OMSS Advocate Summer 2017

The OMSS Advocate is a newsletter for members of CMA's Organized Medical Staff Section. The Advocate covers events and issues that impact or are of particular interest to hospital medical staffs.

In this issue:

PRINT/DOWNLOAD: Click here to download a printable pdf of the OMSS Advocate. 


Letter from OMSS Chair

Fellow members,

It is a great honor to serve as Chair of CMA-OMSS, and to work with the outstanding individuals who serve with me on the Executive Board:

  • Vice-Chair: Vimal Nanavati, M.D.
  • Secretary: Steve Kmucha, M.D.
  • Delegate: Marcelo Rivera, M.D.
  • Delegate: Tom Tremoulet, M.D.
  • Trustee: Damodara Rajasekhar, M.D.

We are still seeking nominations to serve on the OMSS Board to fill vacancies for alternate delegates. Individuals selected will serve until the CMA-OMSS annual meeting in Anaheim on Friday, October 20, 2017, when formal elections will be held.

On behalf of the OMSS Executive Board, we encourage all of you to consider running in the CMA-OMSS formal elections and to join us on October 20 to vote. OMSS has a vital role in protecting self-governance and quality care in our state. We need leaders to carry on the good work of OMSS beyond 2017.

In addition, all OMSS members are welcome to participate in the American Medical Association (AMA-OMSS) quarterly conference calls and their annual assembly. AMA provides a platform for our voice to be heard at the federal level. Members will receive announcements about the next quarterly AMA call.

For more information about nominations and the AMA-OMSS call schedule, please contact Yvonne Choong, CMA Vice President of Health Policy, at ychoong@cmanet.org or (916) 551-2884. Forms are also available online at www.cmanet.org/omss.

In addition, we are soliciting input on the identified major issues for CMA’s House of Delegates. Providing your insight on major issues is critical to having our voice heard at CMA. These major topics are discussed in the OMSS monthly calls.

Last year, we saw an increase in OMSS membership, reaching 89 members. We hope to increase to 100 in 2017. As of Tuesday, May 16, I’m very pleased to report that we now have 86 members. With your help, we should be able to reach our goal of 100 members.

On behalf of the OMSS Board, I want to thank CMA staff for helping us increase membership and funds for the Legal Defense Fund, which is vitally important for protecting self-governance when it is threatened. In addition to revitalizing The OMSS Advocate, staff are also sending slide decks to all members quarterly. Please add five minutes to your medical staff meeting agendas to share the latest information with all physicians.

Of course, all members and those who are considering membership are welcome to contact me at any time. We are all working toward a common goal, and communication is key to our success.

Best regards,
John Luster, M.D.

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Update on Tulare Medical Staff Trial

By Long Do, CMA’s Director of Litigation

Trial was held in the medical staff’s case against the hospital over the course of two and a half weeks in April and May 2017. More than a dozen witnesses testified, including five expert witnesses, and hundreds of pieces of evidence were submitted to the court.

The medical staff established that it was blindsided by the hospital’s abrupt announcement in January 2016 to terminate its relationship with the medical staff while simultaneously recognizing a new medical staff with vastly different bylaws and new medical staff officers. No physician on the medical staff was aware of these plans, much less had an opportunity to provide input or vote on the drastic changes, other than a handful of select physicians who secretly collaborated with the hospital.

The hospital, on the other hand, sought to show that its actions were in response to a totally dysfunctional medical staff and that the replacement medical staff developed organically out of concerned physicians. Both claims by the hospital collapsed under the weight of the evidence. Witness after witness and document after document presented in the trial proved that the medical staff was working hard to discharge its important functions, holding regular meetings and conducting diligent peer review activities.

The evidence also revealed that, far from a group of concerned physicians forming the replacement medical staff, it was in fact the hospital board’s vice-chairman who schemed to create the replacement medical staff, coercing or misleading the other physicians to go along with his plan. The vice-chairman worked with the hospital’s CEO to carry out the scheme. The few physicians who were involved in the creation of the replacement medical staff were told what leadership positions they would assume (no elections were held), they did not get to see the new medical staff’s bylaws even though some asked to see the bylaws (which were drafted by the hospital’s attorneys), and the hospital board was given limited information before taking a vote to replace the medical staff.

