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Another delay of CMS hospital star ratings system

CMS will delay an update to its controversial hospital star rating system for the second time in four months. The update was expected to launch this month and the new setback means the tool might not be available to the public until 2018.

CMS told reporters that it needed more time “to continue its examination of potential changes to the Star Rating methodology based on public feedback.” Until CMS releases the update, the ratings from December 2016 will remain on the Hospital Compare website.

The star ratings are intended to provide patients with more transparency on hospital quality, and are based on seven different latent variable models. Hospital scores are calculated using 57 quality measures broken up into seven categories:
•    Mortality
•    Patient experience
•    Readmissions
•    Safety of care
•    Care effectiveness
•    Care timeliness
•    Efficient use of medical imaging

However, since the day it was proposed many hospitals and healthcare organizations have argued against the five-star system. Some argued it unfairly penalized hospitals with poorer or sicker patients, that the methodology it uses is flawed, and that patients’ perceptions aren’t the same as quality.

Joint Commission updates EM standards to match CMS

In response to CMS’ final emergency preparedness rule issued earlier this month, The Joint Commission announced revisions to its emergency management (EM) standards. CMS is expected to approve the updated standards before they go into effect on November 15.

Accredited organizations can access the proposed drafts on their Joint Commission Connect™ extranet site, with more information on the way.

The Joint Commission’s standards come with new Elements of Performance on the following topics:

•    Continuity of operations and succession plans
•    Documentation of collaboration with local, tribal, regional, state and federal emergency management officials
•    Contact information on volunteers and tribal groups
•    Annual training of all new or existing staff, contractors, and volunteers
•    Integrated healthcare systems
•    Transplant hospitals

Several of the new requirements merely provide more specifics on what The Joint Commission already expects. This includes including documentation for existing practices and annual training for staff.

CMS first announced the emergency preparedness CoPs in September 2016, compelling hospitals to communicate and coordinate their emergency plans with other hospitals and government agencies.

They also require regular emergency preparedness training with staff and disaster contingency planning. CMS published the final version of the new Appendix Z of Medicare’s State Operations Manual online, and state surveyors will use newly created E-tags to score deficiencies and expectations set in it.

 

CMS temporarily suspends some Medicare requirements for hurricane-stricken hospitals

Joint Commission also suspending surveys of hurricane affect hospitals temporarily

CMS Administrator Seema Verma announced the agency is temporarily suspending certain Medicare requirements for healthcare providers assisting with Hurricane Irma recovery efforts in Florida, Puerto Rico, and the U.S. Virgin Islands. The Joint Commission also announced that it would be suspending survey activities in the affected areas for the time being.

At the moment, CMS is waiving the following enrollment requirements:
•    Payment of the application fee
•    Fingerprint-based criminal background checks
•    Site visits
•    In-state licensure requirements

“CMS is dedicated to making it as easy as possible for the individuals and families impacted by Hurricane Irma to access medical care during this difficult time,” said Verma. “There are healthcare providers and suppliers in the aftermath of the hurricane that are ready and willing to help. CMS has established a hotline for providers and temporarily suspended certain Medicare requirements so that these healthcare professionals can provide services to those in need.”

The toll-free hotline she’s referring to is for non-certified Medicare Part B providers and other practitioners so they can enroll in federal health programs and receive temporary Medicare billing privileges. First Cost Service Option, a Medicare Administrative Contractor, will work to assist providers in these areas to temporarily enroll healthcare providers. The number is 855-247-8428, and it’s in service between 8 a.m. and 6 p.m. ET

Starting September 18, 2017, providers will be able to initiate temporary Medicare billing privileges over the phone and on the same day. In addition, CMS is:

•    Allowing providers not currently enrolled to initiate temporary billing privileges by providing limited information. This information includes (but isn’t limited), National Provider Identifier (NPI), Social Security Number (SSN) or a business Employer Identification Number taxpayer identification numbers (SSN/EIN/TIN), and valid in-state or out-of-state licensure.
•    Temporarily ceasing revalidation efforts for Medicare providers in areas directly impacted by Hurricane Irma.
•    Waiving the practice location reporting requirements
•    Not taking administrative actions on providers who fail to notify them about their temporary practice location. This temporary process will remain in effect from September 7 until the disaster designation is lifted. After that, it must be reported through appropriate channels.

“CMS will continue to work with all states and geographic areas in the path of hurricanes Irma and Harvey,” according to the press release. “The agency continues to update its emergency page (www.cms.gov/emergency) with important information for state and local officials, providers, healthcare facilities, suppliers and the public.”

