resolutions. All three passed the House of Delegates by large margins and now become WSMA policies.
B-1 Fair Process for Employed Physicians
Introduced by: Yakima County Medical Society
This resolution explores why “At Will” employment which prevails in other industries is not consistent with the physician’s duty to patients.
B-3 Fair and Professional Medical Staff Peer Review
Introduced by: Yakima County Medical Society
Reaffirms WSMA Peer Review policy, and requests that the WSMA Judicial Council provide an unbiased review of the Smigaj vs. YVMH court documents in order to help other physicians and hospitals avoid a repetition of this worst case scenario.
B-4 Physician and Physician Assistant Recredentialing
Introduced by: Dave Krueger, MD, Delegate Yakima County Medical Society
The “Washington Practitioner Application Authorization and Release of Information” form requires physicians and PAs to agree to abide by the bylaws, rules, regulations, contractual agreements, and policies of all of the healthcare organizations in which they practice. Under this new policy, those rules and regulations must be disclosed.