The Medical staff counselor
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This article--the second in a series analyzing the physician-hospital contracting process from the physician's perspective--addresses negotiation of specific contract terms, including such controversial issues as exclusive contracts, mandatory managed care arrangements, and tie-in of contract terms and medical staff privileges. Also discussed are the goals and expectations of physicians and hospitals during the contracting process.
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This article--the third in a series analyzing the physician-hospital contracting process from the physician's perspective--addresses the legal issues involved in physician-hospital arrangements, including those arising under federal and state illegal remuneration, antitrust, and tax laws. New applications of these issues to physician-hospital organizations and practice management/practice acquisitions by hospitals are also addressed, as well as other recent hospital efforts to maximize the benefits to be gained from the physician-hospital relationship.
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The occasional imposition of antitrust liability on medical staff members for actions involving peer review is not a sufficient reason to abandon medical staff participation in the peer review process. This article reviews some of the case law in which the applicability of the intracorporate conspiracy doctrine to medical staff peer review activity has been decided and explains why appropriate medical staff involvement in such activity does not raise the risk of antitrust liability.
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Hospital medical staffs will have to make a major transition over the next few years from quality assurance to continuous quality improvement. As this article discusses, many elements of the change are new to health care, as yet untested, and should be approached carefully.
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This article describes the types of medical staff credentialing and peer review activities that invite the scrutiny of the Federal Trade Commission. To avoid antitrust problems, medical staffs and their members are advised to offer recommendations based on specific quality-of-care concerns. Antitrust problems will arise, however, if the medical staff or its members engage in collective activities that involve threats or coercion directed at the hospital's governing board or that are calculated solely to exclude an entire class of potential competitors.