Quiz 3 Key Terms Flashcards
What is the definition of “privileging” according to The Joint Commission?
The process whereby the specific scope and content of patient care (clinical) services are authorized for a healthcare practitioner by a healthcare organization on the basis of evaluation of the individual’s credentials and performance.
What is “credentialing”?
A process for establishing the qualifications and competence of medical staff applicants through review of their training, licensure, and practice history.
What is the primary purpose of the HCQIA (Health Care Quality Improvement Act)?
To improve the quality of medical care by encouraging physicians to identify and discipline physicians who are incompetent or who engage in unprofessional conduct, while providing immunity from lawsuits for those who participate in peer review activities.
Who has the ultimate responsibility for approving medical staff privileges?
The hospital’s governing board (board of directors/trustees) has the ultimate responsibility for the overall quality of care and for approving medical staff privileges, though they typically rely on the medical staff’s recommendations.
What does “peer review” refer to in a hospital setting?
A process where physicians evaluate the quality of work done by their colleagues to maintain standards of care and improve quality, often conducted through confidentiality-protected committee proceedings.
What are the four requirements for immunity under HCQIA?
1) Reasonable belief that the action was in furtherance of quality healthcare; 2) Reasonable effort to obtain the facts; 3) Adequate notice and hearing procedures; 4) Reasonable belief that the action was warranted by the facts known.
What is a “professional review action” under HCQIA?
An action or recommendation taken by a professional review body based on a physician’s competence or professional conduct that affects or may affect the physician’s clinical privileges or medical staff membership.
What is the National Practitioner Data Bank (NPDB)?
A federal database created by HCQIA that collects and releases information on adverse actions taken against healthcare practitioners, including medical malpractice payments and certain professional review actions.
What is “economic credentialing”?
The use of economic criteria unrelated to quality of care or professional competence in determining a physician’s qualifications for initial or continuing hospital medical staff membership or privileges.
What is the doctrine established in Johnson v. Misericordia Community Hospital?
A hospital has a duty to exercise due care in the selection of its medical staff and can be liable for negligent credentialing if it fails to verify the accuracy and completeness of information in a physician’s application for privileges.
In the Poliner case, what did the court establish about HCQIA immunity?
That HCQIA immunity applies when temporary restrictions on a physician’s privileges are imposed to protect patients during an investigation, and that courts should not second-guess peer review decisions if the statutory requirements are met.
What lesson does the Kadlec case teach about reporting requirements?
Healthcare entities have an obligation to be truthful when providing information about former staff members to other facilities, and can be held liable for fraudulent misrepresentations that conceal dangerous conduct.
What is an Accountable Care Organization (ACO)?
A group of healthcare providers who work together to manage and coordinate care for Medicare fee-for-service beneficiaries, with goals of improving quality, coordinating care, and reducing unnecessary costs.
What is a “complementary and alternative medicine” (CAM) practitioner?
A healthcare provider who uses practices outside of conventional medicine, such as acupuncture, Eastern medicine, naturopathy, massage therapy, or herbal medicine, often as part of an integrative approach to healthcare.
What is the duty of a hospital regarding the clinical competence of its medical staff?
A hospital has a duty to ensure that its medical staff is qualified and competent, which includes proper credentialing, periodic review of clinical performance, and taking action when issues arise.
What is a “licensed independent practitioner” according to The Joint Commission?
Any individual permitted by law and by the organization to provide care, treatment, and services without direction or supervision.
What is the “substituted judgment doctrine” in medical staff issues?
Not typically applied in medical staff issues, but in patient consent contexts it refers to making decisions for incompetent patients based on what they would have decided if competent.
What is an exclusive contract in a hospital setting?
An arrangement where a hospital grants exclusive rights to a physician or physician group to provide certain clinical services (like radiology, anesthesiology, or emergency medicine) within the facility.
What is the “corporate practice of medicine” doctrine?
A legal doctrine prohibiting corporations from practicing medicine or employing physicians to provide professional medical services, though many states have exceptions for hospitals and other healthcare organizations.
What are The Joint Commission’s general competency areas for credentialing?
1) Patient care, 2) Medical/clinical knowledge, 3) Practice-based learning and improvement, 4) Interpersonal and communication skills, 5) Professionalism, and 6) Systems-based practice.
What was the doctrine of “charitable immunity”?
A now largely abandoned legal doctrine that protected charitable organizations, including hospitals, from tort liability on the basis that their assets were held in trust for charitable purposes or that beneficiaries implicitly waived their right to sue.
What is “respondeat superior”?
A legal doctrine meaning “let the master answer” that holds an employer liable for the negligent acts of employees performed within the scope of their employment.
What is the distinction between an employee and an independent contractor in healthcare liability?
An employee works under the hospital’s control regarding means and methods, making the hospital liable under respondeat superior; an independent contractor controls their own work methods, theoretically shielding the hospital from liability.
What is “apparent agency” or “agency by estoppel”?
Legal doctrines that make a hospital liable for the acts of independent contractors (like physicians) when patients reasonably believe these individuals are hospital employees based on the hospital’s representations or conduct.
