Florida Physician Strikes Out in Challenging Hospital Reappointment Denial

bylawsIn January, a Florida appellate court upheld the denial of a physician’s request to halt a hospital’s intention to deny reappointment to the medical staff.  The physician involved in the case was a member of the medical staff and was recredentialed pursuant to the hospital’s recredentialling cycle.    The doctor asked the trial court to stop the hospital from implementing the denial until the trial court fully considered the case; which request the court granted.  The appellate court, however, decided the trial court was wrong and overturned the decision.

The basis of the doctor’s claim was that the hospital didn’t follow the medical staff bylaws and that, therefore, the hospital’s decision shouldn’t be implemented, at least not until the court could have a trial-like hearing on the issue, which might take many months to schedule.  The appellate court relied on a state law granting immunity to the hospital for the denial and stated that the doctor didn’t make the proper argument that would have justified the trial court granting his request to delay implementing the decision.

Specifically, Florida law grants medical staffs the authority for reviewing applications, but is clear that the final decision rests with the hospital governing body.  Most medical staff bylaws codify the very same principle, though there is room to create more of a collaborative relationship between governing bodies and medical staffs on the issue.  Medical staffs ought to be vigilant about the wording of their medical staff bylaws, since they are considered to be a contract between them and the hospital.

In the present case, however, the doctor was ultimately denied the right to delay the hospital’s decision because he did not argue that the hospital decision involved fraud.  The case is yet another example of why medical staffs have to take a very pro active role in creating medical staff bylaws, which is no easy feat, since most physicians consider medical staff bylaw creation to be only slightly more exciting that paint drying contests.

Florida Seeks Relief from Healthcare Reform Provision

One of the requirements of the national healthcare reform law is that health insurers must spend at least 80% of their premiums on delivering healthcare services.  The current requirements (so called “medical loss ratios”) are 65% for traditional insurers and 70% for HMOs.  Earlier this month, state Insurance Commissioner Kevin McCarty requested US HHHS Secretary Kathleen Sebelius to delay the provision of the healthcare reform law that requires health insurers to spend 80% of their premiums on providing healthcare services.  If granted, the delay would allow insurers to meet the 60% and 70% established levels.  The reason for Commissioner McCarty’s request:  belief that the 80% requirement would decimate the health insurance market in Florida.

It is well known that Governor Scott campaigned against the healthcare reform law.  Similar requests for waivers can be expected around the country, as well as legal challenges to the law’s constitutionality.  Interestingly, there has been no delay in the state’s desire to curtail physician and hospital expenditures and their primary move in that direction, the quasi privatization of the state Medicaid program and introduction of a competitive bid process.  Though most will feel the squeeze, there is clear opportunity for those physicians and other healthcare business people willing to assume more economic and clinical risk.