December 2008 Joint Commission Online Now Available

The December 2008 issue of Joint Commission Online is now available. Updates in the latest issue include:

• Accreditation changes effective January 1, 2009 to comply with CMS application for continued deeming authority;
• No new National Patient Safety Goals (NPSGs) will be created for 2010 in order to review the 2009 NPSGs;
• The elimination of "thresholds" in Conditional Accreditation (CA) and Preliminary Denial of Accreditation (PDA) decisions;
• The announcement that organizations will receive their National Quality Improvement Goal data in March;
• The announcement of five new members to The Joint Commission Board of Commissioners.

Click here for the full issue of Joint Commission Online:
http://www.jointcommission.org/Library/jconline/jconline_dec_2008.htm

Rhode Island Begins Electronic Credentialing System January 1

On January 1, 2009, the Rhode Island Department of Health (HEALTH) will no longer issue wallet cards to new or renewing licensees. All primary source verification will be conducted through HEALTH's online system.

When a license is first issued, HEALTH will send written notification containing the license number, expiration date, and information on how to use the online system in lieu of the wallet card.

If you have any questions about the new system, contact Charlie Alexandre at charles.alexandre@health.ri.gov.

Click here to visit HEALTH's online license verification system:

http://www.health.ri.gov/hsr/professions/license.php

OIG Releases Two Studies on Adverse Event Reporting

The Department of Health and Human Services Office of the Inspector General (OIG) has released two studies on how hospitals and states are collecting and utilizing data on adverse events.

In the study titled, Adverse Events in Hospitals: Overview of Key Issues, the OIG identifies adverse events as "any harm to a patient as a result of medical care, such as infection because of contaminated equipment." The study also notes that while better reporting of adverse events will lead to a higher quality of care, there are several barriers to proper reporting. For example, the report states that hospital staff may be too busy and forget to report an incident. Others may be hesitant to report an adverse event, fearing that it will lead to legal action.

The OIG's second study, Adverse Events in Hospitals: State Reporting Systems, examined the 27 states that have established adverse event reporting systems. Although each state has a different reporting system, they have all been using their data to make quality improvements in their healthcare systems.

To read the OIG's studies, click here:

Adverse Events in Hospitals: Overview of Key Issues
http://www.oig.hhs.gov/oei/reports/oei-06-07-00470.pdf

Adverse Events in Hospitals: State Reporting Systems
http://www.oig.hhs.gov/oei/reports/oei-06-07-00471.pdf

Source: BNA

More States Moving Toward Health IT Implementation

According to a report by the National Conference of State Legislatures (NCSL), more states are moving toward health IT (HIT) implementation, recognizing its impact on improving the quality of care, while lowering costs.

The report shows that between 2007 and 2008, more than 370 HIT bills were introduced at the state level, three times more than the number introduced between 2005 and 2006.

Supporters of HIT cite improvements it can make in patient record-keeping and the prevention of duplicate records.

Source: Healthcare IT News
http://www.healthcareitnews.com/story.cms?id=10590&fromRSS=true

AOIA Announces First Subscriber to XML-Based Physician Profile Service

The American Osteopathic Information Association (AOIA) has announced that Collaborative Fusion, Inc. (CFI) is the first subscriber to its XML-Based Physician Profile. CFI customers can use the service to conduct automated primary source verification of physician specialty information within the AOIA database.

AOIA developed the system to aid with emergency response efforts as part of the Emergency System for Advanced Registration of Volunteer Health Professionals (ESAR-VHP).

CFI customers will be able to access the service as part of the CORES Platform. CORES reports provide information such as certification histories that can be used for primary source verification.

Source:
American Osteopathic Information Association
Contact: Annette Gippe
agippe@osteotech.org

CMS Renews TJC's Deeming Authority for Ambulatory Surgical Centers

The Centers for Medicare & Medicaid Services (CMS) has renewed The Joint Commission's (TJC) deeming authority for ambulatory surgical centers for the maximum term of six years.

TJC is one of four accrediting bodies granted deeming authority by CMS. Organizations wishing to enter the Medicare program must first be surveyed by one of these four accrediting bodies. Once certified, they can opt to have future surveys conducted by one of the accrediting bodies or by CMS state surveyors.

