This Week's Headlines:

Hospital CoP Changes Affect EMTALA Compliance

Time, signature issues cited

A one-word change in the Conditions of Participation (CoP) regulations that went into effect Jan. 26, 2007, will make a dramatic difference in compliance requirements for Medicare and EMTALA, says Stephen A. Frew, JD, a web site publisher and risk management specialist (www.medlaw.com).

That change, which is "buried deep" within 22 pages of CoP regulations, requires that every entry in the medical record be timed, Frew adds, and it also may influence how medical records affect malpractice claims.

"Most risk managers have pushed for timed entries in the medical record to help document sequence and timeliness of care," he notes. "Often EMTALA and other compliance issues hinge on the time of various entries."

Calling time "the new documentation trap," Frew points out that most hospitals that have not gone to electronic medical records have very few timed entries.

The Center for Medicare & Medicaid Services (CMS) notes in its comments that "the timing of medical record entries is crucial for patient safety and quality of care. Timing applies to all medical record entries, not just to the authentication of verbal orders. This would include orders, progress notes, procedure notes, patient assessments, H&Ps [histories and physicals], etc.

"Timing establishes when an order was given; when an activity, intervention, treatment or procedure occurred; or when an activity, intervention, treatment or procedure is to take place," CMS goes on to state in the final regulations. "Timing and dating of entries establishes a baseline for future actions or assessments and establishes a timeline of events. Many patient interventions or assessments are based on time intervals or timelines of various signs, symptoms or events.

"We proposed minor revisions that would clarify that all patient medical record entries must be legible, complete, dated, timed and authenticated in written or electronic form," the regulations state.

The first applications of the rule likely will occur in EMTALA investigations in the "dedicated emergency departments" of a hospital – the ED or the obstetrics, psychiatric or urgent care areas, Frew says.

"On the medical malpractice side," Frew adds, "ambiguities in treatment records caused by lack of timed entries might be fodder for plaintiff's attack on the record's accuracy."

Risk managers should conduct immediate policy and procedure reviews to assess their facility's exposure, he advises. "Policy changes, staff education, and intense quality auditing will be required in most facilities."

Back to top

Additional Performance Data Required By JCAHO

The Joint Commission is revising its contracts with the nearly 50 organizations that report hospital performance data to require additional patient-level data that will not identify the hospital.

Beginning with second-quarter 2007 core measure data, reported to The Joint Commission by Oct. 31, 2007, performance measurement systems will be expected to report hospital-specific aggregate data for three measure sets, plus a 100% sample of anonymous patient-level data for all performance measures in the measure sets.

At present, JCAHO requires the organizations to report hospital-specific aggregate data for three measure sets, plus a 20% sample of de-identified patient-level data for four outcome measures.

The data reported by accredited hospitals to The Joint Commission and to the Hospital Quality Alliance's Hospital Compare web site "are garnering an increasing amount of attention for use in accreditation, consumer choice, pay for performance, and quality improvement," noted Nancy Foster, the American Hospital Association's vice president for quality and patient safety policy. "It is imperative that they be as accurate as possible."

The announcement by JCAHO reinforces its commitment to ensuring that data can be used reliably for a variety of purposes, Foster added.

Back to top

CMS Offers Guidance On HIPAA Security Rule

The Centers for Medicare & Medicaid Services has released guidance to help organizations comply with HIPAA security standards when they allow remote access to electronic protected health information (EPHI) through portable devices or external systems or hardware.

Entities covered by the Health Insurance Portability and Accountability Act should be "extremely cautious," CMS said, about allowing offsite use of or access to EPHI , and must implement policies and procedures to protect EPHI that is stored on remote or portable devices/media or transmitted over an electronic communications network.

The agency said it may rely on the guidance in determining whether actions by a HIPAA-covered entity are reasonable and appropriate for safeguarding the confidentiality, integrity, and availability of EPHI.

Back to top

On-line NPI Information Available Through WEDI

Health care providers can receive free on-line information about the National Provider Identifier (NPI) in the form of on-demand audio and video web casts.

The service is being offered by the Workgroup for Electronic Data Interchange (WEDI) and the Blue Cross and Blue Shield Association to help educate providers on how to obtain and implement their NPI by the May 23, 2007, deadline, according to a WEDI statement.

Only about 60% of providers had obtained their NPI by the beginning of 2007, the Centers for Medicare and Medicaid Services (CMS) estimates. All entities covered by HIPAA including providers, health plans, and clearinghouses that process health care transactions using HIPAA format, must implement the 10-digit NPI code by the May 23 deadline.

Two 60-minute webcast audio or video sessions are available: one for large practices or institutional providers, and a second version tailored for individual providers or small group practices. The webcasts, which include PowerPoint materials, cover these topics:

• Who needs an NPI?
• The application process
• Obtaining and sharing NPIs
• NPI and paper claim submitters
• Provider practice considerations and impacts
• Resources and general questions