Have you ever wondered about the reasoning behind hospital discharge paperwork or the requirement that every patient sign a HIPAA form?Here are explanations for some of the health care policies you come across on a daily basis.
Patient Visitation Rights
When: Previously, patient visitation rights for Medicare-specified hospitals were last updated in July 1999. Since January 2011, the Centers for Medicare and Medicaid Services (CMS) have mandated that these hospitals may not deny a patient the right to choose a visitor.
Who/What: President Obama wrote a memo to the Secretary of Health and Human Services, Kathleen Sebelius, on April 15, 2010, instructing her to take steps to protect the rights of same-sex couples to choose their hospital visitors. The resulting provisions were amended to the Social Security Act, in Section 1861, and include language that protects patients and their visitors regardless of sexual orientation or marital status. This new language also dictates how hospitals are accredited.
Why: Before the January 15 amendment, the Social Security Act left many patients’ rights up to the states to decide. Several states refused to defend a patient’s right to choose a visitor if said visitor was not a marital spouse or immediate family member. In his memo to Secretary Sebelius, President Obama iterated that states’ denial of patient visitation rights was discriminatory and unjust.
In Practice: Hospitals must disclose visitation rights to every patient and may not prevent the patient from choosing any visitor desired as long as that visitor does not interfere with hospital procedures or safety regulations.
Update: Since January 15, states like Wisconsin have moved to stop enforcing the new law protecting same-sex couples’ visitation rights.
Sources:
- Bond B. Hospital visitation regulations go into effect today. Office of Public Engagement weblog. January 18, 2011.
- U.S. Department of Health and Human Services. Centers for Medicare and Medicaid Services. 42 CFR Parts 482 and 485. Medicare and Medicaid programs: changes to the hospital and critical access hospital conditions of participation to ensure visitation rights for all patients. November 19, 2010.
- Marley P. Walker seeks to stop defense of state’s domestic partner registry. May 16, 2011. Milwaukee Wisconsin Journal-Sentinel.
Hospital Discharge
When: The new policy went into effect on April 1, 2011.
Who/What: Update to the Affordable Care Act (ACA) from the CMS.
Why: The requirement of a face-to-face encounter as part of the ACA helps to ensure that physicians make appropriate judgments about a patient’s need and eligibility for home care prior to discharge from the hospital.
In Practice: Physicians must fill out a form certifying a face-to-face encounter with a patient before discharge.
Update: CMS has continued to clarify this policy to the extent that it allows an auxiliary staff member working with the physician to complete the form and have the provider sign it.
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Meaningful Use of Certified Electronic Health Records (EHR)
When: Beginning in 2011, hospitals may gradually implement EHR systems voluntarily. Those that do not comply by 2016 will incur financial penalties.
Who/What: Financial incentives are awarded to hospitals that can demonstrate “meaningful use” of certified EHR technology in their efforts to improve care and efficiency. The CMS handles meaningful use certification for Medicare patients, and state bureaus handle the proceedings for Medicaid patients.
Why: The financial incentives encourage hospitals to migrate their patients’ data to EHRs. CMS believes that EHRs will improve the health information technology infrastructure in the long term, ultimately increasing health care quality, efficiency and patient safety.
In Practice: Although it is strongly encouraged now, eventually hospitals will be required to use computerized physician order entry (CPOE) and make sure providers keep an updated inpatient problem list throughout a patient’s hospital stay.
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Medical and Surgical Instrument Disinfection Guidelines
When: The latest Centers for Disease Control and Prevention (CDC) guidelines were released in 2008.
Who/What: The CDC publishes guidelines for cleaning, decontaminating and sterilizing medical and surgical instruments after use. Instructions include sterilization method/cleaning agent, strength/dilution of cleaning agent and length of exposure.
Why: Depending on the device and where and how it is used, certain decontamination procedures must be followed to reduce any risk of pathogenic infection in subsequent patients.
