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CMS proposes new rule for community mental health centers

The Centers for Medicare and Medicaid Services (CMS) issued a proposed rule that would provide conditions of participation for community mental health centers (CMHCs).

Medicare beneficiaries who receive care from a CMHC have an alternative to inpatient treatment, and are provided with partial hospitalization services, including physician services, psychiatric nursing, counseling, and other social services.

CMS’ new rule includes the following standards:

• Establishing qualifications for CMHC employees and contractors.
• Mandating CMHCs to notify clients of their rights and to investigate and report violations of client rights. These proposed requirements also promote continuity of care by highlighting the need for communication of client needs when they are discharged or transferred.
• Organizing a treatment team, developing an active treatment plan, and coordinating services to ensure an interdisciplinary approach to individualized client care.
• Creating a Quality Assessment and Performance Improvement (QAPI) program. This will require CMHCs to identify program needs by evaluating outcome and client satisfaction data and making changes based on that data to improve their quality of care.
• Put into place organization, governance, administration of services, and partial hospitalization services requirements, with special attention to governance structure.

CMS is accepting comments until August 16, 2011. If you’d like to submit one, visit http://www.regulations.gov and search for rule “CMS-3202-P.”

To view the press release, click here.

CMS proposes new rule: Perform well, be rewarded

The Centers for Medicare & Medicaid Services (CMS) has announced a new rule for hospital inpatient value-based purchasing that plans to give monetary incentive for hospitals to meeting and exceed quality and safety measures, and is also intended to make care safer by reducing medical errors.

Under the program, hospitals that do well both in terms of quality of care and the patient experience – or hospitals that have made improvements in their delivery of care – would be rewarded with higher payments. And, the higher a hospital’s performance or improvement during the performance period during any given fiscal year, the higher the hospital’s value based incentive payment.

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Something wicked this way comes…

Steve MacArthur, for Mac’s Safety Space, December 6, 2010

OK, maybe not really wicked, but what’s the point of blogging if one doesn’t occasionally lapse into frantic hyperbole. If I had added “details at 11,” it would be just like watching prime time TV, but I digress.

First some history – back in 2004,  CMS weighed in on the increasing use of wheeled computer workstations and other such devices.

One of the interesting things in the 2004 memo is the discussion of the whole “in use” concept as a function of clear corridor width. Back then, and you can absolutely assume that there’s been a change – we’ll get to it in a moment, “in use” was identified as “not left unattended for more than 30 minutes,” which was practically applied to linen carts, medication carts, janitorial carts, etc., that were not to be (and I do love this turn of phrase) “included in the exclusions,” such as placing chairs  in front of computer work stations, that would decrease clear corridor width. So one could interpret “in use” as having a somewhat more flexible interpretation, because you could have anything in the corridor for 30 minutes and it would be okay.

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CMS adds patient safety measures to hospital comparison website

Starting in 2011, the Centers for Medicare & Medicaid Services (CMS) plan to add new standards for patient safety measures to its Hospital Compare website in order to enhance the effectiveness of Medicare’s fee-for-service program and monitor healthcare-related diseases and hospital-acquired infections.

The Hospital Compare site aims to improve the quality, efficiency, and transparency of care in the agency’s Medicare fee-for-service program by providing useful information on hospital’s treatment operations that will allow consumers to make knowledgeable decisions about which care providers to use based on the cost and quality of services they offer.

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Joint Commission changes standards as part of deeming authority application

The Joint Commission announced yesterday that, as part of its application to the Centers for Medicare & Medicaid Services (CMS), a number of changes will be made to the accreditation process.

Industry experts have noted that many of the changes are requirements hospitals already meet due to existing state or other regulatory requirements. According to The Joint Commission’s announcement, many of the requirements are already being met by accredited facilities.

“A lot of these [requirements] are current law or regulation,” says Elizabeth Di Giacomo-Geffers, RN, MPH CNAA, BC, CSHA, a healthcare consultant in Trabuco Canyon, CA, and former Joint Commission surveyor.

Di Giacomo-Geffers suggests facilities compile a list of the changes to see which changes the hospital already complies with–a checklist of yes, no, or not applicable.

“If the answer is no, you’re not complying with the requirement, then ask, what do we need to make this happen?” she says.

Many of the changes have resulted in added specificity to existing standards, though others have required the creation of entirely new standards. All changes go into effect immediately. These requirements will not be scored, however, until July 2009. The Joint Commission has a policy that it will, when possible, give its accredited organizations six months notice for new requirements.

The Joint Commission’s official announcement can be found here. The new requirements can be downloaded here.

Stay tuned to the AHAP Blog for further analysis on this issue in the coming days.

CMS proposes changes to wrong site, wrong patient, wrong surgery rules

Hello, everyone. The Centers for Medicare & Medicaid Services (CMS) issued several proposed decision memos yesterday indicating they will not pay for wrong site/patient/surgery cases. The proposed decision memos can be found on the CMS Web site at the following links:

Surgery on the Wrong Body Part

Surgery on the Wrong Patient

Wrong Surgery Performed on a Patient


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?

Medicare Improvements for Patients and Providers Act

I just wanted to update you on a news brief I posted to the group a few weeks back. Congress overruled yesterday President Bush’s veto of the Medicare Improvements for Patients and Providers Act, based on a bill authored by Senate Finance Committee Chairman Max Baucus (D-Mont.).

While the primary focus of the bill is to improve several key aspects of Medicare, for those of us working in the area of accreditation, under the category of “Enhancements for Rural and Other Hospital Care,” note this short passage:

Revokes unique authority of the Joint Commission on the Accreditation of Healthcare Organizations to deem hospitals in compliance with Medicare Conditions of Participation.

There will be a 24-month transition period for The Joint Commission to complete the application process for deeming authority, and “the amendments made by this section shall not effect the accreditation of a hospital by the Joint Commission, or under accreditation or comparable approval standards found to be essentially equivalent to accreditation or approval standards of the Joint Commission, for the period of time applicable under such accreditation.”

Additional information can be found online here: http://finance.senate.gov/sitepages/medicare2008.htm

What are your thoughts? Does this level the playing field for other accrediting organizations? What effect do you think this will have on hospital accreditation, if any?

We have reached out to The Joint Commission and several other organizations for comment; I will be sure to distribute to the group follow-up information as it arises.