Source: The Joint Commission
http://www.jointcommission.org/NewsRoom/NewsReleases/nr_121208.htm

Section 1921 Implementation Delayed

The Practitioner Data Bank branch of the Health Resources and Services Administration (HRSA) has announced that implementation of Section 1921 of the Social Security Act has been delayed. The final rule was returned to the Secretary of Health and Human Services without any action from the Office and Management and Budget (OMB).

Section 1921 would require the NPDB to be queried for all licensed healthcare professionals including chiropractors, podiatrists, pharmacists, physician assistants, ophthalmologists, professional and paraprofessional nurses, physical therapists, respiratory therapists, and social workers.

It is expected that Section 1921 and other pending final rules from HRSA will be held for review by the incoming Secretary of Health and Human Services.

For more information on Section 1921, click here:
http://www.npdb-hipdb.hrsa.gov/about1921.html

The Joint Commission Issues Sentinel Event Alert on Healthcare Technology

NEWS RELEASE

Media Contact:
Ken Powers
Media Relations Manager
630-792-5175
kpowers@jointcommission.org

Joint Commission Alert: Prevent Technology-Related Health Care Errors

(OAKBROOK TERRACE, Ill. – December 11, 2008) Technology is often touted as the “cure” for health care, but a new Joint Commission Sentinel Event Alert issued today warns that implementation of technology and related devices is not a guarantee for success, and may actually jeopardize the quality and safety of patient care.

The Joint Commission’s Alert urges greater attention to understanding when a technology may (or may not) be applicable, choosing the right technology, understanding the impact technology can have on the quality and safety of patient care and attempting to quickly fix technology when it becomes counterproductive. The Alert makes clear that the overall safety and effectiveness of technology in health care ultimately depend on its human users, and that any form of technology can have a negative impact on the quality and safety of care if it is designed or implemented improperly or is misinterpreted.

The Alert notes that there is very little data on the number of errors directly caused by the increasing combined use of health information and devices. As an example, however, root cause analysis of errors shows that computerized medication orders and automated dispensing cabinets for medications are frequently involved. In addition to specific recommendations contained in the Alert, The Joint Commission urges health care organizations to use its Information Management accreditation standards to improve patient safety while using technology. Since technology is so common in health care—from admitting patients to the operating room to ordering and administering medication—any Joint Commission accreditation standard can be tied to technology.

“Innovations in technologies and information systems are vitally important to improve health care quality and safety, but we must be mindful of the safety risks and preventable errors that these implementations can create or perpetuate” says Mark R. Chassin, M.D., M.P.P., M.P.H.., president, The Joint Commission. “The strategies contained in this Alert give organizations and caregivers guidance that can help prevent patient harm and maximize the beneficial impact of these innovations.”

The Alert notes that the implementation of technology can threaten care and patient safety when:

· Clinicians and other staff are not included in the planning process;
· Providers do not consider the impact of technology on care processes, workflow and safety;
· Technology is not fixed when it becomes counterproductive; and
· Technology is not updated.

To reduce the risk of errors related to health information and technology, The Joint Commission’s Sentinel Event Alert recommends that health care organizations take a series of 13 specific steps, including the following:

· Look for possible risks in how caregivers carry out their work and resolve these issues before putting technology into place;
· Involve the caregivers who will ultimately use the technology;
· Train everyone who will be using the technology and provide frequent refresher courses;
· Make clear who is authorized and responsible for technology—from putting it into use to reviewing safety; and
· Continually seek ways to improve safety and discover errors.

Other strategies for reducing technology-related errors include avoiding distractions for staff using technology, monitoring and reporting errors and near misses to find the causes, and protecting the security of information.

The warning about preventing technology-related errors is part of a series of Alerts issued by the Joint Commission. Previous Alerts have addressed anticoagulants, wrong-site surgery, medication mix-ups, health care-associated infections, and patient suicides, among others. The complete list and text of past issues of Sentinel Event Alert can be found at http://www.jointcommission.org/SentinelEvents/SentinelEventAlert/sea_42.htm.

Source:
http://www.jointcommission.org/NewsRoom/NewsReleases/nr_12_11_08.htm

HHS Issues Final Rule for PSOs

Date: November 21, 2008
For Release: Immediately
Contact: AHRQ Public Affairs
(301) 427-1258
(301) 427-1855


The U.S. Department of Health and Human Services has issued a final rule for Patient Safety Organizations (PSOs).

