The new revised Medicare conditions of participation (COPs) shift the oversight focus toward patient health outcomes and away from burdensome and costly procedural requirements.
"It's inevitable that federal regulations and [Joint Commission] accreditation requirements will eventually dovetail," says Robert Pollack, MD, director of Professional Quality Analysts in Casselberry, FL. "There are definite similarities."
"A quick glance at the proposed rules shows reference in several places to the Joint Commission," says Janet McIntyre, spokeswoman for the Joint Commission. "We're pleased with that. HCFA seems to have moved from a prescriptive stance to one that's more performance-based and that's compatible with what we've done."
Accreditation of hospitals by the Joint Commission has been around longer than Medicare. At first, HCFA's requirements were very close to the accrediting agency's. As the years went by, however, the rules became increasingly dissimilar. HCFA's became more and more structure- and process-oriented, while the Joint Commission's stayed in the outcomes mode. It remains to be seen whether this new focus on quality will downplay a continuing need for Joint Commission accreditation.
"The new Medicare COPs will not be exactly the same as Joint Commission requirements, but they're along the same vein," explains Rachael Weinstein, RN, senior health insurance specialist at HCFA. The COPs have to be included in the Joint Commission's requirements by virtue of its deemed status. So hospitals going through accreditation are automatically subject to HCFA's requirements as well as to the standards of the accrediting body. Nonaccredited facilities are surveyed directly by their state survey agencies under an agreement with Medicare, and as such they too are subject to the COPs.
"If there were any differences between Joint Commission standards and ours," continues Weinstein, "it's the Joint Commission that would have to revise its standards. A couple of years ago, for example, we added discharge planning and HIV look-back provisions, and the Joint Commission had to pick up those pieces."
If there's a complaint that alleges noncompliance with a Medicare COP, HCFA has the authority to go into an accredited hospital and investigate. If a condition is not met, HCFA no longer recognizes the deemed status of that hospital, even though they may still be accredited.
"We disregard the deemed status and put that facility under state monitoring until the Medicare conditions are met," Weinstein explains. "Once they're met, the facility goes back under the Joint Commission."
The new requirements empower the federal government as well as state Medicaid agencies to compel improved performance or termination of an organization's participation if it fails to correct seriously deficient performance. Under the current regulations, termination actions are initiated based on the evidence found during the survey. There will be no changes in that regard in applying the new COPs. If HCFA seeks a termination, it could be successful at arguing that, based on the evidence found during a survey, the requirements were not met even though a hospital may argue that its performance met the regulatory standards.
HCFA invited public comment on this fundamental shift in its regulatory approach. The agency was especially interested in advice on how to improve its new approach and what flexibility could be added. Once the comments came in, HCFA started analyzing them and working on a final rule. "The intention is to try to get something out within a year," says Weinstein. The current regulations are in effect until the final rule is published.