CMS targets employee health in new inspection program

'CMS [carries] a big stick. Their voice is going to be heard.'

The status of employee health is rising, but so are the expectations. As part of a heightened focus on reducing hospital infections, the Centers for Medicare and Medicaid Services (CMS) is developing a national survey program that will include interviews with employee health professionals.

When CMS surveyors arrive to ask about hospital infections, they may interview employee health professionals about needlesticks, tuberculosis screening, hepatitis B vaccination, respirator fit-testing and annual flu shots, according to the draft document "Acute Care Hospital Infection Control Tool for Surveyors." CMS survey requirements also influence the surveys of accrediting bodies, such as The Joint Commission.

"This is a new era where infection prevention has really risen up the priority list," says Daniel Schwartz, MD, MBA, chief medical officer of CMS's Survey and Certification Group in Baltimore, MD.

In the past, infection control and employee health may not have received much attention or support from top hospital leadership, he says. But the new tool "does give the hospital leadership priority focus and lets them know what they need to do," Schwartz says. "We hope they're going to support [infection control and employee health] as they try to make the hospital a safe place for the patients."

The Obama administration has targeted hospital infections as a way to reduce health care costs while improving patient care. The Partnership for Patients, a public-private initiative that is fueled by up to $1 billion in funding from the Affordable Care Act, set a goal of reducing hospital-acquired conditions by 40% from 2010 to 2013.

"The goal is to reduce and eliminate healthcare acquired infections. Occupational health nurses play a role in that," says Karen Hoffman, RN, MS, CIC, infection preventionist with the CMS Survey and Certification Group.

'Multi-faceted effort to improve care'

CMS created the infection control tool with assistance from the Centers for Disease Control and Prevention. It uses a "patient tracer" method similar to The Joint Commission surveys and emphasizes interviews and observing care rather that review of hospital policies and documents.

"Surveyors are looking at what's going on at the bedside and trying to get a sense for how the hospital is dealing with these issues of infection control and prevention of transmission of infections," says Schwartz.

The infection control tool doesn't add any new CMS requirements. In fact, some surveyors may already have been asking some of the questions. "This tool just adds some consistency and gives some structure to this particular part of the survey," he says.

The draft tool has been used by 10 states, Puerto Rico and Washington, DC, and was being revised for a new version to be released in January. A final version is due in October 2012. CMS is encouraging hospitals to use the draft tool for self-assessment.

"The survey and certification process and tool are part of a much larger, multi-faceted effort to improve quality of care and safety in hospitals," says Schwartz.

This broad view of quality encompasses transmission of infections that threaten the health of employees as well as patients. For example, the draft worksheet that is used by surveyors includes questions about the use of personal protective equipment. The surveyor would observe and indicate if employees were using the "appropriate mouth, nose, eye protection" for aerosol-generating procedures "and/or procedures/activities that are likely to generate splashes or sprays of blood or body fluids."

"For the protection of health care personnel, we want the hospitals to be monitoring needlesticks. We want to suggest to the hospitals that if somebody is at risk of picking up hepatitis B, that they are at least offered the vaccinations and follow up testing," Schwartz says.

CMS voice will be heard

To Bruce Cunha, RN, MS, COHN-S, manager of employee health and safety at the Marshfield (WI) Clinic, the CMS tool is an important acknowledgement of the importance of safety in hospitals – not patient safety versus employee safety, but overall safety.

"If you have a good safety program in place, that's going to incorporate all your processes," says Cunha, who also surveys facilities for the Accreditation Association for Ambulatory Health Care (AAAHC) in Skokie, IL.

The CMS tool is likely to have an impact on the accrediting bodies, which certify hospitals for CMS. "If CMS is asking those questions, so will AAHC and The Joint Commission," he says.

In the past, the level of concern about employee health has varied based on the surveyor, says MaryAnn Gruden, MSN, CRNP, NP-C, COHN-S/CM, manager of Employee Health Services at Allegheny General Hospital and the Western Pennsylvania Hospital in Pittsburgh and association community liaison for the Association of Occupational Health Nurses in Healthcare (AOHP).

"There does seem to be a [new] willingness to acknowledge that employee and patient safety are tied together," she says.

With the new survey tool, hospitals can't help but take more notice of employee health issues, says Cunha. "CMS has got a big stick. There's no doubt about it," he says. "Their voice is going to be heard."