The rule becomes effective on Jan. 19, 2009. It provides final requirements and procedures for PSOs, new entities, with which clinicians and health care providers can work to collect, aggregate and analyze data -- within a legally secure environment of privilege and confidentiality protections -- to identify and reduce patient care risks and hazards.

"I expect the final rule and the creation of Patient Safety Organizations to greatly improve the quality of health care for all Americans," HHS Secretary Mike Leavitt said. "By making it easier for clinicians and health care organizations to report and learn from adverse events without fear of new legal liability, we will be able to improve our nation's health care systems and minimize factors that can contribute to mistakes."

Under interim guidance issued on Oct. 8, AHRQ has already listed 15 PSOs. During the remainder of the interim period, these organizations will maintain their status as PSOs. However, these and other PSOs listed throughout the interim period are expected to comply with the final rule once it takes effect.

"The Patient Safety Organization final rule describes the clear, legally protected framework for how hospitals, clinicians, and health care organizations can work together to improve patient safety and the quality of care nationwide," said AHRQ Director Carolyn M. Clancy, M.D.

The listing of PSOs is authorized by the Patient Safety and Quality Improvement Act of 2005 (Patient Safety Act). The Patient Safety Act is intended to encourage voluntary, provider-driven initiatives to improve the safety of health care through the establishment of legal protections to ensure that providers who report patient safety information do not incur new legal liability; to promote rapid learning about the underlying causes of risks and harms in the delivery of health care; and to share those findings widely, thus speeding the pace of improvement.

The final rule is consistent with many of the provisions of the proposed rule issued on Feb. 12. However, it also includes new requirements for PSOs, such as:

• The requirement that a PSO notify providers if the patient
  safety work product it submits is inappropriately disclosed or its security is breached
• Requirements for how a component PSO maintains separation
  between itself and its parent organization(s) have been made more flexible.

The final rule also makes several important changes from those in the proposed rule regarding the listing and delisting of PSOs and the ways in which PSOs must comply with statutory requirements, including:

• Expansion in the types of entities and organizations excluded
  from listing as PSOs
• Revisions to how PSOs should disclose certain relationships with
  health care providers
• Increased flexibility in how PSOs can store patient safety work
  product
• Automatic expiration of Departmental listing after 3 years
  unless a PSO's listing is continued by the Secretary and
• An expedited delisting process for PSOs in a limited number of
  serious circumstances

AHRQ administers provisions dealing with PSO operations, and the HHS Office for Civil Rights (OCR) enforces confidentiality provisions. The final rule addresses concerns regarding how providers may efficiently collect and analyze patient safety event information with privilege and confidentiality protections while complying with existing reporting requirements that seek similar information.

"OCR is pleased to partner with AHRQ to protect and ensure the confidentiality of the information used by providers and PSOs to improve the safety and quality of patient care nationwide," said OCR Director Winston Wilkinson.

To read the final rule and access more information about PSOs, including background on the rulemaking process, visit AHRQ's PSO Web site at http://www.blogger.com/www.pso.ahrq.gov. Additional information about the confidentiality and disclosure of patient safety work product may be found at OCR's Web site at http://www.blogger.com/www.hhs.gov/ocr/psqia/.

AHIC Advises HHS to Build Regulatory Compliance of EHRs

The American Health Information Community (AHIC) issued a recommendation to the Department of Health and Human Services (HHS), urging HHS to promote electronic health records (EHR) compliance.

AHIC encourages the creation of EHR templates to reduce redundancy in information collection. AHIC also encourages HHS to convene a panel of experts who can determine what licensing, regulatory, quality, and payment data should be included in EHR templates. These templates would be stored in a database accessible to the public.

To read more on AHIC's recommendations, click here:
http://www.govhealthit.com/online/news/350669-1.html

Source: Government Health IT

AHRQ Launches Quality Measurement Clearinghouse

The Agency for Healthcare Research and Quality (AHRQ) has launched the National Quality Measures Clearinghouse (NQMC), a repository of the quality measurements and measure sets currently used by the Department of Health and Human Services for reporting data and determining payment.

