Accrediting bodies and hospitals are adjusting to the changes and limitation brought on by the COVID-19 pandemic, with more emphasis on remote surveying and other accommodations.

Accreditation and compliance activities were hampered at many hospitals. Although some departments were busier than normal with COVID-19 patients, other areas were without patients because elective procedures had been canceled, notes Patrick Horine, chief executive officer at DNV GL Healthcare in Milford, OH.

Without the usual volume of patients, some hospitals reduced staff to compensate. In many cases, those workers included the people who work with accreditation activities, Horine says.

Some staff with whom DNV GL interacts directly have either been furloughed or they are working at home, with limited (if any) access to their physical work environment, Horine reports. The accrediting body has been working to facilitate communication with these contacts and to work around the limitations they have with access to data.

“CMS [Centers for Medicare & Medicaid Services] has issued a number of waivers, so there is a lot that has been set to the side for now. The waivers have created a different dynamic for what we should have hospitals focus on,” Horine says. “In light of the present circumstances, we want the focus to be on infection prevention measures and their responsiveness under emergency preparedness. Those are always important concerns under our program, but now there is more intense scrutiny on those aspects to ensure they are able to maintain a level of service while managing patients, staff, and visitors.”

DNV GL also is looking at how hospitals are maintaining quality of care in other areas of the hospital not related to COVID-19. There is concern that the reallocation of resources and staff reductions from less business could lead to adverse consequences, Horine says.

Time to Improve

Hospital quality leaders may even find this period will reveal areas for improvement that otherwise might have gone unseen, Horine predicts.

“It’s a good opportunity for hospitals to see where their shortcomings are. There have been a lot of lessons learned in the pandemic and how hospitals respond to it, lessons on how they manage these patients, the physical environment, and lessons related to infection prevention,” Horine says. “That’s where we’re focusing now and where CMS wants facilities to focus right now.”

In addition to patient handling issues related to COVID-19, hospital queries to DNV GL have involved many issues related to personal protective equipment (PPE), such as how to clean it, how to keep it anyone from stealing it, and dealing with shortages while still caring for patients.

The future for surveys remains uncertain, Horine says. Limitations on travel and social distancing requirements make surveys difficult for CMS or any accrediting body. CMS has indicated it may conduct remote surveys for some as well as complaint surveys related to immediate jeopardy, he notes. CMS also announced the suspension of nonemergency survey inspections of nursing homes so it can better focus on infection control complaints. “As things start to open up, we can expect surveys to resume, but we have had to move a lot of surveys forward from when we normally would have done them. There is going to be a fair amount of catch-up to do, and CMS is very cognizant of that,” Horine says. “With reaccreditation surveys, CMS has offered extensions. When we can safely return to on-site surveys, those probably will be the first priority.”

More Remote Surveying

For DNV GL’s annual surveys, it is working with CMS to conduct at least part of the annual survey, and possibly all of it, remotely, Horine notes.

“Once they lift the restrictions, CMS is going to require that a full on-site survey be done. They’re not giving a free pass,” he says. “If a provider does not go through with a full on-site survey after the pandemic has passed, [CMS is] going to terminate the provider agreement they’ve approved in the short term.”

DNV GL also is using remote surveys for its certification programs, which are offered separately from CMS accreditation. Hospitals have expressed interest in pursuing these certifications during the pandemic, partly because some employees have down time while the volume of non-COVID-19 patients is low, Horine explains. When the remote survey finds compliance issues that must be addressed, DNV GL may have to follow up with an on-site survey at a later date, Horine says.

“Some of these certifications are related to the care of COVID-19 patients also, such as the management of stroke patients who come in during the period and the use of ventricular assist devices [VADs],” Horine says.

“It’s created a good opportunity for attention to these programs that aren’t necessarily governed under CMS, but which have applicability in the treatment of COVID-19 patients,” Horine continues. “They can demonstrate continued compliance even under these difficult times.”

(Editor’s Note: Hospital Peer Review requested input from The Joint Commission, but a spokesperson replied that they were unable to provide comments.)