JCAHO Revises Standards on Anesthesia, Environment of Care, and Medical Staff

Following through on its intent to become more specific, the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) has revised several standards. As anticipated, the accreditor has taken more care in defining the various levels of sedation and anesthesia along the guidelines of the American Society of Anesthesiologists.

The introduction to the revised anesthesia standards (effective January 1, 2001) now defines the four levels of sedation and anesthesia: minimal sedation, moderate sedation (or conscious sedation), deep sedation, and anesthesia.

But sedation and anesthesia aren't the only areas that the JCAHO has revisited. As of July 1, 2000, facilities will also be required to conduct 50% of their fire drills unannounced, create an incident command system, and reduce the potential for organization-acquired illnesses through revised Environment of Care (EC) standards.

And finally, the Joint Commission has revised the intent of one medical staff standard in the Comprehensive Accreditation Manual for Hospitals (CAMH), MS.8.3, which now more clearly outlines the medical staff's role in the peer review process, effective immediately.

The revised intent clearly states that the medical staff must be involved in designing the peer review process and outlines the components of that process, including: definition of those circumstances, specification of participants in peer review, the method for selecting peer review panels, time frames for peer review, when external peer review is required, and participation in the process by the individual being reviewed.

Number of nonelderly uninsured climbs

The number of nonelderly uninsured grew to 18.4% in 1998, up from 17.3% in 1994, an additional 4.2 million people, according to a study by the Urban Institute published in the July/August issue of Health Affairs. One reason for the increase in the uninsured is a decline in Medicaid coverage, which fell from 10% in 1994 to 8.4% in 1998. Private nongroup coverage dropped from 5.7% in 1994 to 5% in 1998. The increase in the number of uninsured was offset by an increase in employer-sponsored coverage and an increase in the number of insured dependent children. The study reports that employer-sponsored insurance increased by about 6.1 million from 1994 to 1998 and the number of dependent children covered increased by 3.3 million.

Lab Managers Urged to Address Medical Records Privacy

At a recent conference of the Clinical Laboratory Management Association, healthcare consultants and lawyers urged lab managers to enhance the protection of patients' private health information in anticipation of pending rules under the Health Insurance Portability and Accountability Act of 1996 (HIPAA).

"You really need to start thinking about [HIPAA] in terms of how it applies to you...because all labs are communicating information electronically," Joan Logue, a principal at Health System Concepts in Longwood, FL, told attendees of the Anaheim, CA, conference.

A provision of HIPAA requires organizations to designate security officers. Labs having their own security officers "is an option," Bill Christie, director of financial product research at Sunquest Information Systems in Tucson, AZ, said. HIPAA sets minimum levels of protection, and if managers feel their labs have enough transactions, that may warrant security officers, he said.

Act Promotes Electronic Signatures, Protects Consumers

Thanks to legislation that President Clinton signed recently, consumers and healthcare professionals can look forward to more frequent use of electronic signatures. The Electronic Signatures in Global and National Commerce Act (S. 761) also known as "E-sig," eliminates barriers to using technology to sign legally binding documents. Effective October 1, an electronic signature will have the same weight in court as a handwritten signature.

As a result, hospitals can move forward to establish procedures to electronically sign many of the documents that currently require handwritten signatures, said Gwen Hughes, RHIA, a practice manager with the America Health Information Management Association. She offered these examples:

• Patient registration. Prior to arriving for appointments, patients will be able to complete registration forms over the Internet.
  
  
• Death and birth certificates. Physicians can sign them over the Internet.
  
  
• Patient consent forms. Patients can sign consent forms electronically. As a result, health information management professionals would not have to scan the signed forms into a computerized patient record system.
  
  
• Informed consent. Physicians can develop online information Web pages for certain surgeries. Patients could electronically sign the pages, attesting that they understand the content, and e-mail the signatures to physicians. Or, patients could e-mail questions to the physicians from the sites.

HIPAA Infraction Penalties

New fines for fraud, established in conjunction with the Health Insurance Portability and Accountability Act of 1996 (HIPAA), have been publicized by the Office of Inspector General for the Department of Health and Human Services (HHS). The rules were proposed by the HHS in 1998.

The final regulations include increasing fines from $2,000 to $10,000 for improperly billed medical services. Responding to concerns that providers would be fined for honest mistakes, the HHS also decided to penalize providers only if they knew or should have known that a billed item or service was not medically necessary or deliberately ignored or recklessly disregarded such information.

The rule was effective on the publication date, and was posted on the OIG Web site at www.hhs.gov/oig/new.html.

