Medicare and Medicaid Programs; CY 2019 Home Health Prospective Payment System Rate Update and CY 2020 Case-Mix Adjustment Methodology Refinements; Home Health Value-Based Purchasing Model; Home Health Quality Reporting Requirements; Home Infusion Therapy Requirements; and Training Requirements for Surveyors of National Accrediting Organizations. Final rule with comment period

This final rule with comment period updates the home health prospective payment system (HH PPS) payment rates, including the national, standardized 60-day episode payment rates, the national per- visit rates, and the non-routine medical supply (NRS) conversion factor, effective for home health episodes of care ending on or after January 1, 2019. This rule also: Updates the HH PPS case-mix weights for calendar year (CY) 2019 using the most current, complete data available at the time of rulemaking; discusses our efforts to monitor the potential impacts of the rebasing adjustments that were implemented in CYs 2014 through 2017; finalizes a rebasing of the HH market basket (which includes a decrease in the labor-related share); finalizes the methodology used to determine rural add-on payments for CYs 2019 through 2022, as required by section 50208 of the Bipartisan Budget Act of 2018 (Pub. L. 115-123) hereinafter referred to as the "BBA of 2018"; finalizes regulations text changes regarding certifying and recertifying patient eligibility for Medicare home health services; and finalizes the definition of "remote patient monitoring" and the recognition of the costs associated with it as allowable administrative costs. This rule also summarizes the case-mix methodology refinements for home health services beginning on or after January 1, 2020, which includes the elimination of therapy thresholds for payment and a change in the unit of payment from a 60-day episode to a 30-day period, as mandated by section 51001 of the Bipartisan Budget Act of 2018. This rule also finalizes changes to the Home Health Value-Based Purchasing (HHVBP) Model. In addition, with respect to the Home Health Quality Reporting Program, this rule discusses the Meaningful Measures Initiative; finalizes the removal of seven measures to further the priorities of this initiative; discusses social risk factors and provides an update on implementation efforts for certain provisions of the IMPACT Act; and finalizes a regulatory text change regarding OASIS data. For the home infusion therapy benefit, this rule finalizes health and safety standards that home infusion therapy suppliers must meet; finalizes an approval and oversight process for accrediting organizations (AOs) that accredit home infusion therapy suppliers; finalizes the implementation of temporary transitional payments for home infusion therapy services for CYs 2019 and 2020; and responds to the comments received regarding payment for home infusion therapy services for CY 2021 and subsequent years. Lastly, in this rule, we are finalizing only one of the two new requirements we proposed to implement in the regulations for the oversight of AOs that accredit Medicare-certified providers and suppliers. More specifically, for reasons set out more fully in the section X. of this final rule with comment period, we have decided not to finalize our proposal to require that all surveyors for AOs that accredit Medicare-certified providers and suppliers take the same relevant and program-specific CMS online surveyor training that the State Agency surveyors are required to take. However, we are finalizing our proposal to require that each AO must provide a written statement with their application to CMS, stating that if one of its fully accredited providers or suppliers, in good- standing, provides written notification that they wish to voluntarily withdraw from the AO's CMS-approved accreditation program, the AO must continue the provider or supplier's current accreditation until the effective date of withdrawal identified by the facility or the expiration date of the term of accreditation, whichever comes first.

What Regulatory Requirements and Existing Structures Must Change If Competency-Based, Time-Variable Training Is Introduced Into the Continuum of Medical Education in the United States?

As competency-based medical education is adopted across the training continuum, discussions regarding time-variable medical education have gained momentum, raising important issues that challenge the current regulatory environment and infrastructure of both undergraduate and graduate medical education in the United States. Implementing time-variable medical training will require recognizing, revising, and potentially reworking the multiple existing structures and regulations both internal and external to medical education that are not currently aligned with this type of system. In this article, the authors explore the impact of university financial structures, hospital infrastructures, national accrediting body standards and regulations, licensure and certification requirements, government funding, and clinical workforce models in the United States that are all intimately tied to discussions about flexible training times in undergraduate and graduate medical education. They also explore the implications of time-variable training to learners' transitions between medical school and residency, residency and fellowship, and ultimately graduate training and independent practice. Recommendations to realign existing structures to support and enhance competency-based, time-variable training across the continuum and suggestions for additional experimentation/demonstration projects to explore new training models are provided.

