The Department of Health and Human Services’ Office of Inspector General (OIG) recently investigated The Centers for Medicare & Medicaid Services (CMS) to check whether the agency, which oversees patient safety at hundreds of U.S. hospitals, considers national security as part of its enterprise risk management (ERM) process.
DNV Healthcare-accredited hospitals, critical access hospitals, and psychiatric hospitals should be aware that the accreditation organization is returning to unannounced, onsite surveys as of September 7.
The goal, according to CMS, is to improve care coordination by ensuring that important medical information is shared with primary care providers (PCP) when a patient shows up at the emergency department or is admitted into the hospital, as well as sharing information with providers after a patient is discharged.
If your healthcare organization has taken advantage of federal 1135 blanket waivers during the national public health emergency (PHE), be sure to review those waivers as you prepare for survey to check if any were inconsistent with requirements under your state emergency or pandemic plan.
Be aware that as COVID-19 cases are declining and vaccination rates are climbing, the emergency waivers and measures approved by the federal government to get through the public health emergency (PHE) will be changing. The FDA sent a notice to hospitals and others April 9 encouraging healthcare organizations to start moving away from the emergency measures taken to preserve and reuse medical devices and other supplies early in the PHE.
CMS sent out a statement noting that federal and state surveyors must be permitted entry unless they show symptoms of the coronavirus as outlined in earlier infection control guidance regarding surveys. The statement apparently was in answer to a query from The Joint Commission (TJC), which was acting on the behalf of someone else, according to the Health Facilities Management Insider.
Effective now, CMS surveyors are resuming hospital surveys on the limited basis as set out in a Quality, Safety & Oversight Group memo last August. Up first are uninvestigated complaints, with a target survey within 45 days.
TJC reminded organizations that, according to its Quick Safety Report No. 40, issued in 2018, “Preventing newborn falls and drops,” that maternal risk factors for infant falls included problems related to Cesarean birth, use of pain medication within four hours, issues on the second or third postpartum night, specifically midnight to early morning hours, and drowsiness associated with breastfeeding.
In a statement in its Joint Commission Online weekly publication, TJC noted that COVID-19 caseloads have been decreasing. “The Joint Commission will return to its usual procedures prior to the pandemic. Organizations will no longer be receiving a phone call or email from their account executive when it has been determined the area is low risk for The Joint Commission’s accreditation survey team to visit. All available resources will be utilized to conduct onsite, unannounced accreditation surveys.”
Be sure to check the “What’s New for 2021” section. Many of the updates, such as the elimination of the Environment of Care session, are not unexpected. Other items did not change, such as the documents that will be requested on the first day of survey.