Medicare Program; hospital inpatient prospective payment systems for acute care hospitals and the long-term care hospital prospective payment system changes and FY2011 rates; provider agreements and supplier approvals; and hospital conditions of participation for rehabilitation and respiratory care services; Medicaid program: accreditation for providers of inpatient psychiatric services. Final rules and interim final rule with comment period

: We are revising the Medicare hospital inpatient prospective payment systems (IPPS) for operating and capital-related costs of acute care hospitals to implement changes arising from our continuing experience with these systems and to implement certain provisions of the Affordable Care Act and other legislation. In addition, we describe the changes to the amounts and factors used to determine the rates for Medicare acute care hospital inpatient services for operating costs and capital-related costs. We also are setting forth the update to the rate-of-increase limits for certain hospitals excluded from the IPPS that are paid on a reasonable cost basis subject to these limits. We are updating the payment policy and the annual payment rates for the Medicare prospective payment system (PPS) for inpatient hospital services provided by long-term care hospitals (LTCHs) and setting forth the changes to the payment rates, factors, and other payment rate policies under the LTCH PPS. In addition, we are finalizing the provisions of the August 27, 2009 interim final rule that implemented statutory provisions relating to payments to LTCHs and LTCH satellite facilities and increases in beds in existing LTCHs and LTCH satellite facilities under the LTCH PPS. We are making changes affecting the: Medicare conditions of participation for hospitals relating to the types of practitioners who may provide rehabilitation services and respiratory care services; and determination of the effective date of provider agreements and supplier approvals under Medicare. We are also setting forth provisions that offer psychiatric hospitals and hospitals with inpatient psychiatric programs increased flexibility in obtaining accreditation to participate in the Medicaid program. Psychiatric hospitals and hospitals with inpatient psychiatric programs will have the choice of undergoing a State survey or of obtaining accreditation from a national accrediting organization whose hospital accreditation program has been approved by CMS. We are also issuing an interim final rule with comment period to implement a provision of the Preservation of Access to Care for Medicare Beneficiaries and Pension Relief Act of 2010 relating to Medicare payments for outpatient services provided prior to a Medicare beneficiary's inpatient admission.

The impetus for legislation revoking the Joint Commission's deemed status as a Medicare accrediting agency

A change in the Medicare law in 2008 removed the "deeming" status of the Joint Commission and forced the accrediting body to formally apply to the Centers for Medicare & Medicaid Services for its continued authority to determine a hospital as eligible for participation in federal programs. This legislation was reportedly justified by a critical concern about the Joint Commission's ability to ensure patient safety through its hospital accreditation program. This article provides a comprehensive evaluation of the issues surrounding congressional legislation revoking the Joint Commission's special authority and calls into question the validity of that concern for the safety of hospitalized patients based on the Joint Commission's performance. The legal history of the Centers for Medicare & Medicaid Services' oversight of hospital accreditation is considered. The 2004 US Government Accountability Office report that triggered the relevant section of the Medicare Improvement for Patients and Providers Act of 2008 is closely examined for validity. Once these relevant factors are reviewed, the reader may conclude that the legislation revoking Joint Commission's deemed status was not adequately justified.

Domestic violence assessments in the child advocacy center

OBJECTIVE

This study was designed to identify the frequency, methods, and practices of universal assessments for domestic violence (DV) within child advocacy centers (CACs) and determine which factors are associated with CACs that conduct universal DV assessments.

METHODS

The study design was a cross-sectional, web-based survey distributed to executive directors of National Children's Alliance accredited or accreditation-eligible CACs.

RESULTS

Responses were received from 323 of 376 eligible CACs (86%). Twenty-nine percent of CAC directors report familiarity with current DV recommendations and 29% require annual education for staff regarding DV. Twenty-nine percent of CACs conduct "universal assessments" (defined as a CAC that assesses female caregivers for DV more than 75% of the time). The majority of CACs use face-to-face interviews to conduct assessments, often with children, family or friends present. The presence of on-site DV resources (OR=2.85, CI 1.25-6.50) and an annual DV educational requirement (OR=2.88, CI 1.31-6.32) are associated with assessment of female caregivers. The presence of on-site DV resources (OR=3.97, CI 2.21-7.14) is associated with universal assessments.

CONCLUSIONS

Many CAC directors are not aware of current DV recommendations and do not require annual DV training for staff. Less than one-third of CACs practice universal assessments and those that do often conduct DV assessments with methods and environments shown to be less comforting for the patient and less effective in victim identification. CACs are more likely to assess female caregivers if they have co-located DV resources and they require DV training of their staff. CACs are more likely to universally screen for DV if they have co-located DV resources.

