CMS: Time to renew conditions of participation in Medicare, Medicaid
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Although the Centers for Medicare & Medicaid Services (CMS) has since made one-by-one updates, a complete review of the conditions is now timely and necessary, according to authors, CMS Chief Medical Officer Patrick H. Conway, MD, and CMS Administrator Donald M. Berwick, MD.
“Review and revision of the entire hospital conditions of participation is needed to achieve current, higher quality and safety standards and remove unnecessary burdensome regulations that are costly to the healthcare system,” the authors wrote, noting that a 1997 revision initiative was derailed by the force of more than 60,000 public comments and dissenting opinions.
The CMS proposed the new major revision to the hospital conditions for participation on Oct. 18, after accepting input from stakeholders for more than a year. The plan “should increase patient-centered care in hospitals and enhance coordination,” according to the authors. “Despite adding new standards, the proposed rule is projected to save more than $900 million annually due to removing unnecessary regulations.”
Among the proposed changes, the CMS wants to address three areas that cause morbidity, mortality and increase costs: care transitions from the hospital, patient-centered care and hospital quality-improvement programs.
The revisions will require hospitals to send necessary medical information to a receiving facility for patients who are discharged to another location. The proposed rule sustains requirements that hospitals maintain effective internal systems for assessing quality, studying adverse events and improving safety and quality of care. It also encourages a stronger patient-centered culture, according to the authors, by allowing flexibility for patients to self-administer medications at home, among other initiatives. The CMS considered new requirements for infection control and prevention, but instead decided to engage the medical community on what may be needed in the future.
Governance and care coordination will be simplified under the proposed rule, according to the authors. One such proposal will allow one governing body to oversee multiple hospitals in a single system. Additionally, hospitals would be allowed to have a single integrated care plan that involves multiple disciplines, removing requirements for stand-alone nursing care plans separate from other plans.
Among the reductions in regulations, Conway and Berwick noted a broadening of the concept of medical staff to all practitioners granted hospitals privileges to practice—allowing hospitals to grant practice privileges to individuals such as advanced practice nurses. The proposal eliminates requirements for authentication of verbal orders within 48 hours and makes permanent the current temporary requirement that all orders be dated, timed and authenticated by the ordering practitioner.
The proposed rule is posted at CMS.gov and will be open for a 60-day public comment period via regulations.gov.