Through this Web site, the public can access healthcare quality measures and apply them to their organizations when desigining their own policy and quality initiatives. The measures are updated on a weekly basis.

To access the NQMC, click here:
http://www.qualitymeasures.ahrq.gov/

Hospital Language and Culture Update Available Online

The Joint Commission's November 2008 Hospital Language and Culture (HLC) Project Update is now available online.

The HLC study explores challenges in providing quality healthcare when there are cultural or linguistic barriers between patients and providers.

The November 2008 Update can be found here:
http://www.jointcommission.org/NR/rdonlyres/635D9494-9832-449E-BEEC-44042D6630CF/0/HLC_Project_Update_Nov_2008.pdf

Source: The Joint Commission

AHRQ Announces Ten Patient Safety Organizations

The Agency for Healthcare Research and Quality (AHRQ) has announced the first 10 Patient Safety Organizations (PSOs) recognized by the Department of Health and Human Services (HHS). AHRQ is the main agency within HHS responsible for improving healthcare safety, quality, and cost-effectiveness.

The 10 newly listed PSOs will collect quality data voluntarily reported by providers and healthcare organizations. Using this confidential data, they will issue recommendations on how to improve patient safety and reduce medical errors.

Each PSO was approved by HHS and given certification that went into effect on November 5. AHRQ will announce new PSOs weekly as HHS certifies more organizations.

The 10 PSOs announced by AHRQ are:

• California Hospital Patient Safety Organization (CHPSO) in Sacramento, CA;
• Missouri Center for Patient Safety in Jefferson City, MO;
• ECRI Institute PSO in Plymouth Meeting, PA;
• Florida Patient Safety Corp. in Tallahassee, FL;
• Health Watch Inc. in Easton, MD;
• Human Performance Technology Group in Collierville, TN;
• Institute for Safe Medication Practices in Horsham, PA;
• Peminic Inc. in Fort Washington, PA;
• Sprixx in Santa Barbara, CA; and
• University Healthsystem Consortium in Oak Brook, IL.

Source: BNA

Joint Commission Accreditation: Lab Decisions Will No Longer Affect Hospital Decisions

Media Contact:
Ken Powers
Media Relations Manager
630-792-5175
kpowers@jointcommission.org

(OAKBROOK TERRACE, Ill. – November 4, 2008) Beginning January 1, 2009, under new Joint Commission policy, laboratory accreditation decisions will no longer immediately impact hospital accreditation decisions. This policy establishes comparability in the way that a laboratory with an adverse accreditation decision rendered by The Joint Commission or one of its cooperative partners, College of American Pathologists (CAP) or COLA, impacts the hospital or other organization with which the laboratory is affiliated. Currently, a laboratory’s accreditation has a direct impact on the accreditation status of its affiliated organization.

Under the new policy, the accreditation of laboratories and hospitals accreditation will continue to be linked, due to the critical importance of laboratory services to the delivery of hospital care. An adverse laboratory accreditation decision, whether due to survey by The Joint Commission, CAP or COLA, will help prioritize the hospital’s or other organization’s next unannounced survey.

“The new approach meets the needs of Joint Commission customers and reinforces the importance of the laboratory in the delivery of patient care,” says Ann Scott Blouin, Ph.D., R.N., executive vice president, Accreditation and Certification Operations, The Joint Commission.

The Joint Commission has been evaluating and accrediting hospital laboratory services since 1979 and freestanding laboratories since 1995. Today, The Joint Commission accredits nearly 2,000 organizations providing laboratory services, representing almost 3,000 CLIA-certified labs, including freestanding labs. The Centers for Medicare & Medicaid Services (CMS) officially recognizes the Joint Commission Laboratory Accreditation Program as meeting the requirements of CLIA ’88.

Source: The Joint Commission
http://www.jointcommission.org/NewsRoom/NewsReleases/nr_11_04_08.htm

DNV Hosting Educational Sessions on NIAHO Accreditation

Det Norske Veritas (DNV), the latest hospital accreditation agency to be granted deeming authority by CMS, will be hosting a one-hour webinar and several day-long workshops to explain its National Integrated Accreditation for Healthcare Organizations (NIAHO) program.