PRACTICE IMPLICATIONS

The presence of DV in the home has significant potential to negatively impact a child's physical and mental health as well as the ability of the caregiver to adequately protect the child. Current practice in CACs suggests a knowledge gap in this area and this study identifies an opportunity to improve the services offered to these high-risk families.

National Practitioner Data Bank for Adverse Information on Physicians and Other Health Care Practitioners: reporting on adverse and negative actions. Final rule

This final rule revises existing regulations under sections 401 through 432 of the Health Care Quality Improvement Act of 1986, governing the National Practitioner Data Bank for Adverse Information on Physicians and Other Health Care Practitioners, to incorporate statutory requirements under section 1921 of the Social Security Act, as amended by section 5(b) of the Medicare and Medicaid Patient and Program Protection Act of 1987 (MMPPPA), and as amended by the Omnibus Budget Reconciliation Act of 1990 (OBRA). The MMPPPA, along with certain additional provisions in the OBRA, was designed to protect program beneficiaries from unfit health care practitioners, and otherwise improve the anti-fraud provisions of Medicare and State health care programs. Section 1921, the statutory authority upon which this regulatory action is based, requires each State to adopt a system of reporting to the Secretary of Health and Human Services (the Secretary) certain adverse licensure actions taken against health care practitioners and health care entities licensed or otherwise authorized by a State (or a political subdivision thereof) to provide health care services. It also requires each State to report any negative actions or findings that a State licensing authority, peer review organization, or private accreditation entity has concluded against a health care practitioner or health care entity.

Standardization of pathology laboratories in Pakistan: problems and prospects

A Total Quality Management System with an internationally recognized accreditation process is the only guarantee of a reliable pathology service. However in a developing country like Pakistan nearly 90% of labs are small and without adequate physical and man power infrastructures. A modified plan may have to be tailored for them. A two tier system has been formulated. Accreditation based on ISO 15189 is to be introduced on voluntary basis. The labs which do not qualify for international standardization would be brought into quality net through a registration process. All such labs will be initiated into a simplified quality management system. Participation in proficiency testing program will be mandatory. They will be provided education and training to become eligible for accreditation. It is hoped that this simplified system will provide an impetus for evolving a workable and comprehensive mechanism through which pathology laboratories in the country will be able to offer better and more reliable services.

[ISO 15189 accreditation in clinical microbiology laboratory: general concepts and the status in our laboratory]

One important trend in the laboratory profession and quality management is the global convergence of laboratory operations. The goal of an accredited medical laboratory is to continue "offering useful laboratory service for diagnosis and treatment of the patients and also aid to the health of the nation". An accredited clinical laboratory is managed by a quality control system, it is competent technically and the laboratory service meets the needs of all its patients and physicians by taking the responsibility of all the medical tests and therapies. For this purpose, ISO 15189 international standard has been prepared by 2003. ISO 15189 standard is originated from the arrangement of ISO 17025 and ISO 9001:2000 standards. Many countries such as England, Germany, France, Canada and Australia have preferred ISO 15189 as their own laboratory accreditation programme, meeting all the requirements of their medical laboratories. The accreditation performance of a clinical microbiology laboratory is mainly based on five essential points; preanalytical, analytical, postanalytical, quality control programmes (internal, external, interlaboratory) and audits (internal, external). In this review article, general concepts on ISO 15189 accreditation standards for the clinical microbiology laboratories have been summarized and the status of a private laboratory (Acibadem LabMed, Istanbul) in Turkey has been discussed.

National regulation and accreditation of Australian health practitioners

In 2010, nurses and midwives, together with a number of other identified health professionals, will come under the Australian National Registration and Accreditation Scheme for Health Professionals. The scheme is focused on the improvement of safety and quality of health care services through the independent accreditation of educational programs and the establishment and maintenance of a national public register. In this column the framework and legislative provisions supporting the scheme are discussed.

Accreditation for cardiovascular imaging: setting quality standards for patient care

The accreditation of laboratories performing noninvasive cardiac procedures is now routinely available and often required by insurance companies. In this article, the history of the accreditation for cardiac procedures is reviewed, the process explained, and the number of accredited laboratories listed. Decision pathways are listed, and common reasons for a laboratory being delayed in approval are described specific for the various modalities. Some of the common compliments and concerns received by the Intersocietal Accreditation Commission are described.