The American Society for Healthcare Engineering (ASHE) recently published answers involving CMS’ new fire safety regulations. The new Conditions of Participation require fire doors be routinely inspected by “qualified persons.”
ASHE clarified to members that there isn’t any class or certification to qualify for door inspection. Anyone who’s familiar with the code requirements for fire doors will meet the “qualified” standard.
For more details, see the ASHE brief on the topic.
In a new blog post, CMS announced that it was extending its electronic clinical quality measure (eCQM) submissions to March 13, 2017 at 11:59 p.m. PST. This gives facilities and extra 13 days to get their submissions in on time.
The data being submitted is from the 2016 reporting period, which will impact facilities’ 2018 fiscal year (FY) payments. The deadline applies to hospitals and critical access hospitals enrolled in either the Hospital Inpatient Quality Reporting (IQR) program or the Medicare Electronic Health Record (EHR) Incentive program.
“CMS also intends to initiate the rulemaking process regarding modifications to the eCQM requirements established in the FY 2017 Inpatient Prospective Payment System (IPPS) final rule in response to concerns raised by stakeholders,” Kate Goodrich, MD, CMS chief medical officer, wrote. “In order to help reduce reporting burdens while supporting the long term goals of these programs, we intend to include proposals regarding the 2017 eCQM reporting requirements for the Hospital IQR and EHR Incentive Programs for eligible hospitals and critical access hospitals in the FY 2018 IPPS proposed rule that we anticipate to be published in the late spring of 2017.”
CMS says it will address stakeholder concerns with the FY 2018 IPPS proposed rule. In particular, they will look at
• Challenges associated with hospitals transitioning to new EHR systems or products
• Upgrading to EHR technology certified to the 2015 Edition
• Modifying workflows
• Addressing data element mapping
• Time allotted for hospitals to implement eCQM specifications updates in 2017
The agency is also proposing to adjust the number of eCQMs required to be reported for 2017 as well as to shorten the eCQM reporting period.
“We believe that these efforts reflect the commitment of CMS to create a health information technology infrastructure that elevates patient-centered care, improves health outcomes, and supports the healthcare providers who care for patients,” she wrote. “We continuously strive to work in partnership with hospitals and the provider community to improve quality of care and health outcomes of patients, reduce cost, and increase access to care.”
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Date: Tuesday, January, 24, 2017 1:00–2:30 p.m. EST
Summary: After much anticipation, CMS has approved its own emergency preparedness rules separate from The Joint Commission and other accreditation agencies. Hospitals and healthcare organizations now have until November 15, 2017 to enact the changes and maintain compliance.
Join expert speakers Marge McFarlane, PhD, MT(ASCP), CHSP, CHFM, CJCP, HEM, MEP, CHEP, and Thomas Huser, MS, CHSP, CHEP, as they guide you through the changes. They will help you identify resources for implementation, provide helpful tips, outline the special focus on fire drills for critical access hospitals, and list the optional and required CMS emergency management standard categories.
- The list of required and optional categories of the CMS emergency management regulations
- The tips, resources, and potential challenges to implementing an emergency prep plan
- How to conduct fire drills for critical access hospitals
Registration: To order the webcast on demand, call HCPro customer service at 800-650-6787 or visit hcmarketplace.com
On December 2, the American Hospital Association (AHA) sent a letter to president-elect Donald Trump asking him to reform CMS regulatory requirements. This is the second letter the group sent the president-elect in the space of three days.
The AHA has 43,000 individual members and nearly 5,000 member hospitals in its ranks. AHA CEO and President Rick Pollack wrote that the balance between flexibility in patient care and regulatory burden was at a tipping point. He continues to say that reducing administrative complexity would save billions annually and allow providers to spend more time on patients, not paperwork.
“[CMS] and other agencies of the Department of Health and Human Services (HHS) released 43 hospital-related proposed and final rules in the first 10 months of the year alone, comprising almost 21,000 pages of text,” he wrote. “In addition to the sheer volume, the scope of changes required by the new regulations is beginning to outstrip the field’s ability to absorb them. Moreover, this does not include the increasing use of sub-regulatory guidance (FAQs, blogs, etc.) to implement new administrative policies.”
The letter includes a list of 33 changes the AHA wants to be made, including
• Suspend hospital star ratings
• Suspend electronic clinical quality measure (eCQM) reporting requirements
• Delete faulty hospital quality measures
• Have readmission measures reflect socioeconomic factors
• Cancel stage 3 of “meaningful use” program.
• Stop federal agencies (HHS, CMS) from forcing private sector accreditors (Joint Commission, DNV, HFAP) to conform with government accreditation standards
• Refocus the Office of the National Coordinator (ONC) on certifying electronic health records
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It’s been almost five months after CMS publicly released its hospital star ratings system amidst widespread controversy and opposition. Now, a new study by WalletHub has provided evidence that hospitals’ ratings are highly linked to their location and socioeconomic factors.