[The evolution of the assessment and development of nursing competences in the Italian health-care system]

. The evolution of the assessment and development of nursing competences in the Italian health-care system. The issue of the skills, in health care organizations, received a boost in the last 15 years as a result of contractual innovations that recognized different career levels in the nursing profession, and of the widespread dissemination of quality systems for certification or accreditation for excellence. These events prompted organizations to assess the competence of their professionals. A further stimulus was given by the recent debate on nursing sensitive outcomes, by the changes in patients' needs and by the increased production of knowledge from the nursing profession which contributed to an increase of competences and to their expanded role. To improve patients' care and avoid conflicts, and to maximize the benefits to users, professionals need to learn to work together, integrating and respecting roles and competences.

How changing quality management influenced PGME accreditation: a focus on decentralization and quality improvement

BACKGROUND

Evaluating the quality of postgraduate medical education (PGME) programs through accreditation is common practice worldwide. Accreditation is shaped by educational quality and quality management. An appropriate accreditation design is important, as it may drive improvements in training. Moreover, accreditors determine whether a PGME program passes the assessment, which may have major consequences, such as starting, continuing or discontinuing PGME. However, there is limited evidence for the benefits of different choices in accreditation design. Therefore, this study aims to explain how changing views on educational quality and quality management have impacted the design of the PGME accreditation system in the Netherlands.

METHODS

To determine the historical development of the Dutch PGME accreditation system, we conducted a document analysis of accreditation documents spanning the past 50 years and a vision document outlining the future system. A template analysis technique was used to identify the main elements of the system.

RESULTS

Four themes in the Dutch PGME accreditation system were identified: (1) objectives of accreditation, (2) PGME quality domains, (3) quality management approaches and (4) actors' responsibilities. Major shifts have taken place regarding decentralization, residency performance and physician practice outcomes, and quality improvement. Decentralization of the responsibilities of the accreditor was absent in 1966, but this has been slowly changing since 1999. In the future system, there will be nearly a maximum degree of decentralization. A focus on outcomes and quality improvement has been introduced in the current system. The number of formal documents striving for quality assurance has increased enormously over the past 50 years, which has led to increased bureaucracy. The future system needs to decrease the number of standards to focus on measurable outcomes and to strive for quality improvement.

CONCLUSION

The challenge for accreditors is to find the right balance between trusting and controlling medical professionals. Their choices will be reflected in the accreditation design. The four themes could enhance international comparisons and encourage better choices in the design of accreditation systems.

Department of Veterans Affairs. Recognition of Tribal Organizations for Representation of VA Claimants. Final rule

The Department of Veterans Affairs (VA) is amending its regulations concerning recognition of certain national, State, and regional or local organizations for purposes of VA claims representation. Specifically, this rulemaking allows the Secretary to recognize tribal organizations in a similar manner as the Secretary recognizes State organizations. The final rule allows a tribal organization that is established and funded by one or more tribal governments to be recognized for the purpose of providing assistance on VA benefit claims. In addition, the final rule allows an employee of a tribal government to become accredited through a recognized State organization in a similar manner as a County Veterans' Service Officer (CVSO) may become accredited through a recognized State organization. The effect of this action is to address the needs of Native American populations who are geographically isolated from existing recognized Veterans Service Organizations (VSOs) or who may not be utilizing other recognized VSOs due to cultural barriers or lack of familiarity with those organizations.

Amendments to Accreditation of Third-Party Certification Bodies To Conduct Food Safety Audits and To Issue Certifications To Provide for the User Fee Program. Final rule

The Food and Drug Administration (FDA, the Agency, or we) is amending its regulations on accreditation of third-party certification bodies to conduct food safety audits and to issue certifications to provide for a reimbursement (user fee) program to assess fees for the work FDA performs to establish and administer the third-party certification program under the FDA Food Safety Modernization Act (FSMA).

The Department of Health's research governance framework remains an impediment to multi-centre studies: findings from a national descriptive study

Objective

We describe our experience of using the standard application form, designed to streamline applications for multicentre research, to seek approval from all primary care organizations (PCOs) in England and Wales to undertake a single telephone interview with a health service manager.

Design

We sent applications ( n=316), by email to each PCO, or consortium of PCOs, attaching a completed standard application form, the 15 required documents, and the approval we had been granted by the lead NHS organization. We maintained detailed records of the responses to our application, subsequent correspondence, additional paperwork requested, and time spent on the approval process.

