Medical Staff Bylaws Webinar: Meeting New Medicare Conditions of Participation and Joint Commission Requirements

Strafford Publications, Inc.

Complying With CMS Changes and Updating Hospital Governance Documents

This CLE webinar will prepare healthcare counsel to advise and guide healthcare providers and hospitals on ensuring medical staff bylaws comply with Joint Commission standards, Centers for Medicare and Medicaid Services (CMS) conditions of participation, and federal and state law. The panel will also review the impact of healthcare reform on medical staff governance.


Medical staff bylaws map out how a healthcare organization will provide quality patient care. Counsel to healthcare providers must ensure that bylaws address areas emphasized by the Joint Commission, including emergency management oversight, privileging, credentialing, appointment, adverse actions, medical executive committee, and documentation.

Moreover, the CMS recently released two final rules modifying the Medicare Conditions of Participation. The CMS provided clarification for hospitals within a multi-hospital system and regarding who may be a member of a medical staff.

Counsel must thoroughly review their healthcare provider clients' bylaws, rules and regulations, and make necessary revisions to ensure compliance with Joint Commission requirements as well as the CMS' final rules.

Listen as our authoritative panel of healthcare attorneys reviews recent developments, the implications for healthcare providers and medical staff operations, and offers strategies for amending and approving compliant bylaws. The panel will also examine the impact of healthcare reform on medical staff governance.


  1. Introduction
    1. Recent regulatory and accreditation changes that affect medical staff bylaws, rules and regulations, and policies
  2. Overview of changes
    1. The Joint Commission
    2. CMS
  3. Recommended changes to bylaws, rules and regs, and policies
    1. MS.01.01.01 changes—advanced tips beyond just the basics people have heard before
    2. Telemedicine
    3. Effect on expiration of covering provider authenticating verbal order grace period
    4. Including NPs and PAs in bylaws and bylaw process
  4. Recent experiences with enforcement
    1. MS.01.01.01
    2. Anticipation on enforcement of authenticating verbal order if grace period expires
    3. Telemedicine


The panel will review these and other key questions:

Date and Time:

Thursday, September 11, 2014
1:00pm-2:30pm EDT, 10:00am-11:30am PDT


Richard D. Barton, Partner, Procopio Cory Hargreaves & Savitch, San Diego, CA
Mr. Barton has represented health care providers and health systems for over 30 years. As trial counsel, he has tried and arbitrated over 100 matters on behalf of health systems, hospitals, physician groups, and individual providers in business, class action, professional liability, fraud and abuse, and administrative matters in both Federal and State court. Mr. Barton has also been retained by numerous hospitals and health systems to serve in a consultative role to assist hospitals, medical staffs and physician groups in their oversight responsibilities.

Scott C. Gardner, Atty, Buerger Moseley & Carson, Franklin, TN

Alma L. Saravia, Shareholder, Flaster Greenberg, Cherry Hill, NJ
Ms. Saravia concentrates her practice in healthcare law. Her clients include physicians, nurses, chiropractors, hospitals, medical staff, nursing homes and other healthcare organizations. She counsels practitioners on licensure and disciplinary matters, including those before the Board of Medical Examiners, where she served as member from 1992 to 1994. Ms. Saravia is a frequent lecturer and author. Her recent speaking engagements include a presentation to the Camden County Bar Association, where she spoke on "Representing Physicians in Today's Legal Quagmire".

For more information or to register, click here. To view the PowerPoint presentation, click here

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