Every hospital is governed by medical staff bylaws specific to their organization. These bylaws dictate a variety of things, like how a medical staff structure is organized and categorized and how credentialing committees function. Read on for a deeper understanding of how it all works.
Medical staff bylaws exist to guide organizations in their journey of providing quality patient care. Bylaws are required by every regulatory agency—like the CMS—and they outline how a medical staff organization is run. Hospitals abide by these laws because it’s how they get access to government funding and receive reimbursement for treating Medicare/Medicaid patients. Bylaws also help hospitals keep up with individual state regulations which is important because these regulations can impact the issuing of medical licenses and malpractice coverage.
Providers need to meet certain requirements stated in the medical staff bylaws to be granted certain privileges. When a provider is on staff they can have membership, membership and privileges, or just privileges. Physicians have membership in a medical staff when they are appointed by a governing body, and to receive said membership they have to meet certain requirements listed in the bylaws, like having a current license or being board-certified.
Providers with membership can fall into various categories. Medical staff categories are dictated by medical staff bylaws and determine what voting rights each member has in medical staff meetings and credentialing committees. Categories vary by organization and are defined by the number and type of patients a provider sees within a certain amount of time. Some categories include:
Hospital bylaws also determine medical staff and leadership structures, which impact credentialing committees and processes.
In a small, rural hospital setting with only a few beds, the structure is very simple. Usually they have one department, the Medical Staff Department, which is made up of all providers, with perhaps one chief of staff or chief medical officer.
A slightly larger hospital setting may have two departments, medicine and surgery. Providers will be divided into two departments and each department will have a leader. These leaders will be overseen by a Chief of Staff.
In an even larger setting, there may be a department for medicine and another for surgery, and within those large departments there may be separate sections with certain specialties. Each individual department will likely have a leader and these leaders will be overseen by a Chief of Staff.
The larger the hospital setting, the more complicated it’s structure can be. The organizational structure and how it impacts credentialing and privileging will be defined in the hospital bylaws.
Within each structure, each member of the medical staff will have set roles and responsibilities. Medical staff bylaws outline those roles and responsibilities. They may look as follows:
This is but a sampling of what medical staff bylaws dictate per hospital setting. As you can well imagine, all of these criteria have an impact on how an organization privileges and credentials their providers. Not only does granting privileges require each application to go through the committee structure, but any revisions or changes too. And as we know, timing is everything in the medical services field. Privileging a physician can take months, and if there isn’t a proper system in place to facilitate the process, it could take even longer.
CredentialStream was created to ensure your organization can meet all medical staff bylaw requirements, from initial applications through final approval. If you're ready for improved workflows and reporting for critical tasks like initial credentialing and recredentialing and privileging, then it may be time to take a look at CredentialStream. Sign up for a demo today!