Setting

The UK Research Governance Framework, which regulates all research conducted in health and social care settings.

Participants

All PCOs in England and Wales.

Interventions

None.

Main outcome measures

Time taken to obtain approval to undertake a telephone interview with a health service manager.

Results

We were unable to establish contact with 13 (4%) PCOs. Six months after submitting our application we had received approval from 259/316 (82%) PCOs and were still awaiting a verdict from 41 (13%). The median time to approval was 56 days (IQR 42-72). Overall, an estimated 318 staff-hours were spent completing supplementary forms, providing additional information and chasing up dormant applications.

Conclusions

Recent initiatives to ‘streamline’ research governance approval have failed to address the problems that face researchers undertaking multi-centre studies. There is an urgent need to develop a simpler process that allows low risk research to take place without threatening staff morale and endangering the quality of the research outputs. In the meantime, we advise researchers to allow far greater time than might reasonably be envisioned to obtain research governance approval.

[ACCREDITATION OF THE HEALTH PROFESSIONAL AS A LAUNCH PAD FOR CONTINUING MEDICAL EDUCATION.]

The rapid development of medical science and health care practice, the need to improve the quality of health care, the ongoing modernization of education was the basis for scientfic rationale and implementation of the system of continuous medical education, which will be gradually expanded to cover individuals who have undergone 2016 accredited specialist.

ICARE improves antinuclear antibody detection by overcoming the barriers preventing accreditation

BACKGROUND

Antinuclear antibodies (ANA) are useful biomarkers for the diagnosis and the monitoring of rheumatic diseases. The American College of Rheumatology has stated that indirect immunofluorescence (IIF) analysis remains the gold standard for ANA screening. However, IIF is time consuming, subjective, not fully standardized and presents several issues for accreditation which is the process leading to ISO 15189 certification for medical laboratories. We propose an innovative tool for accreditation by using the quantitative evaluation of the automated image capture and analysis "ICARE" (Immunofluorescence for Computed Antinuclear antibody Rational Evaluation).

METHODS

We established the optimal screening dilution (1:160) and a fluorescence index (FI) cutoff for ICARE on a cohort of 91 healthy blood donors. Then, we evaluated performance of ICARE on a routine cohort of 236 patients. Precision parameters of ANA detection by IIF were evaluated according to ISO 15189.

RESULTS

ICARE showed an excellent concordance with visual evaluation (88%, Kappa=0.76) and significantly discriminated between weak to moderate (1:160-1:320 titers) and high (>1:320 titers) ANA levels. A significant correlation was found between FI and ANA titers (Spearman's ρ=0.67; P<0.0001). Using ICARE, we reported precision parameters such as repeatability (CV<13.8%) and reproducibility (CV<13.1%) as well as absence of inter-sample contamination for ANA detection by IIF according to ISO 15189 standards.

CONCLUSIONS

ICARE offers a precious help for the accreditation of IIF qualitative methods. This innovative quantitative approach is in adequacy with the process of continuous improvement of the quality of clinical laboratories.

Medicare and Medicaid programs: revisions to deeming authority survey, certification, and enforcement procedures. Final rule

This final rule revises the survey, certification, and enforcement procedures related to CMS oversight of national accrediting organizations (AOs). The revisions implement certain provisions under the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA). The revisions also clarify and strengthen our oversight of AOs that apply for, and are granted, recognition and approval of an accreditation program in accordance with the statute. The rule also extends some provisions, which are applicable to Medicare-participating providers, to Medicare-participating suppliers subject to certification requirements, and clarifies the definition of "immediate jeopardy."

[METHODOLOGICAL APPROACHES TO DEFINING CRITERIA FOR ACCREDITATION OF SPECIALISTS (IN CASE OF MEDICAL PARASITOLOGISTS)]

In 2016, provision is made for the transition for an accreditation system for all health workers to have individual permits for specific kinds of medical activities. Regular accreditation of health workers is one of the constituents of medical education, which is being intensively elaborated by the Ministry of Health of Russia jointly with a professional community by the module principle of using an accumulation system of valid credits. Despite the fact that higher educational establishments belong to different agencies, educational programs for physicians, criteria and procedures for their accreditation must be uniform. In this connection, there is today's challenge of methodological and methodical approaches to defining criteria for the accreditation of specialists of healthcare facilities of the Ministry of Health of Russia, bodies and institutions of the Russian Federal Service for Supervision of Consumer Rights Protection and Human Welfare. In the context of systemic and functional methodological approaches, the paper shows a procedure for defining criteria for the accreditation of specialists (in case of medical parasitologists).