The hospital also claimed that getting rid of the medical staff was necessary to address deficiencies found in a Medicare audit survey, but the evidence at trial showed that the hospital did not bother to inform the medical staff of any problems found, did not brief the board of the findings before it voted to terminate the medical staff, and ultimately was using the Medicare survey as pretext for its scheme to get rid of the medical staff’s duly-elected leadership. The hospital’s own expert witness admitted on cross-examination that the hospital’s termination of the medical staff was not justified under its own bylaws and related governance requirements.

With the completion of witness testimony, the trial now moves into the critical briefing stage. Both sides will have an opportunity to review the testimony and evidence and prepare exhaustive legal briefs summarizing the facts and legal arguments. The court will hold final closing arguments in the case on October 2, 2017. A decision then can be expected 30 to 60 days thereafter. CMA intends to submit an amicus brief to the court to underscore the importance of this trial and the need to safeguard medical staff independence and self-governance against hospital overreach. The fact that CMA is involved in this case has not gone unnoticed. Here’s an article from the local paper covering the trial, with specific mention of CMA’s concerns.

We are optimistic that the medical staff will prevail. The evidence that has been presented confirms CMA’s concerns that the hospital is trying to create a false narrative about medical staff dysfunction in a thinly-disguised attempt to trample over the medical staff’s independence and right to be self-governing. In any event, hospitals may never unilaterally replace a medical staff, its duly-elected officers, and its bylaws.

There is some indication that the hospital’s illegal scheme has had a negative impact on patient care. The local newspaper recently published an article about a Medicare investigation into two patient deaths in August and September last year (after the hospital-created medical staff took over) in the hospital’s surgery room. According to the article, Medicare discovered that the hospital’s operating room director had “expressed his concerns” about understaffing problems in the surgery room to the original medical staff in 2015, which in turn asked the hospital administration to take up the issue, “but no solutions were enacted.” The original medical staff’s MEC also discussed the problem and, according to the Medicare investigation, MEC meeting minutes indicated that it believed “[t]here needs to be full backup coverage for emergency cases after hours” and recommended that administrators assure full coverage for emergency cases after hours and on weekends. “Currently,” the MEC minutes added, “there is only a skeleton crew for emergency cases, which puts patients at risk.” Nothing was done by the hospital despite the MEC’s concerns and recommendations. Instead, the article reports, the hospital board “suddenly terminated its relationship with its existing Medical Executive Committee, the one that had discussed surgical delays.” The replacement medical staff that took over did nothing to address the problem and never even discussed it until three weeks after the first patient death. The article also indicates that the surgeon involved in the patient deaths was part of the group of physicians who formed the replacement medical staff and was named as the new surgery department chair after the medical staff coup.

A significant development in this case could arise on July 11 when citizens in Tulare vote on the recall of Parmod Kumar, M.D., the dominant figure on the hospital board who spearheaded the effort to replace the medical staff. The trial has only made him look worse before he is to face the voters. If he is replaced with an independent voice on the board, to join the two new board members who were elected last November, the new board could take steps to unravel the replacement of the medical staff.

As always, please don’t hesitate to reach out to me if you want more details or have questions. 

Long Do is Legal Counsel and Director of Litigation at CMA. He can be reached at ldo@cmanet.org. 

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Save the Date: Tulare Webinar, 7/12

Long Do, Legal Counsel and Director of Litigation at the California Medical Association (CMA), will be hosting a webinar on July 12 to provide an update on the lawsuit against Tulare Regional Medical Center for violating the self-governance rights of its medical staff. The one-hour webinar will start at 12:15 p.m. and is free to CMA and CMA-OMSS members.

Additional information and registration details will be available very soon. If you would like to be notified when registration opens, email CMA’s Education Coordinator Juli Reavis at jreavis@cmanet.org.

If you are unable to attend the live event, the webinar will be archived for on-demand viewing shortly after the live presentation at www.cmanet.org/on-demand

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The Joint Commission clarifies use of text messaging for patient orders

In May 2016, the Joint Commission announced that based on its research of secure texting technology it now approved of the use of this technology by practitioners provided that such use is in accordance with professional standards of practice and applicable laws and regulations. At that time, the Joint Commission further indicated that any secure texting service or platform used by health care providers should have encryption and message retention capabilities as well as the ability to restrict who can receive texted orders.