In Practice: Providers must determine what level of cleaning each instrument requires before repurposing. Some tools only require cleaning with soap and water, while others require a steam cleaning cycle followed by a wash with an enzymatic agent and then a dip in bleach or other sterilizing chemical.
Sources:
- Rutala WA, Weber DJ, Healthcare Infection Control Practices Advisory Committee. Guideline for disinfection and sterilization in healthcare facilities, 2008.
- Petersen BT, Chennat J, Cohen J, et al. Multi-society guideline for reprocessing flexible gastrointestinal endoscopes: 2011. Infect Control Hosp Epidemiol. 2011;32(6):527-537.
Documentation of History and Physical Examinations
When: A final rule was passed on January 26, 2007.
Who/What: CMS published the amendment to its Conditions of Participation (CoPs) for health care organizations to address procedures for documenting history and physical examinations to properly bill Medicare. The ruling lengthened the allotted time given to doctors to document a patient’s history and physical examination from seven to 30 days before the patient is admitted to the hospital.
Why: According to a memorandum from the director of the Survey and Certification Group at the CMS, the history and physical documentation regulations were adjusted to ease the burden of physicians who were required to perform history and physical exams no more than seven days before a patient’s hospital admission.
In Practice: Now physicians may administer an exam up to 30 days before a patient is admitted. However, they still may only give an exam up to 24 hours after the patient is admitted.
Sources:
- Whitman B. CMS changes hospitals rules for completing history and physical documentation. ACP Internist. April 2007.
- U.S. Department of Health and Human Services. Centers for Medicare and Medicaid Services. Center for Medicaid and State Operations/Survey and Certification Group. Hospitals—publication of the hospital condition of participation: requirements for history and physical examinations; authentication of verbal orders; securing medications; and post-anesthesia evaluations final rule. CMS January 26, 2007.
The Emergency Medical Treatment and Labor Act (EMTALA)
When: The EMTALA was originally passed in 1986.
Who/What: The U.S. Congress enacted the EMTALA to allow people to receive emergency medical care whether or not they can pay for it. The CMS defends the law through provisions in sections 1866 and 1867 of the Social Security Act.
Why: The law was passed to ensure that hospitals would not turn away any person in need of emergency care just because they could not pay to visit the emergency room.
In Practice: Medicare-specified hospitals with emergency services must provide a medical screening examination upon request to patients with emergency medical conditions and attempt to stabilize them. Hospitals must also provide transfers to patients who request them, as well as to those the hospital is unable to stabilize.
Update: On December 23, 2010, CMS published a notice of proposed rule updates to the EMTALA with reference to “hospital and critical access hospital inpatients and hospitals with specialized capabilities.” The notice solicited public comment on the issue, with a submission deadline of February 22, 2011.
Sources:
- Department of Health and Human Services. Centers for Medicare and Medicaid Services. EMTALA overview.
- Centers for Medicare and Medicaid Services. Proposed rule. Medicare program; emergency medical treatment and labor act: applicability to hospital and critical access hospital inpatients and hospitals with specialized capabilities. Federal Register. December 23, 2010.
HIPAA: The Privacy Rule
When: The Health Insurance Portability and Accountability Act (HIPAA) originally passed in 1996.
Who/What: The Department of Health and Human Services (HHS) established the Privacy Rule as part of HIPAA to require “covered entities” such as health care providers, health insurance providers and health care clearinghouses to protect patients’ health information.
Why: The Privacy Rule was passed to protect patients’ medical information, especially when it is transferred electronically.
In Practice: Covered entities must adhere to standards of transacting information and inform patients of their rights under the Privacy Rule.
Update: On February 17, 2009, Congress passed the Health Information Technology for Economic and Clinical Health (HITECH) Act as part of the American Recovery and Reinvestment Act of 2009. The HITECH Act encourages health care providers to adopt health information technology and coincides with provisions for patients’ rights to privacy of information in HIPAA.
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