News from the End of Life

JCAHO modifies patient safety goals

An important part of any accreditation survey by the Oakbrook Terrace, IL-based Joint Commission on Accreditation of Healthcare Organizations is the review of a home health agency’s compliance with the Joint Commission’s National Patient Safety Goals. Some of the safety goals were designed more for acute care settings than for home care, so the Joint Commission has modified the goals to better reflect home care practice. The modifications for the home care patient safety goals are effective immediately. They are:

  • Goal #4, which relates to elimination of wrong-site, wrong-patient, wrong-procedure surgery, has been removed from the home care goals.
  • The wording of Goal #3 (improving the safety of high-alert medications), Goal #5 (improving the safety of using infusion pumps), and Goal #6 (improving the effectiveness of clinical alarm systems) has been modified slightly to reflect home care services.

These modifications are the first step in a two-phase plan for the Home Care Accreditation Program. The second phase includes the review of available sentinel event data and determination of the feasibility of identifying new program-specific evidence or experience-based requirements for 2005. Any changes to accreditation requirements made during 2004 will be implemented Jan. 1, 2005.

To view the 2004 National Patient Safety Goals for Home Care on-line, go to:

MedPAC: No payment update for home health

Federal advisors were generous with recommendations to update Medicare payments to physicians and hospitals in 2005, but they showed no generosity to the home health sector. Commissioners on the Medicare Payment Advisory Commission (MedPAC) in Washington, DC, voted in late January to recommend to Congress that physician services receive a 2.5% update for fiscal year 2005, but voted against a payment update for home health services.

The commissioners further recommended that Congress continue to monitor access to care for home health services. The commission also recommended that skilled nursing facilities receive no payment update. In addition, MedPAC recommended in its January report that U.S. Department of Health and Human Services Secretary Tommy Thompson instruct skilled nursing facilities to report nursing costs separately from other costs, such as drugs and medical supplies.

The commission stated that a 3.4% update was adequate for inpatient hospital services, and hospitals not furnishing quality data to the Centers for Medicare & Medicaid Services would be subject to a 0.4% reduction.

"What we’ve learned in the past is that a recommendation for an increase to all hospitals is not an efficient way to keep Medicare up to par," explains commission chair Glenn Hackbarth, an independent consultant based in Bend, OR. "Rural hospitals aren’t treated as fairly with every hospital getting an increase.

"I think the recommended updates are appropriate because there are a lot of uncertainties this year with the new Medicare legislation. It doesn’t mean we won’t be back next year saying that we should be making another adjustment," he adds.

The commission spent considerable time debating whether a 1.8% overall margin increase was adequate for all hospitals.

"This recommendation doesn’t flow with what we know," says David Durenberger, director of the National Institute of Health Policy at the University of St. Thomas in Minneapolis. "We need to figure out the rationale on using the Medicare margin as a proxy for quality and access data."

"I’d like to remind you that this would be for one year only, and that the overall margin is only one factor determining Medicare payments," says Julian Pettengill, a staff analyst for MedPAC.