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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A proposal by CMS to have accrediting organizations (AOs) post the details of survey reports online was withdrawn by the agency, not because of negative comments — although there were plenty — but because, well, it might be prohibited under federal law.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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Only 80 days until the AHAP conference

Just wanted to let you all know that there are only 80 days between now and the AHAP conference on May 14 and 15! For those who have already signed up, I hope you are as excited as we are to get together with peers and learn about the latest trends in accreditation. I’m particularly interested to sit in on the panel scheduled that will have speakers from The Joint Commission, DNV, and HFAP to discuss accreditation options.

For those who haven’t signed up yet and are interested, you can check out the agenda and any related registration information by clicking here. The early-bird rate is still available and will be through March 13.

It’s sure to be a good time with fellow healthcare accreditation buffs, Vegas style!

Update: NIAHO certification program

Hello,

I just wanted to share a snippet from a recent article in Briefings on The Joint Commission about a pair of hospitals which have switched to DNV, Inc.’s accreditation program. The following explains a bit about the NIAHO survey process. Hope this is of interest.

Six surveyors showed up at Citizens Medical Center (Victoria, TX) for what would end up being a three-day survey. They were presented with a list of documents to present for review, along with a tentative three-day schedule. As part of prior preparation, the documentation was quickly pulled and presented.

The survey consisted of document reviews and discussions, review of open patient records, interviews with staff, life safety tours, and more.

“All in all, the survey was very thorough, comprehensive, collaborative, and educational,” says Caren Adamson, assistant administrator at Citizens Medical Center. “We were held accountable to the prescriptive requirements of the CoPs and were assessed with our compliance with the ISO standards and our underlying framework for ongoing compliance.”

Purdy has found that the survey process for her facility has been a less stressful process for staff.

“They make it clear they’re looking at the process, not the individual,” says Judith Purdy, RN, risk/quality director at Hays (KS) Medical Center. “The staff appreciate that.

It’s not so much a new survey process,” says Purdy. “They survey the CoPs. The hospital is very familiar with those and comfortable being surveyed by those standards.”

Staff is trained in the CoPs and very aware of those standards, she explains.

“We’ve been talking to the employees for over a year that this is the agency we’re looking towards shifting to. They’ve been hearing this information for months,” says Purdy. “There is a sense of anticipation waiting for this to really happen.”

Purdy also noted there will likely be a learning curve on both sides of the survey process at first.

“To some degree they’re still training the surveyors, but as a rule there will be a generalist, a clinical person and a life safety person,” says Purdy. This list does not necessarily include a physician, and the generalist can fulfill a clinical or nonclinical role or both and will be trained in the standards to do so.

DNV has stated that they will attempt to send the same surveyors each year, with the thought that the survey process will benefit from a surveyor that has a level of knowledge about the facility and how it functions and operates.

Who’s making the switch?

In the upcoming issue of Briefings on The Joint Commission, I was able to talk with accreditation professionals at two hospitals who have applied for and been surveyed by DNV and intend to leave The Joint Commission as soon as their DNV application is approved. The conversations left me curious–how many of our members here at AHAP are looking at DNV’s accreditation process as a possible alternative?

My question to the field is–are you going through any sort of process, formal or informal, to take a look at DNV as an alternative? Has anyone decided to make the switch? What factored into the decision (for or against changing accrediting organizations)?

DNV on the Web

Hello,

Thought this might be of interest to our members: healthcare lawyer and consultant David Harlow posted in his blog yesterday about potential benefits and costs to moving to DNV’s NIAHO program for hospital accreditation. Even more interesting, though, is that his post received direct feedback from DNV in the form of a reply by Executive Vice President Darrel Scott.

Scott responded directly to issues about rumored confusion about insurance companies and the NIAHO program, and clarified the timeframe in which a hospital must become ISO-9001 compliant upon entering the NIAHO accreditation program (within two years of their first accreditation effective date).

Looks like DNV is monitoring what folks are saying in the field. Have any of you started exploring the option of changing accrediting organizations in the future? What sort of questions are you hoping to have answered about DNV, NIAHO, and ISO-9001?

CMS approves DNV application to accredit hospitals

Hello, everyone. I just wanted to update you on a developing story:

The Centers for Medicare and Medicaid Services (CMS) announced Friday the approval of DNV Healthcare, Inc. as a deeming authority for U.S. hospitals. DNV is the first new organization to receive deeming authority for hospitals in more than 30 years.

According to the pre-Federal Register announcement, DNV was recognized “as a national accreditation program for hospitals seeking to participate in the Medicare or Medicaid programs” effective September 26, 2008 through September 26, 2012.

“We’re coming into this business not just as another option,” says Yehuda Dror, president of DNV Healthcare. “We want to take a leadership position.”

“I think a lot of people will explore the possibility,” says Bud Pate, REHS, is Vice President for Content and Development for The Greeley Company; a division of HCPro, Inc. “There are some hurdles that people will need to walk through—since DNV is new they’re going to need to work through some residency issues, contract issues, that may exist and may mention The Joint Commission but none of these are insurmountable.”

DNV has crafted a system intended to combine CMS Conditions of Participation (CoP) with ISO 9001 quality management. This program, called the National Integrated Accreditation for Healthcare Organizations or NIAHO(SM), was created to make the accreditation process more streamlined as well as identify means for improving current standards and promoting continual improvement.

“The ISO-9001 certification seems to be a logical progression to the focus on quality assurance and quality improvement that has occurred in healthcare, primarily in hospitals,” says Larry Poniatowski, RN, BSN, CSHA, principal consultant for Accreditation Compliance Services with The University HealthSystem Consortium. “The issue here now will be to see how well it’s embraced by hospitals.”

Twenty seven U.S. hospitals in 22 states have been accredited by DNV Healthcare using the NIAHO(SM) program in addition to other accreditation services.

In mid-2007, DNV Healthcare acquired Cincinnati-based TUV Healthcare Specialists with the belief that the acquisition would help cement DNV’s application to CMS. In 2006, TUV had unsuccessfully applied for deeming authority.

DNV Healthcare is a division of Houston-based DNV USA, a subsidiary of the Norwegian company Det Norske Veritas. DNV focuses on risk management and training in several industries, including healthcare.

We’ll be providing additional coverage here on the blog as well as in Briefings on The Joint Commission in the upcoming issue.

What is your sense of DNV’s chances? Is your facility considering looking into moving away from Joint Commission accreditation? Are you interested in further details on how DNV’s process works?