Hospitals
Hospital contracted services: keeping the list the rule requires
Under 42 CFR 482.12(e), a hospital's governing body is responsible for services furnished in the hospital whether or not they're under contract. It must make sure contracted services are provided safely and effectively, and the hospital must keep a list of all contracted services, including the scope and nature of each.
In a hospital, contracts tend to be spread across departments, which is exactly why that list goes stale.
What each entry should show
The rule asks for the scope and nature of each contracted service, so a vendor name alone isn't enough. A useful entry says what the vendor does, where in the hospital, which department oversees it, who owns the contract, and its current dates.
Many hospitals also note how each service is reviewed for quality. The governing body has to make sure contractors furnish services that let the hospital meet the Conditions of Participation, and that's hard to show without a record of how you checked.
A worked example
Say the biomedical equipment contract was amended last spring to add maintenance on imaging equipment. The list still says general biomed services. Nothing is wrong with the work, but the list no longer shows the scope, and the scope is what the rule asks for.
Now multiply that by every department that signs its own contracts: lab, imaging, dietary, environmental services, staffing, transport. The list goes stale one amendment at a time.
Physician agreements and the master list
Physician service agreements are often tracked separately because of the Stark law. One condition of its personal service arrangements exception is that the arrangements cover all of a physician's services to the hospital. That can be met by cross-referencing a master list of contracts that is kept and updated centrally, available to the Secretary on request, and kept in a way that preserves the history of contracts (42 CFR 411.357(d)(1)(ii)).
That's a second list with its own rules. Drawing both from the same contract records is easier than keeping two spreadsheets in sync.
What to watch
Is the list complete across departments?
Lab, imaging, biomed, environmental services and dietary may all sign their own.
Does each entry show the scope and nature of the service?
That's what the rule asks for. A vendor name without the service doesn't do it.
Does each entry match a current contract?
A list that names a vendor without the current agreement behind it doesn't help much.
Who updates it when a contract changes?
If updating the list is a separate job, it will fall behind.
Are physician agreements on a master list that keeps its history?
The Stark personal services exception can rely on a centrally kept master list, and old contracts have to stay visible on it.
Could you hand it to a surveyor today?
That's a useful test of whether the list is real.
How Sapphires helps
- One list of every contract, each with a category, service lines and its signed PDF.
- Each contract has a named owner, and owners see only their own, so departments keep theirs current.
- Amendments stay with the contract and restate the terms, so the record shows what's in effect now.
- A read-only auditor role can see contracts and their change history.
- An export of every contract and PDF, by service line, status or vendor, is done for you on request.
42 CFR 482.12(e): hospital contracted services
42 CFR 411.357(d): Stark personal service arrangements