Since CMS approved NIAHO on Sept. 26, hospitals have been asking:

• How do we implement NIAHO?
• How do the standards differ from TJC?
• What impact can NIAHO have on our overall quality programs?

Attend a one-hour webinar, or for a full-day in depth workshop in a city near you.

Online Webinar:
Thursday, Nov. 6, 10:00 a.m. or 2:00 p.m. (ET)

Full-day Workshops:
Chicago, Nov. 11
Columbus, Nov. 13
Atlanta, Nov. 19
Houston, Nov. 20
Newark, Dec. 2

Breakfast, lunch and beverages are included in registration fee, along with complete program materials for the day-long workshops.

To register for the webinar or a workshop in your area, click here:
http://www.elabs7.com/c.html?rtr=on&s=ay26,cgpz,mxa,j5ov,29q2,c13t,7hre

"Letter of Concern" Not a Violation of Due Process

A federal appellate court has ruled that a Nebraska statute authorizing "letters of concern" to be part of a physician's public record without prior notice to allow the physician to contest the letter is not unconstitutional (Kloch v. Kohl, 8th Cir., No. 07-2120, 11/3/08).

The U.S. Court of Appeals for the Eighth Circuit ruled that the Nebraska Uniform Licensing Law, which allows this practice, does not violate Dr. Gregory Kloch's right to due process because it has no significant and direct impact on his medical licensure or his ability to practice in the state.

Because a letter of concern does not necessarily constitute a disciplinary action, the state is not required to take immediate steps to revoke his license or take other measures to prevent a physician from practicing medicine.

The court stated that “Nebraska could not have disciplined a physician on the basis of conduct discussed in a letter of concern without first formally charging the physician and holding a hearing to test the allegations,” thus refuting the appellant's argument that the statute violates his right to appeal the concerns raised in the letter.

The court also ruled that because the letter of concern was posted to the department's Web site and available upon request, Kloch was given adequate notice to review and contest the letter against him.

Click here for the court's full opinion:
http://www.ca8.uscourts.gov/cgi-bin/new/getDocs.pl

Source: BNA

HHS Inspector General Says CMS HIPAA Oversight Is Ineffective

An October 27 report from the Department of Health and Human Services Inspector General states that “limited actions” by CMS have “not provided effective oversight or encouraged enforcement of the HIPAA Security Rule by covered entities.”

The main concern of the report is that CMS relies on complaints in order to identify organizations to investigate for failure to comply with HIPAA regulations.

The HHS Inspector General admits that the audit cited in the report was performed in 2007, before CMS signed a contract in January 2008 with PriceWaterhouseCoopers to assist with compliance reviews. However, it still stands behind its recommendation that CMS take a more proactive approach to identifying HIPAA compliance issues.

CMS disagrees with the report. While compliance reviews would be beneficial, CMS believes that the complaint-driven system encourages voluntary compliance. It also stated that the Inspector General's report fails to highlight other steps taken by CMS to improve HIPAA compliance such as industry outreach, education, and complaint investigation and resolution.

Source: Government Health IT
http://www.govhealthit.com/online/news/350651-1.html

Click here to view the HHS Inspector General's report:
http://oig.hhs.gov/oas/reports/region4/40705064.pdf

CMS Sends Out Clarification Memo on Standing Orders

CMS sent an October 24, 2008 memo to State Survey Directors clarifying standing order documentation guidance that was issued in February and April.

The memo includes guidance revisions issued to physicians who use preprinted forms for standing orders. It also provides the following clarification regarding the use of rubber signature stamps:

"The CoPs [Conditions of Participation] do not prohibit the use of rubber stamps in a hospital setting, when properly controlled, for authentication of medical record entries. However, as a point of information for surveyors and providers, we are taking this opportunity to add an information-only statement to the interpretive guidance for §482.24(c)(1) to note that some payers, including Medicare, may not accept such stamps as sufficient documentation to support a claim for payment. "

Click here for the full memo: http://www.cms.hhs.gov/SurveyCertificationGenInfo/downloads/SCLetter09-10.pdf

Joint Commission CAH Accreditation Receives Conditional Approval from CMS

The Oct. 24 Federal Register by the Centers for Medicare & Medicaid Services (CMS) states "the Joint Commission received conditional approval for its critical-access hospital (CAH) accreditation program, but the program was placed on probation until it fixes the gaps between its standards and Medicare's conditions of participation."