In the December 2016 issue of the Joint Commission Perspectives, the Joint Commission clarified its position, stating that the use of secure text messaging for patient care orders is currently not acceptable. In issuing the clarification, the Joint Commission cited uncertainty regarding the impact of secure text orders on patient safety. In addition, the Joint Commission cited several additional concerns including 1) the burden on nurses who would need to transcribe text orders into the EHR taking them away from other critical duties and 2) the fact that unlike a verbal order, which can be clarified and confirmed as it is given, a texted order may necessitate contacting the ordering practitioner for additional discussion prior to order entry, which could lead to delay in treatment.

In addition, the Joint Commission and the Centers for Medicare and Medicaid Services have developed the following recommendations:

  • All health care organizations should have policies prohibiting the use of unsecured text messaging for communicating protected health information.
  • Computerized provider order entry (CPOE) should be the preferred method for submitting orders as it allows providers to directly enter orders into the electronic health record.
  • In the event that a CPOE or written order cannot be submitted, a verbal order is acceptable, although verbal orders should be used infrequently.

Questions regarding this clarification can be directed to textingorders@jointcommission.org

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Fundraiser of the year

Damodara Rajasekhar, M.D., OMSS Trustee, was honored with the first ever “Fundraiser of the Year” Award by the California Medical Association (CMA) Political Action Committee (CALPAC) at the January 2017 meeting of the CMA Board of Trustees.

Dr. Rajasekhar, a neonatologist from Apple Valley, received the award for his tireless dedication to raising money for the CMA Legal Defense fund and promoting OMSS membership. 

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CMA Legal Defense Fund and Political Education Fund campaign continue to reach new levels

The California Medical Association (CMA) Legal Defense Fund supports litigation to protect or establish important legal rights of physicians to practice their profession and assure high quality medical care. This fund preserves and protects your and your medical staff’s rights.

The fund is used to support physicians in cases like that of the Tulare Regional Medical Center, where the medical staff is engaged in an unprecedented legal battle with the hospital administrators. This lawsuit is critically important to all medical staffs and physicians throughout California to protect self-governance rights and the physician-patient relationship.

An update on fundraising will be provided in our next edition of the Advocate. For those wishing to contribute to making this fund sustainable as CMA continues its battle in Tulare and defends medical staffs throughout the state, make checks payable to “California Medical Association” and mail to: California Medical Association, Attn: Nick Birtcil, Associate Vice President of Political Operations, 1201 J Street, Suite 275, Sacramento, CA 95814.

The Legal Defense Fund of the California Medical Association is a collection of monies voluntarily contributed by the CMA membership for appropriate litigation costs. These funds shall be administered by the Executive Committee of the CMA Board of Trustees. The purpose of this fund shall be to provide monetary support in cases, generally brought by our members, which seek to protect or establish important legal rights of physicians. CMA will consider providing assistance only in those cases which reflect those principles and policies that CMA has established and that impact our members in their practice of medicine. Contributions to the California Medical Association Legal Defense Fund are not tax deductible as charitable contributions for federal income tax purposes. However, the contribution may be tax deductible as a business expense for federal income tax purpose. Contribution to this fund is not a political contribution. 

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Expanding educational opportunities for medical staffs

The California Medical Association (CMA) is expanding its education programming with specific opportunities for OMSS members.


CMA’s webinars are free for members and their staff ($99 for nonmembers). Check www.cmanet.org/eventsfor an updated list of webinars coming in the months ahead and on demand. Look for notification of a new webinar featuring Ulfat Shaikh, MD, MPH, MS, FAAP, Director of Healthcare Quality at UC Davis Health this summer. Dr. Shaikh will cover national and statewide issues in quality care initiatives as well as the health care quality certificate program she is developing for all physicians.

Please contact Juli Reavis, CMA Education Program Coordinator (jreavis@cmanet.org), with suggestions for relevant webinar topics.

Medical staff education at 2017 Leadership Academy

The 20th Annual Western Health Care Leadership Academy was held in San Diego May 5-7, 2017. New to the agenda this year were three workshops of particular importance to medical staffs.