[THE FUNCTIONAL CONSTITUENT OF A BIOLOGICAL COMPONENT IN PROGRAMS FOR TRAINING SPECIALISTS IN THE AREA OF PARASITOLOGY FOR ACCREDITATION]

The paper considers the functional aspects of a biological component in programs for training specialists in the area of Parasitology for accreditation within the current enactments, including those on modernization of public health and additional professional education. The working program of the module "Fundamental Disciplines" has been used as an example to outline approaches to molding a medical parasitologist's capacity and readiness to solve professional tasks on the basis of knowledge of fundamental disciplines: biology, immunology, and medical geography. Education fundamentalization is shown to suggest more unsupervised work of a learner in the teaching process. The fundamental constituent of a biological component of the 'programs for training learners in the specialty of Parasitology for accreditation is shown in the interaction of all sections of this area with special and allied subjects.

[New frontiers of education in healthcare]

Competency is the ability to use a structured set of knowledge, skills, and attitudes in a specific professional context, or in professional training. Over the past 10 years there has been an acceleration of the trend towards a competency-based design of the education of healthcare professionals, rather than just defining learning objectives or relying on the content of disciplinary programs. The choice for a competency-based curriculum is not only the result of a changed pedagogical vision, but also an answer to the request of accountability toward society about how are the professionals trained and also to allow comparability between universities and nations. In recent years, many international initiatives have defined competency models for medicine and more specifically for public health. This article summarizes these initiatives, putting them in the context of the evolving Italian legislation.

[Background for governmental accreditation of "anesthesiology" as a specially approved medical specialty]

In 1960, "Anesthesiology" was accredited as a "specially approved medical specialty" for approving registered anesthesiologists. Exclusive training for more than two years of anesthesia under an adequate mentor is required for candidates to be qualified as registered anesthesiologists. In 1963, the Japan Society of Anesthesiology (JSA) established the system to qualify board certificated anesthesiologists as proper mentors responsible for the training of the candidates. This ranks as one of the most significant events in the JSA history and the society launched the first qualification system in the history of medical practice in Japan. Every member of the present society should fully understand the hidden background of the qualification system of the specialty for achieving greater social recognition of anesthesiologists in this country.

Regulation and oversight of independent health facilities in Canada

Independent health facilities ("IHFs") are an important part of Canada's health care system existing at the interface of public and private care. They offer benefits to individual patients and the public at large, such as improved access to care, reduced wait times, improved choice in the delivery of care, and more efficient use of health care resources. They can also provide physicians greater autonomy, control of resources, and opportunity for profit compared to other practice settings, particularly because IHFs can deliver services outside of publicly-funded health care plans. IHFs also present challenges, particularly around quality of care and patient safety, and the potential to breach the principles of "Medicare" under the Canada Health Act. Various measures are in place to address these challenges, while still enabling the benefits IHFs can offer. IHFs are primarily regulated and overseen at the provincial level through legislation, regulations and provincial medical regulatory College by-laws. Health Canada is responsible for administering the overarching framework for "Medicare". Oversight and regulatory provisions vary across Canada, and are notably absent in the Maritime provinces and the territories. This article provides an overview of specific provisions related to IHFs across the country and how they can co-exist with the Canada Health Act.

Governance, policy and system-level efforts to support safer healthcare

Over the past 10 years there have been concerted efforts across Canada to create safer healthcare systems both by improving practices at the frontline and by creating an environment that encourages the development of effective safety practices and a safety culture. There have been major changes in organizational policies regarding the disclosure of adverse events to patient and families, the reporting of patient safety incidents to facilitate learning, and new accreditation requirements. Governing bodies for healthcare organizations have been given clearer accountabilities for quality of care and patient safety, and improved performance measurement, greater engagement of patients and families, and a trend toward greater transparency have aided efforts to improve patient safety. However, some areas where changes were anticipated, including the reform of medical liability processes and changes to regulations that govern health professional practices have not progressed as much as some expected. Overall, a decade following the release of the Canadian Adverse Events Study and the creation of the Canadian Patient Safety Institute many healthcare organizations have made only limited progress toward the creation of "a culture of safety" and a safer healthcare system.