Under updated "conditions, critical-access hospitals are allowed to provide inpatient psychiatric or rehabilitation services in a distinct-part unit as long as those services comply with hospital requirements in other sections of Medicare's conditions of participation." After the Joint Commission "has submitted its revised distinct-part unit standards [to reflect the updated conditions], the CMS will conduct a survey to validate the changes."

The Joint Commission CAH accreditation pro has been placed under a 180 day probationary period from November 21, 2008 through May 28, 2009 to revise its accreditation standards to meet or exceed CMS standards set forth in the Medicare conditions of participation. The conditional approval period applies to TJC CAH accreditation granted between November 21, 2008 through November 21, 2001.

The full Federal Register announcement can be found here:
http://frwebgate5.access.gpo.gov/cgi-bin/TEXTgate.cgi?WAISdocID=457935302722+1+1+0&WAISaction=retrieve

Frist to Step Down from HCA Board

According to a securities filing, Thomas Frist, Jr. will step down from the Hospital Corporation of America (HCA) board effective January 1 and will be replaced by his son, William Frist, who will serve on the company’s patient safety and qualiy of care committee.

October 29 Health Care Staffing Certification Call Hosted by The Joint Commission

"Health Care Staffing Certification – What’s New?
Ask the Experts!"

In this one-hour call Michele Sacco and Joint Commission staff will discuss the latest information about changes to certification, and give you plenty of
time to ask questions about the following topics:

- 2009 changes to scoring and decision rules
- Certification participation requirements
- The CMIP (Certification Measurement Information Process)
- Performance measurement requirements
- Standards interpretation.

This call will be helpful to both certified and not-yet-certified organizations.

Wednesday, October 29
11:30 am (Central Time)

To register, please go to

http://www.surveymonkey.com/s.aspx?sm=gg8KLdhMoonkrM_2bq2e3NGw_3d_3d

State Report Outlines Challenges of E-Health Implementation

The first annual report of the State Alliance for E-Health, a panel created by the National Governor's Association, called on states and the federal government to work together to implement improvements in health information technology (HIT).

The variation of state provider licensure requirements was cited as one of the challenges of implementing a national HIT system for licensing. Recommendations offered by the report include:

• The adoption of a core licensure application in every state based on the Federation of State Medical Board's Common Licensure Application Form
• Promoting the use of online licensure applications
• Developing a national core set of credentialing parameters
• Directing each state professional board to select a central CVO for primary source verification
• Directing each state professional board to require state and federal criminal background checks for all applicants seeking a state license
• Standardization of the regulatory framework for each field of advanced practice nursing

The full report can be found here: http://www.nga.org/Files/pdf/0809EHEALTHREPORT.PDF

Norway-based Company Granted CMS Deeming Authority

The Centers for Medicare & Medicaid Services (CMS) granted deeming authority to Det Norske Veritas (DNV) , a Norway-based company. DNV joins The Joint Commission and the American Osteopathic Association as the newest organization to receive hospital accreditation authority in 30 years.

DNV is recognized for its integration of international quality standards with the Medicare Conditions of Participation.

Source: Healthcare Finance News
http://www.healthcarefinancenews.com/story.cms?id=8693&page=1

PCMA Opposed to Proposed DEA E-Prescribing Rule

The Pharmaceutical Care Management Association (PCMA) released its comments opposing a proposed rule on e-prescribing from the DEA, published on June 28, 2008.

The proposed rule would authorize prescribers to electronically submit prescriptions for controlled substances directly to pharmacies. The DEA believes that e-prescribing will reduce prescription fraud and errors due to illegible handwriting.

