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Tom Price confirmed as HHS secretary  

On February 10, the U.S. Senate voted 52 to 47 confirming Rep. Tom Price, MD (R-GA) as the new head of the Department of Health and Human Services (HHS). Price is an orthopedic surgeon and the first physician to head the HHS since the George H.W. Bush administration. He’s known for his opposition to the Affordable Care Act.HHS logo

Price’s appointment has been highly controversial, in part due to his investments in healthcare companies that could potentially benefit or be harmed by his actions as HHS secretary.

A recent survey of nearly 1,100 physicians revealed a sharp divide in opinions on Price’s appointment; with 46% feeling positive and 42% leaned negative. The survey also revealed that 47% of respondents believe that Price will diminish patients’ ability to access quality care, with 42% who believed the opposite.

FAQs on Joint Commission antimicrobial stewardship standard

In the wake of a CMS ruling that will make antibiotic stewardship programs (ASP) mandatory, The Joint Commission recently announced that it will roll out a similar standard. Effective January 1, 2017, the new Medication Management standard 09.01.01 requires facilities to create an effective ASP. The standard applies to:

Syringe

To help facilities with the new requirements, The Joint Commission has compiled a set of FAQs on antimicrobial stewardship, which can be viewed here.

CMS extends eCQM reporting deadline

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 Logo

“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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Trump: For every new healthcare regulation, two must be removed

On January 30, President Trump signed a new executive order declaring a “one-in, two-out” rule for executive departments or agencies, including healthcare. Under the executive order, for a new healthcare regulation to be implemented, two older regulations will have to be eliminated.

“If you have a regulation you want, number one, we’re not going to approve it because it’s already been approved probably in 17 different forms,” Trump said during the signing. “But if we do, the only way you have a chance is we have to knock out two regulations for every new regulation. So if there’s a new regulation, they have to knock out two.”The White House

The order also sets an annual cap on the cost of new regulations and cuts the regulatory budget for fiscal year 2017 to zero. This means the only way to afford new regulations issued between now and September 30, 2017 is by repealing existing regulations.

While each agency will decide which regulations they think can be cut, the White House will ultimately decide which ones to gut. Regulations dealing with national security, foreign affairs, and the organization, management, or personnel of federal agencies are exempt.

Reminder: SAFER Matrix now in effect

The Joint Commission is now using its SAFER Matrix with all accredited organizations. The matrix replaces the old scoring method of categorizing risk using “A” and “C” rankings.

The SAFER matrix is a three-by-three grid labeling the level of risk and harm observed for a standard. The approach is meant to help organizations prioritize and focus their efforts on the direst areas of risk.

To see our previous Accreditation Insider on the SAFER Matrix, click here.

Briefing on Accreditation and Quality subscribers can view or the following stories.

 

Report: Financial penalties prove effective against readmissions

Based on data collected from more than 2,800 hospitals, researchers were able to prove the effectiveness of the Hospital Readmission Reduction Program (HRRP). Harvard and Beth Israel Deaconess Medical Center researchers added that facilities that were penalized the most saw the greatest improvement in readmission reduction. Nearly $1 billion in penalties have been imposed so far.

“It’s a quite clear example that when hospitals are reimbursed, not just for how much they do but how well they do it, it makes an impact on their behavior,” study co-senior author Robert W. Yeh, MD, told HealthLeaders. “That is what you would expect from an individual and this seems to incentivize organizations to act collectively to move in the same direction.”Money

Researchers looked at 30-day readmission rates for patients with acute myocardial infarction (AMI), congestive heart failure, or pneumonia. In January 2008, the readmission rates at penalized institutions were 21.9% for AMI, 27.5% for heart failure, 20.1% for pneumonia, compared to 18.7%, 24.2%, 17.4%, at non-penalized facilities. However, once HRRP was announced in March 2010, rehospitalization rates declined notably faster at penalized hospitals. Compared to non-penalized facilities, penalized hospitals decreased their AMI readmissions by 1.24%,  1.25% for heart failure, and 1.37% for pneumonia.

For a full interview with the researchers, visit HealthLeaders Media.

Joint Commission Leadership standard now aligns with CMS

On January 9, 2017, Joint Commission Leadership (LD) standard 01.03.01,element of performance (EP) 12, for home health and hospice will be expanded to apply to hospitals, critical access hospitals, and ambulatory surgical centers.

The standard requires that the leadership/governance of a healthcare facility is the one ultimately held accountable for the facility’s safety, quality, and compliance. Previously, however, the Joint Commission standard didn’t have an EP that referred to leadership’s legal responsibility. In addition, the EPs varied between different types of facilities on what to do if leadership failed to meet its responsibilities.
The Joint Commission announced it was expanding EP 12 to the additional settings as a way to standardize compliance across all accredited facilities and to come into alignment with CMS’ Conditions of Participation.

Hard copy versions of accreditation manuals published after November 2016 will include the new EP, and the change will be made to the accreditor’s E-dition in January. For more information, contact Laura Smith, Joint Commission project director, at lsmith@jointcommission.org.

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Joint Commission targets CAUTIs with updated NPSG

Earlier this year, The Joint Commission updated its National Patient Safety Goal (NPSG) on catheter-associated urinary tract infections (CAUTI) for hospitals and critical access hospitals. It also created a new CAUTI NPSG for nursing care centers.

“An estimated 1 to 3 million healthcare-associated infections strike nursing home residents annually, and many of these are infections related to urinary catheters,” wrote David Baker, MD, MPH, FACP, Joint Commission executive vice president, in a blog post. “CAUTIs can lead to serious complications and hospitalizations. And, the rate of these infections is even higher for hospital patients. This is why The Joint Commission felt it was important to implement its new National Patient Safety Goal for nursing care centers and an updated goal for hospitals and critical access hospitals to reflect the latest scientific evidence.”

Among the new changes are requirements to:

•    Educate staff on how to correctly use and insert indwelling catheters.
•    Educate patients and family on CAUTI risks and prevention
•    Use evidence-based guidelines to write catheter use policies.
•    Follow written procedures based on established evidence-based guidelines for inserting and maintaining an indwelling urinary catheter.
•    Maintain an up-to-date record of catheter use; who has one inserted, when was it implanted, etc.

All the changes go into effect on January 1, 2017 and are meant to improve staff training, educate patients, and update policies with evidence-based practices. In addition, the Department of Health and Human Services announced that it wants to see a 50% reduction in CAUTI by 2020.

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Joint Commission publishes 2017 Survey Activity Guide

The Joint Commission just published its 2017 Survey Activity Guide, with information on how to prepare for your next survey. It also contains details on policy changes in 2017, such as the new antimicrobial stewardship program standard for hospitals, critical access hospitals, and nursing homes.

Joint Commission updates ASC survey process

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.