Unique device identification system. Final rule

The Food and Drug Administration (FDA) is issuing a final rule to establish a system to adequately identify devices through distribution and use. This rule requires the label of medical devices to include a unique device identifier (UDI), except where the rule provides for an exception or alternative placement. The labeler must submit product information concerning devices to FDA's Global Unique Device Identification Database (GUDID), unless subject to an exception or alternative. The system established by this rule requires the label and device package of each medical device to include a UDI and requires that each UDI be provided in a plain-text version and in a form that uses automatic identification and data capture (AIDC) technology. The UDI will be required to be directly marked on the device itself if the device is intended to be used more than once and intended to be reprocessed before each use.

Office-based surgery: embracing patient safety strategies

Office-based surgery continues to grow as more procedures are being performed in the outpatient setting. With this exponential growth, there is an increasing emphasis on safe and effective patient care. Current research shows both gaps in safety and opportunities for improvement. Practice managers, clinicians, and other personnel should be cognizant that office procedures are coming under intense regulatory scrutiny. Effective strategies to maintain quality and patient safety include the use of checklists, obtaining office accreditation, encouraging board-certification and proper credentialing of proceduralists, and appropriate patient and procedure selection. There is increasing regulation of ambulatory surgery on state and national levels that will likely affect the financial and care quality aspects of office-based practice. Socioeconomic and political forces will continue to shape the future of office-based surgery.

[Laboratory accreditation: a long and useful process]

The publication of the 13 th January 2010 order makes the official accreditation necessary for all the laboratories of medical biology in France. This accreditation is delivered by a single official authority: the Cofrac. This accreditation is the acknowledgement of the ability of the laboratory to perform medico-technical acts corresponding to the scope of the accreditation. It must satisfy normative standards (Standard 15189), specific application documents of the Cofrac (SH REF 02), and legislative and regulatory rules in order to guarantee the reliability of the medical biology tests performed and the quality of the offered services in the sole interest of the patients. The accreditation is a long lasting process, which appears in a first step as very constraining. In the long term, it is experienced by the personnel as an acknowledgement of their quality and efficiency.

As the pendulum swings--medical products class actions litigation in Canada: recent developments

During the relatively short history of class proceedings in Canada, developers and manufacturers of medical devices and pharmaceuticals ("medical products"), including medical products designed for patients with diabetes, have found themselves at the receiving end of a significant number of class action claims. As a result, medical products litigation has become the battleground for some of the most significant developments in Canadian class actions law. This article provides a broad overview of some of the most significant developments. The authors pay particular attention to developments regarding the test for class action certification and consider whether high-profile dismissals of certification motions represent a trend toward raising the threshold for plaintiffs seeking to obtain certification of a proposed class action. The authors also consider a decision arising out of a lengthy class action common issues trial in which the medical device company was victorious. In the authors' view, the class action pendulum in Canada, particularly as it relates to medical products claims, remains in motion. It behooves all affected players to keep their eye on this ball with rapt attention to see where it may move next.

Closing the regulatory regress: GMP accreditation in stem cell laboratories

Contemporary biomedical research is conducted amidst regimes of national and transnational regulation. Regulation, like rules generally, cannot specify all the practicalities of their application. Regulations for biomedical research impose considerable constraints on laboratories and others. In principle, there is a never-ending regress whereby scientists have to provide increasingly more guarantees that protocols have been followed, standards reached and maintained, and rules adhered to. In practice, regulatory regress is not the actual outcome, as actors find ways of establishing closure for all practical purposes. Based on ethnographic case studies of two sites of biomedical work--the UK Stem Cell Bank and an anonymous laboratory working with primary human foetal material--this article documents the possibility of regulatory regress and strategies aimed at its closure.

Department of Health and Human Services. Patient Protection and Affordable Care Act; standards related to essential health benefits, actuarial value and accreditation. Final rule

This final rule sets forth standards for health insurance issuers consistent with title I of the Patient Protection and Affordable Care Act, as amended by the Health Care and Education Reconciliation Act of 2010, referred to collectively as the Affordable Care Act. Specifically, this final rule outlines Exchange and issuer standards related to coverage of essential health benefits and actuarial value. This rule also finalizes a timeline for qualified health plans to be accredited in Federally-facilitated Exchanges and amends regulations providing an application process for the recognition of additional accrediting entities for purposes of certification of qualified health plans.

The many cases of XFJ: suitable to drive a taxi or "killer cabbie"?

