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Revisions to The Joint Commission Standard MS.1.20

Credentialing Resource Center Connection, October 25, 2007

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Anne Roberts, CPMSM, CPCS, is the director of medical affairs at Children's Medical Center in Dallas, where she oversees the medical administration, graduate medical education, and medical staff services department.

Dear credentialing colleague:

The Joint Commission's (formerly JCAHO) latest revisions to MS.1.20 continue to cause confusion throughout the field, sparking  debates between The Joint Commission, healthcare attorneys, and medical staff leaders across the nation.

The American Healthcare Lawyers Association (AHLA) as well as the National Association Medical Staff Services (NAMSS) have written open letters to The Joint Commission expressing their concerns with the newly published standard, which is to go into effect in 2009. NAMSS's position paper indicates that there are many vague terms used in the new standards that are open to various interpretations.

One of the key concerns is the confusion regarding what must be included in the bylaws versus what can be maintained in associated documents, such as the rules and regulations or the medical staff policies. The reasoning behind The Joint Commission's dictation of where hospitals should maintain such information is still unclear as to how such a change will improve patient safety or quality of care. The time, effort, and cost of revising medical staff bylaws can be extensive-it reminds me of the old saying "if it's not broken, don't fix it".

Another key concern is the balance of medical authority and governance. The revised standards appear to allow a mechanism to develop a process that allows medical staff members to bypass the decisions made by the medical executive committee. Hospitals already have processes in place for dispute resolution and conflict of interest procedures.

The Joint Commission has scheduled conference calls on October 25th and November 1st, open to accredited organizations to discuss the revised standards. Most of us are hoping for additional revisions to standard MS.1.20 before 2009, but are preparing for what changes we will need to make if no additional revisions are made.

Remember, clear, effective communication is the key to success!

That's all for this week.

All the best,

Anne Roberts, CPMSM, CPCS

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