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CMS releases final hospital/CAH CoPs

Last week, the Centers for Medicare and Medicaid Services (CMS) posted the final rule reforming the Hospital/CAH CoPs. This rule is available on display copy only and will publish officially to the Federal Register on May 16th.  The DC office is in the process of completing a thorough review of the final rule and will pull a team together to discuss the provisions, and will provide a comparative analysis of the final provisions to the comments that Joint Commission submitted.

A quick review of the final rule can be found here.

HHS encourages equal visitation and representation rights

The Department of Health and Human Services (HHS) issued a press release this week to give added support to The Centers for Medicare & Medicaid Services (CMS) Conditions of Participation (COP) rules released in November of last year giving patients the right to choose their own visitors during a hospital stay.

The guidance given by the HHS emphasizes that hospitals should respect patients’ wishes concerning their representatives (whether expressed in writing, orally, or through other evidence unless prohibited by state law) in an effort to make it easier for family members, including a same-sex domestic partner, to make informed care decisions for loved ones who are incapacitated.

The CMS also sent a letter this week to State Survey Agencies (SSAs), highlighting the equal visitation and representation rights requirements and directing SSAs to be aware of the guidance when surveying for hospitals’ compliance with CoPs.

Read the full press release here.

Latest Sentinel Event Alert:Radiation risks of diagnostic imaging

The Joint Commission released its latest Sentinel Event Alert this morning highlighting the need for healthcare facilities and staff to maintain radiation doses as low as possible during diagnostic imaging in order to decrease exposure to repeat doses. The Alert asks healthcare organizations to address contributing factors to eliminate avoidable exposure by weighing the medical necessity of a given level of radiation against the risks.

According to the Alert, the US population’s total radiation exposure has nearly doubled over the past two decades, and  studies have estimated that 29,000 future cancers and 14,500 future deaths could develop due to radiation from the 72 million CT scans performed in the US in 2007.

In response, the Centers for Medicare & Medicaid Services (CMS) will require accreditation of all facilities providing advanced imaging services (CT scans, MRI, PET, nuclear medicine) including non-hospital, freestanding settings beginning January 1, 2012. The state of California is also requiring facilities that furnish CT X-ray services to become accredited by July 1, 2013.

The Joint Commission gives some suggested actions leaders can take to raise awareness among staff and patients of the risk associated with aggregate radiation doses and provide proper testing and dosage through effective processes, safe technology, and a culture of safety.

Click here to download the Sentinel Event Alert and the full list of recommendations.

HHS aims to improve health and cost for dual eligible patients

The U.S. Department of Health and Human Services (HHS) has introduced three new initiatives to help states lower the cost of healthcare for patients with dual eligibility for both Medicare and Medicaid, as well as reduce hospitalization for this group.

The three separate proposals include:

  • A demonstration program to test two new financial models in hopes to better coordinate care for individuals enrolled in Medicare and Medicaid
  • A demonstration program aimed at helping states improve the quality of care for people in nursing homes in order to reduce hospitalizations
  • Creating a technical resource center to help states improve care for high-need high-cost beneficiaries

The dual eligible population is represented by approximately nine million Americans, and accounts for more than $300 billion in state and federal healthcare spending every year.

The idea is that these initiatives will bring better care coordination and for this population, which in turn will improve the health of dual eligible beneficiaries making them less frequent consumers of healthcare services in general.

Source: Healthcare Finance News

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