COPs adopt patient- centered approach

Continuous, integrated care is new focus

The Health Care Financing Administration's proposed Medicare conditions of participation (COPs) focus both provider and surveyor efforts on the actual care delivered to the patient, the performance of the hospital as an organization, and the impact of the treatment furnished by the hospital on the health status of its patients. Following are some specific areas the COPs will cover:

· A section on patient rights requires hospitals to notify patients of their rights to file grievances, have advance directives followed, participate in developing and implementing care plans, be free from verbal and physical abuse, and have privacy and confidentiality protected.

· A section on patient admission, assessment, and plan of care requires that new patients receive comprehensive assessment of their needs and written plans of care including coordination of services.

· The quality assessment and performance improvement (QA and PI) section requires hospitals to monitor the quality of care they provide in an objective way, focusing on elements such as patient satisfaction and medication errors. It charges each hospital with the responsibility for carrying out a PI program of its own design to effect continuing improvement in the quality of care furnished to its patients.

HCFA developed the proposed COPs with the following fundamental objectives in mind:

- Focus on the continuous, integrated care process that a patient experiences across all aspects of hospital services, centered around patient assessment, care planning, service delivery, and quality assessment and performance improvement.

- Adopt a patient-centered approach that recognizes the contributions of various skilled professionals and how they interact with each other to meet the patient's needs. Requirements that encourage administrative and enforcement structures are eliminated.

- Stress quality improvements, incorporating to the greatest possible extent an outcome-oriented, data-driven QA and PI program. The new COPs require that each hospital participate in its own QA and PI program.

- Facilitate flexibility in how a hospital meets performance expectations, and eliminate process requirements unless there is consensus or evidence that they are predictive of desired outcomes for patients.

- Require that patient rights are ensured.