Guidelines for physician contracting with alternative delivery systems.

The rapid proliferation of alternative healthcare delivery systems--particularly health maintenance organizations (HMOs) and preferred provider organizations (PPOs)--means that physicians contemplating participation in one of these entities must obtain, at the least, information about the group's ability to operate efficiently and effectively. For physicians who are contracting directly with a specific HMO, PPO, or independent practice association (IPA), issues that are relevant in all situations include termination, submission of data, discipline procedures, no solicitation covenants, arbitration clauses, rights to discontinue treatment, use of consultants, compliance with state and federal laws, and exclusivity.

New JCAH standards affect medical staff, quality assurance.

Medical staff composition, credentialing procedures, governance, and quality assurance are the major areas affected by recent revisions in the Joint Commission on Accreditation of Hospitals' Accreditation Manual for Hospitals. The most controversial revision expands the definition of the medical staff to include not only physicians and dentists but also other nonphysician practitioners. Much of this controversy is unwarranted, however, because the standard is purely permissive; no hospital is required to change its medical staff composition if it chooses not to. Institutions are now permitted, if not encouraged, to examine specific classes or categories of providers and to determine the appropriateness of their practice within the hospital setting. Criteria for granting staff membership or clinical privileges must be developed for each category. Mechanisms for appointing medical staff members and for granting clinical privileges must be "hospital-specific"; each hospital; even those within the same system, chain, or geographic area, must have separate and distinct policies and guidelines for decision making in the credentialing process. The credentialing mechanism also must be "described to each applicant." The phrases "ethical criteria," "ethical pledge," and "ethical standards" have been completely dropped from the accreditation requirements. The previous standards subjected both the JCAH and the hospital to liability hazards. The newer standards not only eliminate the potential liability associated with the adoption of a particular code of ethics but also give the hospital greater latitude in enforcement, since the institution is not limited to a particular codification of principles or religious ethics. The medical executive committee's (MEC's) role and composition have also been redefined.(ABSTRACT TRUNCATED AT 250 WORDS)