Environmental Overview

• Identification of “never events” (i.e., unacceptable medical errors) resulting in reduced or denial of payments by CMS and private payers

• Emphasis on pay for performance (P4P) by private and public payers regarding expected compliance with certain protocols, healthcare practices, and quality outcomes

• Transparency to the general public via hospital rankings, published costs and outcomes, accreditation status, and mandatory reports to state and federal government

• Greater demands being placed on boards of directors and hospital management to develop sufficient resources to ensure that quality-of-care standards and expectations are met through the hospital’s quality improvement program that adopts metrics and benchmarks to measure progress in meeting targeted clinical quality standards as part of the hospital’s corporate and governance policies

• Good quality means good business

• The Joint Commission’s focused professional practice evaluation (FPPE) and ongoing professional practice evaluation (OPPE)

• Adoption of new Joint Commission Leadership Standards, which view the medical staff as equal partners with board and management on issues affecting patient care and safety

• New Joint Commission Sentinel Alert on importance of working toward zero errors in the hospital through development of a culture of safety or “just culture” More aggressive enforcement environment, especially by the OIG, which is beginning to hold hospital boards and management responsible for the provision of substandard or unnecessary care that leads to “never events” or adverse patient outcomes

• Legal and accreditation expectations and requirements mandate that medical staff physicians are appropriately credentialed and privileged to exercise every one of the clinical privileges given to them during appointments...