PCMA opposes the rule, citing four concerns:

• E-prescribing standards will prevent pharmacies from being able to substitute generic drugs
  
• Real-time DEA registration verification of prescribers is not possible because the DEA database is only updated weekly, not in real-time
  
• Prescribers should be allowed to verify their identity and license in-person at a DEA registered facility where they hold privileges, a state or professional license board, or with state or local law enforcement
  
• If the e-prescribing system remains idle for 2 minutes, prescribers must re-authenticate their request, which would create a work burden

The proposed rule can be found here: http://frwebgate4.access.gpo.gov/cgi-bin/PDFgate.cgi?WAISdocID=699774509331+0+1+0&WAISaction=retrieve

PCMA's Comments can be found here: http://www.pcmanet.org/wp-content/uploads/2008/09/finalpcma-docketno-dea-281.pdf

Source: Business Wire 2008

2008 Presidential Candidate Health Plans

Both Sen. Barack Obama (D-IL) and Sen. John McCain (R-AZ) share an interest in making healthcare accessible and affordable for all Americans under their possible administrations. In some ways, their plans are similar. Both candidates are pushing for lower drug costs, innovations in health information technology, cost and quality transparency from insurance providers, and portability of coverage.

However, the candidates diverge when it comes to whether healthcare based on a public plan or the private market will provide the most benefits to Americans, with Obama pushing for the development of a new public plan and McCain emphasizing affordable coverage through private companies.

The candidates are expected to discuss their respective health plans and other domestic policy issues during a town hall meeting debate on October 7 at Belmont University in Nashville, TN.

Below are highlights of each candidate’s plan:

McCain

• Market competition among insurance providers will lead to lower costs and higher quality
  
• Provide a tax credit of $2500 per individual and $5000 per family towards the purchase of coverage through the provider of their choice
  
• Expand the benefits of Health Savings Accounts (HSAs) to reward Americans for saving towards additional medical expenses
  
• Create Guaranteed Access Plans (GAP) - A non-profit organization would be established to contract low-cost plans with state and private insurers
  - Those who were previously denied coverage would be able to form into large pools eligible to purchase plans through GAP under a group rate
  - Available to all Americans regardless of pre-existing condition or other inability to qualify - Intended to help low-income Americans and those who lack employer benefits
  
• Create a national program to assist seniors with managing their healthcare
  - Modeled after state programs, seniors would receive a monthly stipend towards home care and would also have access to counselors who can help them manage their medical finances

Obama

• Expand Medicare and SCHIP and establish a new public program to increase access to health coverage
  - The plan would be modeled after the Federal Employee Health Benefits Program (FEHB) currently used by members of Congress and federal employees
  - Available to small businesses, the self-employed, those without employer benefits, as well as those who do not qualify for Medicaid or SCHIP
  
• Mandate health coverage for every child either under the national plan or a parent’s plan - Children would be eligible for coverage under a parent’s plan until the age of 25
  
• Require all employers, except small businesses, to contribute either to their employees’ individual health plans or directly to the national plan
  
• Provide a tax credit to small businesses of up to 50 percent of all premiums paid on behalf of their employees
  
• Establish the National Health Insurance Exchange (NHIE) to monitor state and private insurance providers
  - Hold state and private providers accountable to the same price and quality standards as the national plan
  - Ensure consumer fairness by requiring providers to be transparent with price and quality data and to justify above-average premium increases
  - Ensure that private companies direct premiums towards patient care, not administrative costs and profit
  

Outside Talent Is Only as Good as Its Portability

Hiring outside talent only benefits an organization if the new employee's performance can be maintained at their new workplace. For some professionals, such as surgeons, whose performance is aided by the help of a strong surgical team, performance portability becomes more difficult.

Source: The Wall Street Journal http://online.wsj.com/article/SB122160027085044781.html.html

Survey Finds Patient Care May Be Harmed by Physician Handoff Errors

A survey showed that interruptions and distractions that occur during patient handoffs between residents may contribute to errors in patient care.

In 2006, 161 residents at Massachusetts General Hospital admitted that handoffs often did not take place in a quiet setting and were often interrupted, leading to misinformation or the incomplete communication of information.

An article in The Joint Commission Journal on Quality and Patient Safety urges physicians to compile complete information before meeting a colleague for a handoff in a quiet location with minimal distractions.

Source: The Boston Globe
http://www.boston.com/news/health/blog/2008/09/hazards_of_hand.html

Joint Commission Sentinel Alert: Blood Thinner Deaths and Overdoses

The Joint Commission has released a new Sentinel Alert that recommends 15 steps for preventing deaths due to errors in the administration of anticoagulants.

The recommendations include establishing best practices such as clearer medication packaging, better staff communication, and the use of bar code labeling and computerized physician orders.