Other Opportunities:

CPPPH: Workshops on physician monitoring
California Public Protection & Physician Health (CPPPH) is hosting workshops this summer in both northern and southern California for medical staffs and groups interested in physician well-being. The workshop, “Monitoring: What Wellbeing Committees Need to Know,” will be offered July 15 in Los Angeles.

Presenters will include medical leaders and experts in the field of physician health. This workshop will cover the core information that well-being committees need to know about monitoring, such as what a monitoring agreement contains, how long monitoring should continue, and, most particularly, how monitoring is carried out by busy practitioners in ways that meet the needs of the physician being monitored, the monitors, the committee, and the hospital or medical group.

Participation is usually limited to those who serve on physician health committees or have similar responsibilities, but because this topic is of wide-ranging interest, invitations are extended to all interested persons with roles related to peer review, credentialing and privileging.

To register or for more information, click here or contact CPPPH at CPPPHInc@gmail.com.

CHA webinar: Cancer surgery volumes and patient outcomes
The California Hospital Association (CHA) is hosting a webinar to unveil new research on how a hospital’s volume of cancer surgeries impacts patient outcomes. The webinar, Cancer Surgery Volumes on Outcomes,” will take place on July 6, 2017, from 10:00 a.m.to 12:00 p.m.

The California HealthCare Foundation has partnered with the California Office of Statewide Health Planning and Development, a health services researcher at Stanford and the Cancer Prevention Institute of California on a study to measure the volume of cancer surgeries performed at each hospital for certain cancers for which there is evidence of an association between low volume of surgeries performed and increased mortality/poor patient outcomes.

This webinar will include a thorough background of the study and experts who will provide suggested course of actions.

California Medical Association members have been offered the discounted CHA member rate of $185. Nonmember registration is $250. For more information or to register, visit www.calhospital.org/cancer-surgery-web.

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CMA releases 2017 annotated Model Medical Staff Bylaws

The California Medical Association (CMA) has released its 2017 Model Medical Staff Bylaws. These bylaws are the definitive guide for medical staffs, providing details on professional and legal structures to support effective medical staff operations and self-governance.

The model bylaws are fully annotated to provide background information on critical provisions, including explanations of relevant state and federal laws, hospital accreditation standards, and other explanatory information.

The 2017 Model Medical Staff Bylaws are available free to any medical staff with an active membership in CMA’s Organized Medical Staff Section (OMSS). If your medical staff is not already an OMSS member, you can join by completing and submitting the OMSS membership application at www.cmanet.org/omss.

The bylaws are also available to non-OMSS members for a fee. 

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CMA’s Health Law Library updated with 2017 content

CMA On-Call, the California Medical Association (CMA) online health law library, has been updated with 2017 content. One of CMA’s most valuable member benefits, On-Call contains nearly 5,000 pages of up-to-date legal information on a variety of subjects of everyday importance to practicing physicians. The searchable online library contains all the information available in the California Physician’s Legal Handbook (CPLH), an annual publication from CMA’s Center for Legal Affairs. New documents for 2017 include:

Other recently updated documents of particular interest include:

CMA and OMSS members can access On-Call documents free at www.cmanet.org/cma-on-call. Nonmembers can purchase On-Call documents for $2 per page. CPLH, the complete health law library, is also available for purchase in a multi-volume print set or annual online subscription service. To order a copy, visit the CMA resource library or call (800) 882-1262. 

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Medical staff survey highlights

The Organized Medical Staff Section (OMSS) of the California Medical Association (CMA) distributed a survey shortly following the 2016 House of Delegates meeting. This survey was designed for the purpose of collecting information about the structure, operations, and governance of California’s medical staffs. The survey asked 40 questions evaluating the many facets of medical staffs’ administration, finances, legal services, medical staff bylaws, governance, and member satisfaction. The data was analyzed to identify trends in medical staff practices and areas in which medical staffs would benefit from additional support and resources.

Below are highlights of from the survey:

  • A majority of California medical staffs review and update their bylaws annually.
  • More than 80 percent have used CMA’s Bylaws Review Service.
  • Two-thirds of medical staffs have contacted CMA for assistance regarding legal, policy and/or operational issues.
  • Complimentary access to CMA legal and policy experts as well as access to CMA’s Model Medical Staff Bylaws are ranked as most important benefits of membership.
  • 100 percent of medical staffs stated that the primary personnel to have access to credential files are office personnel, officers and department chairs.
  • A majority of medical staffs’ total annual operating budgets are less than $250,000.
  • Half of medical staffs noted that they hold an estimated reserve fund of more than $100,000 – while the other half operate between $30-$50,000 and $50,001-$100,000.
  • The majority of OMSS members are satisfied with the CMA services provided to their medical staff.