For 10 years, the refugee now known by the pseudonym XFJ attempted to gain accreditation to drive a taxi-cab. After many internal reviews and rejections by the Victorian Taxi Directorate, XFJ appealed to the Victorian Civil and Administrative Tribunal (VCAT). The difficulty for XFJ was that shortly after arriving in Australia, he had killed his estranged wife. The Supreme Court of Victoria subsequently found him not guilty of murder on the grounds of insanity. Since XFJ's mental health has been stable for many years, much of the legal argument at VCAT and the court cases that followed centred around whether he was "suitable in other respects to provide the service" of driving a taxi, as required by s 169(1)(b)(ii) of the Transport Act 1983 (Vic). This article looks at the tension between the expert medical evidence and the concept of "suitable in other respects" which XFJ's opponents claimed included the maintenance of public confidence and the meeting of community expectations.

Department of Health and Human Services. Patient protection and Affordable Care Act; data collection to support standards related to essential health benefits; recognition of entities for the accreditation of qualified health plans. Final rule

This final rule establishes data collection standards necessary to implement aspects of section 1302 of the Patient Protection and Affordable Care Act (Affordable Care Act), which directs the Secretary of Health and Human Services to define essential health benefits. This final rule outlines the data on applicable plans to be collected from certain issuers to support the definition of essential health benefits. This final rule also establishes a process for the recognition of accrediting entities for purposes of certification of qualified health plans.

Factors associated with intern noncompliance with the 2003 Accreditation Council for Graduate Medical Education's 30-hour duty period requirement

BACKGROUND

In 2003 the Accreditation Council for Graduate Medical Education mandated work hour restrictions. Violations can results in a residency program being cited or placed on probation. Recurrent violations could results in loss of accreditation. We wanted to determine specific intern and workload factors associated with violation of a specific mandate, the 30-hour duty period requirement.

METHODS

Retrospective review of interns' performance against the 30-hour duty period requirement during inpatient ward rotations at a pediatric residency program between June 24, 2008 and June 23, 2009. The analytical plan included both univariate and multivariable logistic regression analyses.

RESULTS

Twenty of the 26 (77%) interns had 80 self-reported episodes of continuous work hours greater than 30 hours. In multivariable analysis, noncompliance was inversely associated with the number of prior inpatient rotations (odds ratio: 0.49, 95% confidence interval (0.38, 0.64) per rotation) but directly associated with the total number of patients (odds ratio: 1.30 (1.10, 1.53) per additional patient). The number of admissions on-call, number of admissions after midnight and number of discharges post-call were not significantly associated with noncompliance. The level of noncompliance also varied significantly between interns after accounting for intern experience and workload factors. Subject to limitations in statistical power, we were unable to identify specific intern characteristics, such as demographic variables or examination scores, which account for the variation in noncompliance between interns.

CONCLUSIONS

Both intern and workload factors were associated with pediatric intern noncompliance with the 30-hour duty period requirement during inpatient ward rotations. Residency programs must develop information systems to understand the individual and experience factors associated with noncompliance and implement appropriate interventions to ensure compliance with the duty hour regulations.

Certification of TB culture and drug susceptibility testing laboratories through the Revised National Tuberculosis Control Programme (RNTCP)

The RNTCP is implementing the Programmatic Management of Drug Resistant Tuberculosis (PMDT) for detecting and treating drug resistant tuberculosis (DR-TB). Diagnostic services for DR-TB is provided through a network of RNTCP certified Culture and Drug Susceptibility Testing (C&DST) laboratories.This paper describes about the process involved in certification of C&DST laboratories for different technologies used in RNTCP.

Discussions and implications of the recent enactment & revision of the healthcare law

Recently, there have been many changes in the area of healthcare. There is no certainty how these changes will affect the healthcare system and public health. However, to at least have these changes positively implemented, it is clear that evaluation through continuous monitoring is necessary. The enforcement of the Medical Institution Accreditation and Medical Dispute Mediation Law as well as legal revisions regarding the public healthcare system are changes to improve the quality of healthcare, while at the same time, provide penalties for infractions of the new law such as medicine/medical device rebates; moreover, legal revisions regarding telemedicine are anticipated to impartially vitalize technical development as well as the pharmaceutical industry. For these changes to have a positive effect on the medical field and people's lives, an accurate comprehension of the system and understanding of the details is necessary to be able to respond sensitively to any changes in the future. Therefore, this paper examined the background information on the current discussion on the changes in the healthcare system, examined the detailed content of the system, and reviewed the areas that were in dispute as well as the main issues to contemplate the expected effects of the changes and future tasks that may be generated as a result. These considerations will act as foundation for an in depth understanding of recent trends in the healthcare system.

