UPDATE: New Guidelines Released as Telemedicine Services Expand

Update: The Joint Commission has retracted the draft standards for telemedicine outlined below, announcing that "At this time, we have closed the field review and decided not to move forward with the proposed telehealth standards." The proposed changes had garnered pushback from some in the industry who were concerned that the standards would be more restrictive than current requirements from the Centers for Medicare & Medicaid Services and state regulators. A spokesperson from TJC told FierceHealthcare that internal review had determined TJC's existing requirements for accreditation adequately applied to telehealth services and that further requirements would be unnecessary. In the future, TJC plans to address enhancements for survey guidance examining telehealth practices and quality and safety issues with telehealth provision.

Telemedicine continues to expand into the healthcare delivery system, and the recent natural disasters across the country have demonstrated just how useful telemedicine can be in a crisis and beyond. As federal and state governments, accrediting organizations, and other healthcare stakeholders recognize the growth and potential of these services, new rules, regulations, and guidelines are beginning to be released. Two major telemedicine efforts were released this month by The Joint Commission and the National Quality Forum.

First, The Joint Commission released proposed revisions to their hospital accreditation standards for hospitals providing “direct-to-patient telehealth services.” TJC, one of the largest and most widely accepted accreditation organizations for hospitals in the United States, introduced changes to two existing standards (Provision of Care Standard 01.01.01 and Rights & Responsibilities of the Individual Standard 01.03.01) and introduced a new standard, Ri.01.08.01. The proposed changes, which are examined in detail here, include requirements for informed consent for patients about the nature of the telehealth services and the provider. The National Law Review article linked above examines how the proposed standards go beyond statutory requirements in some cases, and how they may affect hospitals and other telehealth providers.

The National Quality Forum, an organization contracted by the federal government to develop healthcare performance measures, recently released a report developing a framework for a telehealth quality measurement program. NQF’s Telehealth Committee recommended various methods to measure telemedicine as a care delivery system along four basic categories: access to care, financial impact to patients and providers, patient and clinician experience, and clinical and operations effectiveness. The report, analyzed here by mHealthIntelligence, also highlights specific existing measures that can be applied to telehealth, as well as examining how telehealth activities can fit into the Merit-based Incentive Payment System (MIPS) introduced in the Medicare Access and CHIP Reauthorization Act (MACRA).

NAMSS will continue to monitor developments in telemedicine and their impacts on MSPs. Specifically, NAMSS recently formed a working group in partnership with the American Telemedicine Association to examine the issue of credentialing by proxy for hospitals attempting to credential telemedicine providers at other locations. The group will be developing a packet of educational and instructional materials to introduce MSPs who may not be as familiar with telemedicine to the topic and provide guidelines for developing credentialing by proxy programs at their own facilities. 

CMS Clarifies Guidance on Hospital Definitions

The Centers for Medicare and Medicaid Services recently released a memo clarifying guidance under Appendix A of the State Operations Manual (SOM). This guidance is meant to shed light on the definition of a hospital under the Social Security Act.

With the rise of “microhospitals,” small facilities that operate like acute care hospitals with a low number of inpatient beds, there has been some confusion regarding the certification process for such facilities. A variety of other facility models have run into the same issues, as care providers attempt new innovations in care and locations that may stray from the traditional idea of a hospital facility.

The CMS memo clarifies that the federal Medicare definition of a hospital under the Social Security Act may not always mesh perfectly with state requirements for the same certification. That is, “a facility may have a license from a state to operate as a hospital,” but “that facility may still not meet the Medicare definition of a hospital.” Hospitals approved, certified, and licensed by state or local authorities are still required to fit the Medicare criteria, including Conditions for Coverage (CfCs), Conditions of Participations (CoPs), and observations by the CMS Regional Office in order to be approved to accept Medicare patients. The details of these observations are described in the memo, linked above.

To read more about microhospitals and their growing role in the care delivery system, click here.