Starting January 1, two-thirds of ambulatory surgical centers (ASC) using the Medicare-deemed option may receive adjustments to their Joint Commission survey team structure and survey length. The Joint Commission is doing this as part of an effort to better align with CMS surveyor guidelines. Onsite survey fees for qualifying ASCs will be adjusted to reflect the number of surveyors on site and the length of the survey. The goals of this are to:
- Give surveyors more time for a thorough evaluation of the clinical component of ASC Medicare-deemed surveys
- Give surveyors time to cover and complete both Joint Commission and CMS requirements, patient tracers, review medical records and credentialing files, and CMS-required worksheets
- Share leading practices with ASCs and produce a more meaningful, educational, and consultative experience
- Create a survey team that has two clinical surveyors (in majority of survey events) who are able to work together in real-time to maintain consistency of interpretation
- Better prepare ASCs for their CMS state survey
The Life Safety Code® component of the survey will remain unchanged (one surveyor for one day) unless circumstances call for additional time.
Organizations with questions on the changes are asked to speak with their Joint Commission account executive.
The high rate of burnout and unengaged physicians and nurses is an increasing concern for the healthcare industry. Burnout is characterized by exhaustion, cynicism, and reduced effectiveness. It’s also a proven influence on care quality, patient safety, physician turnover, and patient satisfaction. However, industry attempts to engage with physicians have been haphazard at best. The Mayo Clinic recently released a new paper on preventing burnout, emphasizing the need for individual physicians and hospital leaders to work together on this problem.
“The reality is that an engaged physician workforce is requisite to achieving institutional objectives, that small investments can have a large impact, and that many effective interventions are cost neutral,” wrote John Noseworthy, MD, president and CEO of the Mayo Clinic, and Tait D. Shanafelt, the Mayo Clinic’s director of the program on physician well-being, in the report.
1. Admit there is a problem and then assess it: Provide your medical staff with many opportunities to talk about the problems they face. These discussions can be done in many different formats: town halls, radio broadcasts, face-to-face meetings and video interviews. Use these discussions to measure engagement and satisfaction with work-life integration each year.
2. Identify physician leaders: Healthcare leaders must look for physicians with the ability to listen to, engage, develop, and lead physicians. But then the organization must help develop and train these leaders. Staff should also be given a chance to evaluate their physician leaders. [more]
The Joint Commission has released prepublication standards for its comprehensive cardiac center (CCC) advanced certification program. The certification is optional and evaluates healthcare organizations’ eligibility to qualify as a CCC. The standards and EPs go into effect on January 1, 2017.
A new study found that out of the 310 million surgery patients who receive surgery every year, 50 million suffer postoperative complications and more than 1.5 million die from those complications. Surprisingly, patients in low- and middle-income countries were less likely to experience complications than those in high-income nations.
The study was the first of its kind at the international level, and was conducted by the International Surgical Outcomes Study Group, led by Queen Mary University of London’s Professor Rupert Pearse and published in the British Journal of Anaesthesia (BJA). Researchers used data on 44,814 patients who underwent surgery within the same seven-day period, comparing different types of surgery with the frequency and severity of adverse outcomes. The patients came from 474 different hospitals in 27 different countries, ranging between high income (U.S., U.K., Germany) and low income (Uganda, Brazil, Romania.)
“There is still a great deal of work to be done to improve patient care around the time of surgery,” he said. “Initiatives such as that led by the Royal College of Anaesthetists Perioperative Medicine programme provide excellent examples of what can be done to resolve these problems.” [more]
During a recent meeting, the American Medical Association (AMA) released new guidance for clinicians on mobile health (mHealth) apps. With the number of health apps growing exponentially, the guidance is meant to help clinicians determine coverage and payment policies for apps providing useful care quality data. The guidance specifically looks at apps that support patient-centered care delivery, care-coordination, and team-based communication.
“The new AMA principles aim to foster the integration of digital health innovations into clinical practice by promoting coverage and payment policies that are contingent upon whether mHealth apps and related devices are evidence-based, validated, interoperable and actionable,” said Steven Stack, MD, AMA’s immediate past president in a press release.
While addressing mHealth apps coverage and payment issues, the guidance addressed the need for apps to:
• Support the patient-physician relationship
• Have a clinical evidence base validating their safety and effectiveness
• Follow evidence-based practice guidelines to ensure patient safety, quality of care, and positive health outcomes
• Ensure that the delivery of any services via the app conform to state practice laws
The AMA is currently working with several health IT companies and organizations to develop technologies and applications that better serve patient care. In its announcement, the association warned that the liability issues for mHealth apps are unclear and physicians should work with their legal teams before promoting or using an app.
These guidelines come several months after The Joint Commission announced that it had reversed its ban on texting medical orders. The accreditor and CMS said they are collaborating on a set of FAQs and had originally hoped to publish their additional guidance by September. http://blogs.hcpro.com/acc/?p=2781
The Joint Commission has published a list of the hospital National Patient Safety Goals (NPSG) that will go into effect on January 1, 2017. The new goals include:
- Improving patient identification
- Improving communication effectiveness amongst caregivers
- Improve safety of using medications
- Reducing the harm associated with anticoagulant therapy
- Medical reconciliation
The document also includes the rationales and Elements of Performance for all the goals.