Ever since CMS announced the star system, many had argued that it was biased against facilities that treat impoverished, sicker patients. To study this, WalletHub looks at the ratings of 657 hospitals in 150 cities across the U.S. comparing ratings to each city’s “stress level,” a composite of stressor caused by work, money, family, and health and safety.
Hospitals in Detroit and Newark, N.J. (the first and ninth most stressed cities) earned an average of 1.5 and one stars respectively. However, hospitals in the California cities of Fremont and Irvine (the least and second-least stressed cities) earned an average of three and five stars, respectively. Meanwhile, CMS reports that safety net hospitals earn slightly lower ratings on average compared to non-safety net hospitals (2.88 to 3.09 stars).
“When we look at hospital quality ratings and rankings, what we are seeing has less to do with what the hospitals themselves are doing and more to do with the communities they are located in and the patients they serve,” said David Nerenz, co-author of the study and the director of the Center for Health Policy and Health Services Research at the Henry Ford Health System in Detroit, to Modern Healthcare. [more]
CMS last week released a list of 97 reporting measures for hospitals, clinician practices, nursing homes, dialysis facilities, and other settings. The measures are being considered for use in Medicare’s quality and value-based purchasing programs.
This year, 39% of the measures focus on patient outcomes, while the remainder focus on patient safety, cost, and appropriate use of diagnostics and services. There was also an increase in measures submitted by specialty societies. CMS annually publishes a list of potential Medicare quality measures to hear back from patients, clinicians, payers, and purchasers on the which measures they think are the best. CMS is teaming up with the National Quality Forum (NQF) for the sixth year in a row on this effort. The feedback the NQF collects will be sent to the multi-stakeholder Measure Applications Partnership (MAP) for consideration.
“We invite you to review the Measures under Consideration List in detail and to participate in the public process during the MAP review,” wrote Kate Goodrich, MD, MHS, CMS director of the Center for Clinical Standards & Quality, in a blog post. “We believe it is critically important to hear all voices in the selection of quality and efficiency measures that are used for accountability and transparency purposes and look forward to another successful pre-rulemaking season. We are committed to working with patients, clinicians, and others on how to best measure the quality and value of care while reducing burden on providers and driving improved outcomes for patients at lower costs.”
The proposed measures are available on CMS and NQF websites, and comments on can be made until 6 p.m. on December 2 at the NQF website.
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.”
The Government Accountability Office (GAO) sent a report on October 13 to the Department of Health and Human Services (HHS) urging for better alignment of healthcare quality measures. The conclusion of the 42-page document is that payers haven’t agreed on what quality measures to track, which puts a burden on healthcare organizations.
“For example, a physician may participate in Medicare and a private health plan that each use different measures for assessing the care of diabetic patients,” the GAO wrote. “In another example, a physician may report similar measures to multiple payers that assess blood sugar levels among diabetic patients, but each measure may use a different threshold to determine which patients have their blood sugar levels under control.”
The GAO says there are three main drivers of these misalignments:
- Dispersed decision-making:Each public and private payer decides which quality measures they want to use and which specifications apply. This is done without regard to the measures that other payers are using.
- Variation in data collection and reporting systems:The electronic health record (EHR) systems, paper records, or clinical data registries that physicians use all differ in how they collect and report quality data. Without standard measures, there’s little incentive for EHR vendors to create systems to facilitate data collection and reporting.
- Few meaningful measures:Of the hundreds of quality measures currently used, only a few are seen as leading to meaningful quality improvements.
“What we have right now is a labyrinth of confusing metrics, specifications and reporting rules that serve no one,” said Kathleen Ciccone, RN, introducing a Healthcare Association of New York State report calling for streamlined measures.
The GAO report recommends that HHS, CMS, and the Office of the National Coordinator for Health Information Technology develop a comprehensive plan, including timelines, for more meaningful quality measures and electronic quality measures. The GAO particularly wants to see the creation of standardized data elements to report on core electronic quality measures.
Hospitals will face new requirements for getting Health Insurance Marketplace (HIM) plans starting on January 1, 2017. The final rule, which was issued by CMS this year, says that hospitals with 50 beds or more can only receive HIM insurance if they:
- Work with a Patient Safety Organization (PSO).
- Are a member of a Quality Improvement Organization.
- Are a member of a Hospital Engagement Network.
- Are accredited by The Joint Commission.
- Implement an evidence-based initiative to improve healthcare quality through the collection, management, and analysis of patient safety events. The initiatives must meet reasonable exception criteria.
The Agency for Healthcare Research and Quality has a list of all the PSOs that apply for the rule. For more information on the new rule and it’s reasonable exception criteria, you can view CMS’ presentation and accompanying Q&A.