The alert can be found here: http://www.jointcommission.org/SentinelEvents/SentinelEventAlert/sea_41.htm

Senate Approves Bill to Require Background Checks on Long-Term Care Employees

On September 10, the Senate Finance Committee approved S. 1577, the Patient Safety and Abuse Prevention Act. The bill would require criminal background checks for all employees with direct patient access in nursing homes and long-term care facilities. The bill does not include hospitals or managed care facilities.

In addition to conducting an NPDB-HIPDB query, participating states must screen job applicants in both the state police database and the FBI’s national criminal history database. The goal of the legislation is to increase patient safety by preventing the hire of employees with prior history of abuse or violence.

Senate Special Committee on Aging Chairman Herb Kohl (D-WI) is calling for the bill to be passed by the end of September. Senate Finance Committee Chairman Max Baucus (D-MT) believes the bill can be passed by unanimous consent.

A full version of S. 1577 is available here: http://www.govtrack.us/congress/bill.xpd?bill=s110-1577

U.S Circuit Court Overturns Kadlec Decision

On May 8, 2008, the 5th Circuit U.S. Court of Appeals overturned the 2006 Eastern Louisiana District Court decision made in the landmark credentialing case, Kadlec Medical Center v. Lakeview Anesthesia Associates. The original ruling stated that Lakeview Medical Center (LMC) and Lakeview Anesthesia Associates (LAA) had an affirmative duty to disclose past drug use by former employee, Dr. Robert Berry, to prospective employer, Kadlec Medical Center.

The new decision states that in providing a neutral employment verification letter to Kadlec on behalf of Berry, LMC could not be held liable for the incident even though they did not disclose Berry’s past drug use. In its opinion, the court stated that there is no law in Louisiana or any other state that requires a hospital to disclose negative information about a current or prior employee.

For a full analysis of the decision, click here: http://www.namss.org/government/News/Kadlec_decision_Overturned.doc.

NAMSS Closes in on MS.1.20 Changes

The Joint Commission’s (TJC) MS.1.20 Task Force held an in-person meeting on May 7 and a phone conference on May 15 to work towards a final revision of Standard MS.1.20.

Over the next two weeks, Task Force members will finalize recommendations to the Board of Commissioners for their May 31 meeting. Changes proposed by the Task Force include:

The flexibility to place operational details such as credentialing either in the medical staff bylaws or in rules or policy and procedures documents
A conflict resolution process requiring the medical staff to work with the medical executive committee to resolve disagreements before going directly to the governing body. When approaching the governing body, both the opinions of the medical staff and medical executive committee must be submitted for review

NAMSS will release the latest revision of MS.1.20 once it is approved by the Board of Commissioners for field review and will alert the membership once a field review date is announced.

Click here for more on TJCs latest announcement: http://www.jointcommission.org/NewsRoom/NewsReleases/nr_06_03_08.htm.

Anesthesiologist’s Drug Dependency not Protected under ADA

An anesthesiologist who was terminated by a practice group in Oregon failed to show that a chemical dependency problem rendered him disabled under the Americans with Disabilities Act or that his termination was improper, a federal trial court ruled June 6 (Tyson v. Oregon Anesthesiology Group PC, D. Ore., No. 03-1192, 6/6/08).

The U.S. District Court for the District of Oregon ruled that Dr. Geoffrey Tyson failed to demonstrate that he qualified, because of his drug dependency problem, as disabled under the ADA or that the practice group that terminated him, Oregon Anesthesiology Group PC (OAG), regarded him as disabled.

In reaching these conclusions, the court found there was insufficient evidence that his chemical dependency, which allegedly led him to divert patient medications and compromised patient care, constituted a condition that limited his ability to work or carry out another major life activity. He also could not show that he was otherwise qualified for the anesthesiology position he held or the other positions he sought while his privileges at an Oregon hospital were suspended.

2009 TJC Standards Available Online

The latest accreditation standards, effective January 1, 2009, are now available online. No major changes or additions were made, other than the reorganization of standards to allow for easier edits in the future.

Proposed 2009 Hospital Payment Rates Published

The Department of Health and Human Services has published the proposed changes to CY 2009 payment rates for hospital outpatient services and ambulatory surgical centers in the Federal Register.

View the proposed changes.