Uniting to Serve Physicians

CMS teams with ABA, provides strategies for success By Elizabeth Sidney

Exploring economic and legislative trends, Chicago Medical Society members learned about their practice options during the annual Physicians Legal Issues Conference. This educational program, which CMS co-hosts with the American Bar Association’s Health Law Section, took place June 13-15, in Chicago.

ACOs and Value-Based Care

Although it hasn’t kicked into high gear yet, the Affordable Care Act is already part of the national fabric, having an impact in the health care market place, said speaker Stephen L. Ondra, MD. As senior vice president and chief medical officer of Health Care Service Corp., parent of Blue Cross Blue Shield of Illinois, Dr. Ondra is on the frontlines of reshaping health care. Prior to accepting this post, he was health policy advisor to President Obama and chief medical officer of Northwestern Memorial Hospital.

Dr. Ondra compares reform to a symphony, with different instruments coming into play at different times, eventually working in unison to move the U.S. toward value-based reimbursement.

New delivery models and payment structures, chiefly the accountable care organization (ACO), will ultimately lower costs through alignment, coordination, risk sharing, and other features. Evidence-based medicine will also become the center of gravity, Dr. Ondra said. For providers who lack the resources to form an ACO, Dr. Ondra said hospitals and physicians have other options as stepping stones to an ACO. These include bundled payments, medical homes, and pay for performance programs. Overall, though, Dr. Ondra concluded that, “ACOs provide the best chance for the U.S. to achieve a healthy competitive market system.”

The Hospital Medical Staff

The medical staff, through its bylaws, is the only entity to provide independent oversight free from the economic pressures potentially placed on hospital owners. But physicians often discover the obligations of employment interfere with professionalism and other critical medical staff duties. In this session CMS Immediate Past President Howard Axe, MD, teamed with Elizabeth “Libby” Snelson, of the law firm Medical Staff PLLC, to describe conflicts that may arise and strategies to resolve them.

To start, physicians should protect their interests and those of patients by staying on top of the issues. For example, they should read emails and other documents closely. Dr. Axe told of changes in electronic voting requirements at some hospitals that now allow non-responses to be counted as “yes” votes. Another key strategy for physicians is a comprehensive set of medical staff bylaws that anticipate potential situations and employ ethical and professional principles to address them.

Medical staff should be advised the hospital attorney doesn’t always represent their best interests. Nor should medical staff necessarily accept offers of free advice from the hospital attorney or allow that individual to represent them in a hearing. In fact, the physician has the right to request a different lawyer. As a self-governing legal entity, the medical staff develops its own bylaws, criteria for membership, peer review, hearings and appeals, credentialing and privileging. For these reasons the medical staff should have its own legal counsel when their interests diverge from those of the hospital, Snelson said. Dr. Axe suggested physicians consult the Illinois State Medical Society’s model medical staff bylaws available at www.isms.org.

Race and Higher Education

Fisher vs. the University of Texas was one of the most closely watched cases of the last U.S. Supreme Court term. While awaiting the decision, speaker William A. McDade, MD, PhD, explained how this challenge to affirmative action could ultimately harm minority health research and access to care in underserved communities.

The strong relationship between diversity in medical education and health care for minorities is substantiated by numerous studies, Dr. McDade said. Legal precedent, established in Bakke (1978), and endorsed in Grutter (2003), also underscores the importance of fostering diversity in clinical care and research.

Dr. McDade, who is deputy provost for research and minority issues at the University of Chicago, said that minorities are more likely to pursue biomedical research that addresses the health needs of racial and ethnic groups. Minority doctors are more likely to practice in underserved communities. And satisfaction with one’s care and caregiver is positively associated with treatment compliance.

Dr. McDade is president-elect of ISMS and a past president of CMS. He serves on the AMA Council on Medical Education.

The Court announced a decision on June 24. While it recognized the educational benefits of factoring diversity into the applications process, the Court remanded the case back to the federal appellate level to resolve the issue of strict scrutiny.