A complete report will be released this summer. 

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Save the Date: IMQ Medical Staff Conference

Save the date for the 2017 Institute for Medical Quality (IMQ) Medical Staff Conference, set for October 26 at the Embassy Suites SFO (Gateway) Hotel in South San Francisco. This event will deliver the information, solutions and best practices that physicians need to successfully lead their medical staffs.

The conference will tackle some of the difficult decisions that face medical staffs, such as credentialing, granting privileges and proctoring practitioners for remote technology (telemedicine), and privileging policies for the new technology. Through examples and discussion, faculty will demonstrate how medical staffs can best position themselves to modernize quality improvement and update peer review systems. The conference will also provide an update on Joint Commission standards, including a discussion about the standards that are most often found noncompliant.

If you are a physician, hospital leader, medical staff director, credentialing specialist or quality improvement professional, you will want to attend this one-day course that addresses the critical challenges facing your medical staff. Click here to learn more.

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Save the Date: 2017 CMA OMSS Annual Assembly

We are pleased to invite you to the 2017 CMA-OMSS Annual Assembly which will be held on Friday, October 20 in Anaheim. The OMSS Assembly will be held from 9:00 a.m. – 4:00 p.m. at the Disneyland Hotel.

This meeting and educational conference is open to all physicians concerned about the role of strong self-governing medical staffs in improving patient care and safety. Participants will have the opportunity to learn about critical issues impacting medical staff governance and operations and network with representatives from medical staffs across the state.

OMSS members receive two free registrations as a member benefit. Not sure if your medical staff is an OMSS member? Contact CMA at medstaffhelp@cmanet.org to join or renew your membership.

Additionally, the president of the California Association Medical Staff Services (CAMSS), Arlene C. Becton, CPCS, CPMSM, is interested in strengthening the CMA-OMSS partnership by increasing communication between CMA, OMSS and CAMSS. To that end, CAMSS members have also been invited to attend the CMA OMSS Annual Assembly.

Register today for this important event at www.cmanet.org/events. Questions? Contact us at medstaffhelp@cmanet.org or (800) 786-4262.

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CMA develops resources to help physicians navigate new out-of-network billing and payment law

On July 1, 2017, a new law (AB 72) will take effect that will change the billing practices of non-participating physicians providing covered, non-emergent care at in-network facilities including hospitals, ambulatory surgery centers and laboratories. The law, signed in 2016, was designed to reduce unexpected medical bills when patients go to an in-network facility but receive care from an out-of-network doctor.

The California Medical Association (CMA) has published a number of resources to help physicians navigate this new system, including an FAQ, instructions for obtaining patient consent, a sample consent form and an overview of billing requirements under the new law. These resources are available free to members only at www.cmanet.org/ab-72.

CMA also recently hosted a members-only webinar on the new out-of-network billing and payment law, which is now available for on-demand viewing.

CMA is working hard to ensure health plans and insurers do not game the system to pay artificially low reimbursement rates to physicians. Additionally, if you experience a change in payor behavior regarding contract negotiations, claims payment or network adequacy concerns, or are experiencing other challenges, CMA wants to hear from you.

For more information, visit www.cmanet.org/ab-72

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Farewell to Manny Heer

Farewell to Manny Heer, who was the Associate Director of Political Operations at CMA and a great advocate for OMSS during his time here. He has moved on to a new position elsewhere. We’ll miss him! A new contact for OMSS will be announced soon.

In the meantime, Yvonne Choong, Vice President for the Center for Health Policy still leads the OMSS for governance and oversight. CMA’s membership team, specifically Becky Paplanus and Kristy Bird, administer membership dues and lead communications and marketing efforts.

If you have any questions at all, please do not hesitate to contact us at (800) 786-4262 or medstaffhelp@cmanet.org

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CMA Practice Resource

CMA Practice Resources (CPR) is a free monthly e-bulletin that focuses on critical payor and healthcare industry changes, as well as how they directly impact the business of a physician practice.