Hospitals are making progress in healthcare quality, according to The Joint Commission’s recently published annual report, “America’s Hospitals: Improving Quality and Safety.” The report covers results from more than 3,300 accredited hospitals on measures covering:
- Children’s asthma
- Inpatient psychiatric services
- Venous thromboembolism care
- Stroke care
- Perinatal care
- Tobacco use treatment
- Substance use care
The report said that because of hospitals’ consistent and excellent quality performance over the past few years, the accreditor has been able to retire 20 accountability measures. Hospitals have been so diligent in using these measures that The Joint Commission no longer sees the need to survey for them. Meanwhile, 39 hospitals were declared Pioneers in Quality for their work in the evolution and utilization of electronic clinical quality measures.
“The results featured in The Joint Commission’s 2016 annual report are important because they show that accredited hospitals have continued to improve the quality of the care they provide, and the data that hospitals collect help them identify opportunities for further improvement,” said Mark R. Chassin, MD, FACP, MPP, MPH, Joint Commission president and CEO, in a press release. “The results also show it’s important to note that where a patient receives care makes a difference. Some hospitals perform better than others in treating particular conditions.”
This October, the Department for Health and Human Services (HHS) announced ambitious, new targets for reducing healthcare-associated infections (HAI) in acute care hospitals, long-term care facilities, and ambulatory surgical centers. The changes have been outlined in the National Action Plan to Prevent HAI: Road Map to Elimination. The HHS used HAI data from 2015 as a baseline, with the new target date set for 2020.
The previous targets for HAI reduction expired in 2013, with only the goal of reducing central line-associated bloodstream infections (CLABSI) by 50% achieved. All others saw partial success, save catheter-associated urinary tract infections (CAUTI) and Clostridium difficile (C. diff) hospitalizations. Between 2009 and 2014, there was no change in CAUTI reduction. Meanwhile, C. diff hospitalizations actually increased by 18%.
Now, the HHS’s new goals require:
- 50% CLABSI reduction
- 50% CAUTI reduction
- 25% invasive Methicillin-resistant Staphylococcus aureus (MRSA) reduction
- 50% facility-onset MRSA reduction
- 50% diff Infection (CDI) reduction
- 30% surgical site infection (SSI) reduction
- 30% reduction of diff hospitalizations
Facilities should have already started working on reducing CAUTIs, since The Joint Commission’s newest National Patient Safety Goal (NPSG) on CAUTIs will go into effect on January 1, 2017.
As of today, CMS, The Joint Commission, and HFAP will be surveying hospitals to the 2012 Life Safety Code® (LSC). The LSC was adopted by CMS in June, with some of the big changes required under the final rule including:
- Facilities located in buildings taller than 75 feet are required to install automatic sprinkler systems within 12 years after the rule’s effective date.
- Facilities are required to have a fire watch or building evacuation if their sprinkler systems is out of service for more than 10 hours.
- Greater flexibility for long-term care (LTC) facilities in what they can place in corridors. LTC facilities will be able to include more home-like items such as fixed seating in the corridor for resting and certain decorations in patient rooms.
- Fireplaces will be permitted in smoke compartments without a one-hour fire wall rating, which makes a facility more home-like for residents.
- For ambulatory surgical centers, alcohol-based hand rub dispensers now may be placed in corridors to allow for easier access.
- Fire watches must be continuous, “constantly circulating” through impaired
- All side-hinged swinging fire doors must be tested annually.
- Once every five years, an internal inspection of sprinkler pipe is required.
- Fire hose valves must be inspected quarterly and tested annually/every three years, depending on size.
- 1-hour fire-rated barriers are required between non-sprinklered construction areas and occupied egress areas.
Visit the Federal Register to see the full list of changes
On October 13, CMS announced a push to improve physician engagement and their experience within the Medicare system. To achieve this goal, the agency is trying to reduce the reduce administrative burdens that physicians have to handle with the new Medicare Access and CHIP Reauthorization Act (MACRA).
“Physicians and their care teams are the most vital resource a patient has. As we implement the Quality Payment Program under MACRA, we cannot do it without making a sustained, long-term commitment to take a holistic view on the demands on the physician and clinician workforce,” said Andy Slavitt, CMS Acting Administrator, in a press release. “The new initiative will launch a nationwide effort to work with the clinician community to improve Medicare regulations, policies, and interaction points to address issues and to help get physicians back to the most important thing they do—taking care of patients.”
CMS has begun an 18-month pilot program to reduce medical reviews for certain physicians. The pilot will relieve some of the scrutiny that certain types of advanced Alternative Payment Models (APM) providers receive for medical review programs. Advanced APMs were considered for this pilot they share financial risk with the Medicare program, giving them a powerful motivation to deliver the most efficient care possible. Once the pilot is over, CMS will analyze the results to see if they can be replicated in additional advanced APMs, specialties, and provider types.
“Like all successful changes, we will begin with the basic steps and build over time,” said Ashby Wolfe, MD, MPP, MPH, Region IX chief medical officer. “Most importantly, we are excited to build on the listening and engagement process we began this year by creating more opportunities for physicians to interact with CMS, especially through our regional offices.”