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CMS's Proposed Hospital Staffing Revisions Get Cool Reception

Margaret Dick Tocknell, for HealthLeaders Media, January 3, 2012

A rule proposed by the Centers for Medicare & Medicaid Services to allow changes in the governance structure and medical staffing at hospitals has little support among the more than 100 public comments submitted.

The rule is part of an extensive CMS review of the entire set of conditions for participation (CoP) that hospitals must meet to participate as deemed hospitals in the Medicare and Medicaid programs. CoP requirements have been reviewed and revised on an ad hoc basis, but this is the first time in many years that CMS has undertaken a retrospective review of the CoP.

The proposed revisions fall into several broad categories, including governance, staffing, care plans,  medications, infection control, and transplant organ recovery. Among the specific proposals:

  • Allow one governing body to oversee multiple hospitals in a single healthcare system.
  • Allow hospitals to grant privileges to physicians and non-physicians to practice within their state's scope of practice regardless of whether they are appointed to the hospital's medical staff.
  • Revise nursing services requirements to allow hospitals to develop either a stand-alone nursing care plan or an overall interdisciplinary care plan.
  • Allow hospitals to set up a program so patients or a support person can self-administer hospital-issued medications as well as the patient's own medications brought into the hospital.
  • Eliminate the requirement that a dedicated log of infection incidents be maintained and instead allow hospitals to develop their own tracking systems.
  • Eliminate the blood typing requirement performed by transplant centers before organ recovery takes place.

The comments filed were primarily from individual physicians and nurses. The usual stakeholders also weighed in, including the American Hospital Association, American Nurses Association, and the American Medical Association. Comments were also submitted by the American Telemedicine Association, Catholic Health Initiatives, and the National Kidney Foundation.

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2 comments on "CMS's Proposed Hospital Staffing Revisions Get Cool Reception"

S Bork (1/9/2012 at 7:23 PM)
Amazing in one article it's all about value based purchasing and quality initiatives, then the next article with the real bottom line[INVALID]it's all about expecting better outcomes, but doing with less. Wanting higher quality but then maybe we can pull this off with untrained staff, or u-do-it medicine... Do you really think that eliminating an infection control log already in place is really in the patient's best interest? Or do you think maybe the hospitals "own tracking system" might just turn up different outcomes? Allowing hospitals to develop a "stand alone" nursing care plan is nice that way everyone can have the very same one. Saves money for sure as we won't really have to individualize the care. Why appoint medical staff to the the hospital when we can just throw open the doors and just let everybody operate when they get here? Same with credentialing[INVALID]toss it. You have a license right? Finally I must admit this one tops it all. One million lives lost, the previous focus on medication errors, thousands of articles, regulations, and rules and now just let the patients manage their own medications. I can just wait as they manage the pain medications. Do patients on the vent have to have a family member adjust the settings? Wow, what an amazing bunch of "proposals".

Jenise McGovern-Lowe (1/6/2012 at 10:35 AM)
I am an RN and a risk manager of an acute care hospital. I am opposed to allowing the patient or support person to administer medications. It would be a dangerous practice. A patients stay in the hospital is based off of an illness or event that requires medical intervention. A treatment plan for his illness is individually developed and based off of current illness/injury and concurrent medical history. Alot of information is collected and reported between medical disciplines licensed to make assessmnets. The assessmnet includes the pts. current condition and his reponse to the treatment provided. This requires a controlled environment that includes all of the consistent routines and any variables. Medication administration has to be a consistent routine and the patients response has a large role in the resolution of the illness, the discharge plan and hospital length of stay. There is a safety risk to the patient and the nurse if she/he were asked to make these medical assessments based off of only half of what she/he is sure of.