Beware of Insurance Law "Myths," Consultant Warns

Providers would do well not to rely on a set of popular misconceptions about the Health Insurance Portability and Accountability Act of 1996 (HIPAA) coming true, a health information consultant said in late July. Most of those misconceptions have as their basis the belief that HIPAA will go away or that someone else will take care of it, according to Steven Lazarus, Ph.D., FHIMSS, president of the Boundary Information Group in Denver, CO.

Some providers and other healthcare entities affected by HIPAA mistakenly believe that Congress will repeal it under a Republican administration, Lazarus told physicians and others listening to an audio conference sponsored by the Medical Group Management Association, of Englewood, CO. "That's very unlikely," he said. "HIPAA was a bipartisan bill. All major healthcare-related legislation between 1993 and 1996 had the administrative simplification provisions contained in HIPAA," Lazarus said.

The misguided hope for a repeal stems from yet another erroneous notion, that HIPAA is a product of the Clinton era. Lazarus pointed out that the push to draft new health insurance legislation actually began during the Bush administration. Providers should expect to see the pace of implementation of HIPAA regulations pick up or slow down, regardless of who occupies the White House next year, he said.

Finally, businesses must realize that enforcement of HIPAA rules is imminent. People think enforcement is far off "because there is no draft enforcement regulation, but there will be one this year," Lazarus said.

HIPAA Help Online

The Health Care Financing Administration (HCFA) has developed an online resource, www.hcfa.gov/medicaid/HIPAA/default.asp, to explain the Health Insurance Portability and Accountability Act of 1996 (HIPAA) which mandated the creation of regulations that will govern privacy, security, and administrative simplification standards for healthcare information.

HCFA breaks the law into bite-sized pieces and presents it in an easy-to-follow format. Visitors will find pages devoted to particular audiences—consumers, state regulators, large and small employers, and self-funded nonfederal government plans-or around topics, such as the Mental Health Parity Act or Preexisting Conditions. Visitors can also get copies of various statutes, regulations, and HCFA bulletins related to HIPAA.

HCFA's HIPAA site includes links to sites that provide more general HIPAA information, general health care, mental health, and women's issues. At the bottom of the HIPAA center's home page are links titled "Administrative Simplification" and "Electronic Data Interchange (EDI)." Both links will take you to pages that provide a list of links that will yield more information about these subjects.

The American Hospital Association also has launched a new Web page (www.aha.org/hipaa/hipaa_home.asp) designed to inform member hospitals about HIPAA.

Fatal Falls Alert

The Joint Commission on Accreditation of Healthcare Organizations' 14th Sentinel Event Alert highlights risk reduction strategies and root-cause analysis (RCA) findings related to fatal falls. The JCAHO reviewed 22 fatal falls, with 13 deaths occurring in general hospitals, six in long-term care facilities, one in a hospital behavioral health unit, one in a psychiatric hospital, and two in "non-behavioral healthcare organizations." The Alert, however, also reveals that the age of patients involved in fatal falls is more relevant than the actual setting of the sentinel event. More than half of the fatalities involved patients over the age of 80.

One-third of the cases involved falling from a bed, with others while walking, in the bathroom, or from a commode, gurney or chair. One-third of the falls were associated with "extraordinary situations," such as patients falling down stairs, laundry chutes, from upper story windows and from roofs and balconies.

In the RCA information reported to the JCAHO, more than half of the organizations identified communication issues among caregivers as the leading contributor to fatal falls. Some of the recommendations for reducing fatal falls include:

• Install bed alarms or redesign bed alarm checks and tests
• Install self-latching locks on utility rooms
• Restrict window openings
• Install alarms on exit doors
• Add fall prevention education for patients, residents, and their families
• Use "low beds" for those at risk for falls

Influenza Vaccine Production Reduced

The July 14 issue of the Morbidity and Mortality Weekly Report indicates that production of this year's influenza vaccine will be less than anticipated. That may lead to a substantial delay in distribution of the vaccine and possibly fewer total doses than were available last year.

The delays are related to manufacturing compliance problems at two of the four companies that manufacture the vaccine and difficulties reported in producing desired quantities of the virus used in the 2000-01 vaccine.

Last year, approximately 80 million to 85 million doses of the influenza vaccine were distributed. Total doses to be available for 2000-01 isn't yet known, but should be between 40 million and 70 million.

Because of the expected delay and possible shortage of influenza vaccine, the national Centers for Disease Control and Prevention (CDC) is recommending that implementation of organized influenza vaccination campaigns sponsored by healthcare providers and others be postponed until early to mid-November.

Vaccination of high-risk populations should proceed routinely during their regular healthcare visits with the available vaccine. Also, the CDC recommends that healthcare providers develop contingency plans in case a vaccine shortage occurs.