Hospitals, government insurers, and private insurers have stepped in with standard guidelines for care, review of medical decisions, and changes in how doctors are paid.
Hospitals and other related institutions do not have standard guidelines in doing things. 
mnli hypothesis: Hospitals and other related institutions do not have standard guidelines in doing things.  premise: Hospitals, government insurers, and private insurers have stepped in with standard guidelines for care, review of medical decisions, and changes in how doctors are paid.