To read previous updates regarding HHS activities related to Hurricane Irma and Hurricane Harvey, please visit https://www.hhs.gov/about/news/hurricane-response/index.html.

George Mills lands gig with Chicago firm as his Joint Commission exit approaches

Two weeks after The Joint Commission confirmed that its engineering department director would be leaving the organization, a Chicago-based professional services firm proudly announced him as a new hire.

George Mills, MBA, FASHE, CEM, CHFM, CHSP, who worked 14 years for the accrediting organization, will transition next month into his new job as director of healthcare technical operations with JLL, the company said Wednesday in a statement.

“George’s vision and passion for the improvement of hospital operations will benefit the hospital systems we serve across the country,” said Peter Bulgarelli, executive managing director of JLL’s Healthcare group, in the statement. “In his new role with JLL, George’s direct work with healthcare organizations on regulatory and compliance matters through JLL solutions and technology will take our platform to the next level for our clients.”

Mills, who will take the lead on JLL’s healthcare technical operations platform, will manage teams focused on a number of areas, including not only compliance matters and facility management but supply chains, sustainability initiatives, and more, the company noted.

Mills said in the statement that his transition will enable him to put his teachings into practice and show healthcare organizations how to implement solutions proactively. “I believe together we can make a difference and show the industry that change is possible,” he said.

JLL Healthcare says it offers solutions related to facilities and real estate in order to push healthcare organizations forward both clinically and financially. The company says its clients include 540 hospitals.

The brand name JLL is a trademark registered to Jones Lang LaSalle Inc.

A spokesperson for The Joint Commission said August 24 that Mills would be leaving his current post effective October 9. John D. Maurer, SASHE, CHFM, CHSP, will take over as acting director on an interim basis.

What providers can do this National Suicide Prevention Week

National Suicide Prevention Week is September 10-16, bringing awareness to the 10th leading cause of death in the United States. This week is a time for physicians, nurses, and other providers to learn more about how their healthcare organizations can help suicidal patients.

Find out how your healthcare organization can help suicide patients

Find out how your healthcare organization can help suicide patients

In 2013, 9.3 million adults had suicidal thoughts, 1.3 million attempted suicide, and 41,149 died. Even more worrying is that the rate of suicides has increased 24% between 1999 and 2014. And as of March 2017, Joint Commission surveyors have been putting special focus on suicide, self-harm, and ligature observations in psychiatric units and hospitals. Surveyors are documenting all observations of self-harm risks, and evaluating whether the facility has:

  • Identified these risks before
  • Has plans to deal with these risks
  • Conducted an effective environmental risk assessment process

 

To learn more about suicide prevention in healthcare, check out the following websites and articles.

George Mills is leaving The Joint Commission

The Joint Commission confirmed Thursday afternoon that a key figure in standards interpretation for the healthcare accrediting organization will be departing this fall.

George Mills, MBA, FASHE, CEM, CHFM, CHSP, who has served as director of the organization’s engineering department for the past six years, will leave his post effective October 9. Mills has been with The Joint Commission for 14 years.

“During his tenure he has served as an advocate for healthcare organizations as they strive to improve the quality and safety of their physical environments,” a spokesperson for The Joint Commission said in an email.

The confirmation came after HCPro’s resident hospital safety expert, Steve MacArthur, safety consultant for The Greeley Company, blogged Thursday on murmurings of an impending Mills exit. The Joint Commission also confirmed MacArthur’s report that John D. Maurer, SASHE, CHFM, CHSP, will take over as acting director of engineering on an interim basis.

“I don’t anticipate that this will engender a significant change in how business will be conducted, including the practical administration of the Life Safety portion of the accreditation survey process,” MacArthur wrote, noting that he has always found Maurer to be “thoughtful, helpful, and equitable.”

Beginning October 9, Maurer will serve as acting director while a search for Mills’ successor is undertaken, the spokesperson said. Mills declined Thursday to comment on his forthcoming departure, and Maurer could not be reached.

 

Joint Commission deletes ORYX standard

The Joint Commission will delete performance improvement standard PI.02.01.03 and its single element of performance on January 1, 2018. The standard had required facilities to receive a composite performance rate of 85% or higher on the ORYX accountability measures.

The accreditor announced that it was deleting the standard because it wasn’t possible for facilities to accurately calculate their composite rates.

So many chart-based measures were retired to maintain alignment with CMS that there weren’t enough left relevant to this requirement. Also, since hospitals can submit data in several different ways, it threw off the composite rate calculations.

https://www.jointcommission.org/assets/1/18/Baking_Deletion_Prepublication.pdf

The measure had been suspended since 2015.