Establishment, present condition, and developmental direction of the new Korean healthcare accreditation system

On July 23rd, 2010 a revised medical law (Article 58) was passed to change existing evaluation system of medical institutions to an accreditation system. The new healthcare accreditation system was introduced to encourage medical institutions to work voluntarily and continuously to improve patient safety and medical service quality. Changes regarding the healthcare accreditation system included the establishment of an accreditation agency, the voluntary participation of medical institutions, accreditation standards centering on the treatment process and patient safety, tracing methodology, and the announcement of comprehensive results concerning accreditation. Despite varying views on the healthcare accreditation system, including some that are critical, it is meaningful that the voluntary nature of the system acknowledges that the medical institutions must be active agents in improving medical service quality. Healthcare quality is not improved instantaneously, but instead gradually through continuous communication within the clinical field. For this accreditation system to be successful, followings are essential: the accreditation agency becomes financially independent and is managed efficiently, the autonomy and regulation surrounding the system are balanced, the professionalism of the system is ensured, and the medical field plays an active role in the operation of the system.

The implications of the ADA Amendments Act of 2008 for residency training program administration

The Americans with Disabilities Act (ADA) is rarely invoked by medical residents in training. Dr. Martin Jakubowski, a family medicine resident with Asperger's disorder, was dismissed for communicating poorly with patients, peers, and supervisors and for issuing dangerous medical orders. In an attempt to become reinstated, he sued under the ADA (Jakubowski v. The Christ Hospital), arguing that the program had failed to make reasonable accommodation for his disability. The Sixth Circuit Court of Appeals ruled in favor of the hospital, finding that although the doctor was disabled under the ADA, he had failed to demonstrate that he was otherwise qualified for the position. This article comments on the ADA Amendments Act of 2008, the Equal Employment Opportunity Commission (EEOC) guidelines from 2011 and their application to medical residency training, and the Accreditation Council for Graduate Medical Education (ACGME) core competencies as essential job functions.

TRICARE: certified mental health counselors. Interim final rule

This rule is submitted as an interim final rule (IFR) in order to meet the Congressional requirement set forth in the National Defense Authorization Act (NDAA) for Fiscal Year (FY) 2011, Section 724, which required the Department of Defense to prescribe regulations by June 20, 2011, to establish the criteria, as had previously been studied in accordance with Section 717 of the NDAA 2008, that would allow licensed or certified mental health counselors to be able to independently provide care to TRICARE beneficiaries and receive payment for those services. Under current TRICARE requirements, mental health counselors (MHCs) are authorized to practice only with physician referral and supervision. This interim final rule establishes a transition period to phase out the requirement for physician referral and supervision for MHCs and to create a new category of allied health professionals, to be known as certified mental health counselors (CMHCs), who will be authorized to practice independently under TRICARE. During this transition period the MHCs who do not meet the requirements for independent practice as established in this rule, may continue to provide services to TRICARE beneficiaries under the requirements of physician referral and ongoing supervision. This transition period, ending December 31, 2014, will allow time for those MHCs who seek to continue providing services under the TRICARE program to meet the independent practice requirements as outlined in this notice. After December 31, 2014, the Department of Defense will no longer recognize those mental health counselors who do not meet the criteria for a CMHC and will no longer allow them to provide services even upon the referral and supervision of a physician.

Reforming undergraduate dental education in India: introducing a credits and semester system

To make higher education in India more dynamic and responsive to a fast-developing society and its aspirations, there has been widespread recognition of a need for reform. Among the proposed changes, expert committees and the National Knowledge Commission have recommended the introduction of a credits and semester system starting in undergraduate education. Technical institutions and some universities have already adopted this system. The country's dental schools are beginning to consider such a change, which would bring them more into alignment with the structure of dental education in North America and many countries in other parts of the world. Since dental schools in most developed countries follow a quarter/semester system, there is much evidence of the merits of such a system for dental education. After providing an overview of the present curriculum structure of dental education in India and the national move toward reform, this article presents the case for a new credits and semester system for undergraduate dental education in India.