Crucial accreditation deadlines on the horizon for pain management and emergency preparedness

Time is running out to meet the new emergency management (EM) Conditions of Participation (CoP) and The Joint Commission’s revised pain management standards. The EM Interpretive Guidelines go into effect on November 15 while the pain management standards go into effect January 1.

Emergency management

The new EM CoPs fill gaps CMS’ previous regulations by compelling hospitals to communicate and coordinate their emergency plans with other healthcare organizations and government agencies. They also require regular emergency preparedness training with staff and disaster contingency planning.

Steve MacArthur, a safety consultant at The Greeley Company, pointed out that a lot of the new requirements include things that hospitals should have already been doing.

“While this rule is new to the ‘marketplace,’ there are really no new concepts contained therein,” he says. “This may provide some guidance for CMS surveyors as they drill down on organizational preparedness activities. But none of this is groundbreaking or in any way representative of a change in how hospitals have done, and will continue to do, business. [It’s] just another set of official ‘eyes’ looking through the compliance microscope.”

Pain management

The Joint Commission prepublished its new pain management standards back in June. The accreditor said it used the revision to address disparities between its standards and what the literature recommended. Some of the changes include:

•    Enabling clinician access to prescription drug monitoring program databases

•    Performance improvement activities focusing on pain assessment and management to increase the safety and quality for patients

•    Identifying the leader or leadership team responsible for pain management and safe opioid prescribing

•    Involving patients in developing their treatment plans and setting realistic expectations and measurable goals

•    Identifying and monitoring high-risk patients as a way to promote safe opioid use

Facilities should assign teams to research best practices in pain management, get the medical staff working on revising protocols and deter¬mining how to gather data on pain management effectiveness, and alert your information technology and electronic health records experts that they will be needed.

The annual fire and smoke door testing requirements will also be due by January 2018.

Joint Commission revises Medication Management EPs

The Joint Commission has revised Medication Management elements of performance (EP) for several of its programs. The changes will go into effect on January 1, 2018 and will impact hospitals, ambulatory care, behavioral care, home care, nursing care centers, critical access hospitals, and office-based practices accredited by The Joint Commission. The revisions will require organizations to:

•    Record the date and time of any medication administered in the patient’s clinical record.
•    Implement a policy to provide emergency backup for essential medication dispensing equipment and for essential refrigeration for medications.
•    Have a written policy addressing the control of medications between when they are received by a provider and given to a patient. Those policies should now include what to do for the “wasting of medications.”
•    Implement a policy describing the types of medication overrides for automatic dispensing cabinets that will be reviewed for appropriateness and the frequency.

The revisions vary depending on the program.

CMS withdraws proposal to have AOs post survey reports online

A proposal by CMS to have accrediting organizations (AOs) post the details of survey reports online was withdrawn by the agency, not because of negative comments — although there were plenty — but because, well, it might be prohibited under federal law.

CMS first made the proposal in April, tucking it into the latter pages of the always-long proposed on changes to the Inpatient Prospective Payment System (IPPS) for the upcoming fiscal year.

The proposal was to have AOs post final survey reports online within 90 days that the same information is available to the hospital or other health care organization, including details of all initial and recertification surveys at that provider in the prior three years, as well as the accepted plans of correction (PoCs).

AOs now post only whether an organization is accredited or not, and do not make details of findings public.

CMS argued its proposal was to promote transparency in health care, and noted that it posts its own  survey reports online. But critics responded that the CMS reports are made available in a hard-to-read spreadsheet and that the federal agency was responsible for far fewer surveys at health care organizations that were often surveyed only after a complaint (IJC 5/1/17).

In public comments to CMS concerning the proposal, The Joint Commission said that requiring survey details be made public would have “chilling effect” on efforts to raise standards of quality. Dr. Mark R. Chassin, president and CEO of The Joint Commission, wrote: “There will be a race to the bottom on quality as health care organizations seek out oversight bodies that will report on the least number of standards comparable to the Medicare requirements. This may also lead to a growth in non-accredited facilities that will then be surveyed at taxpayer expense and with fewer oversight visits.”

Other groups similarly weighed in against the proposal, and offered alternatives. In the end though, it was shot down because it might potentially be prohibited.

In the IPPS final rule published Aug. 2, CMS noted that its proposal included revising the federal regulations overseeing Medicare to incorporate the requirement for AOs to post report details publically.

“Section 1865(b) of the Act prohibits CMS from disclosing survey reports or compelling the AOs to disclose their reports themselves. The suggestion by CMS to have the AOs post their survey reports may appear as if CMS was attempting to circumvent the provision of section 1865(b) of the Act. Therefore, this provision is effectively being withdrawn.” — A.J. Plunkett (aplunkett@h3.group)

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