The Breakthrough In CoP By The Recent CMS Updates- Know All The Inside Reforms For 2019

The Breakthrough In CoP By The Recent CMS Updates- Know All The Inside Reforms For 2019


The Centers for Medicare and Medicaid updates for the new CoP standards which will come into effect in January of 2019.  

Recently, there were numerous updates made by CMS in the healthcare industry. The Medicare program has updated and eliminated various reforms for a better patient care atmosphere in a hospital. Consequently, Conditions of Participation (CoP) has also been updated by CMS.  The published finalized plan for the CY 2019-20 was in the limelight as Centers for Medicare and Medicaid reformed several CoP standards and regulations.

Why are the CoP updates important in healthcare? – In order to receive financial backing from the Medicare and Medicaid programs, the healthcare organizations must follow and include themselves in the stated standards. Hospitals and other associations are required to comply with CMS and for that it mandatory for them to meet the CoP requirements. 

CoP background

CoP was first established from the consideration that various hospitals and healthcare organizations were out of reach of the Joint Commission accredited program. Therefore the Medicare legislation created a program under the federal law where hospitals and other healthcare providers can volunteer consequently. This was done to include those facilities which were still deprived of the benefits of the Medicare program.

The OCR initiates to publish the updated CoP in the federal register and then CMS publishes it in the interpretive guidelines. These changes are made in respect to the Hospital Improvement Rule, plans of care and staff policy changes by the CMS.

Conditions of Participation (CoP) standards are chiefly the rules within which an entity is governed for participating in the activities of the Medicare and Medicaid program. CoP standards are first published in the federal register, and then CMS publishes the interpretive guidelines. CMS updates CoP a few times a year regarding various alterations in surveys and certification memos. The updates are mandatory to be followed by all the nurse practitioners and other medical staff of every organization.

Over the revision, CoP has updated various steps and margins within which a registered nurse can act. The new standards also determine the detailed contributions of the nursing staff in patient care. CMS has changed the way nurses interact with the patients, and it has also impacted the patient-nurse relationship profoundly.

Recent updates by CMS

The new changes are currently affecting more than 13,000 home health agencies (HHA) under the Medicare program. If the healthcare agencies want to get reimbursed for treating Medicaid and Medicare patients, then they must consider and comprehend the new changes stated below:-

  • Updates in the facilities accredited by the Joint Commission, Health Care Facility Accreditation Program, CIHQ, and DNV Healthcare.
  • CMS has also issued the revised memos related to privacy and confidentiality, humidity, an insulin pen, and practice memo.
  • Various changes have also been made to IV medications, safe injection practices, restraint reporting, soft wrist restraints as well as standing reports.
  • The proposed changes also include discharge planning, infection control worksheet, and the final worksheet on QAPI.
  • The modernized lists illustrate that Quality Assessment and Performance Improvement (QAPI) must create and follow system to plan, assess, scrutinize and regularly report the outcome data.
  • The most significant change made was in regards to the significance of updating the care plan assessment system. Earlier, the nurse practitioners would only consult the physicians and then modify the documents. But after the 2019 updates by CMS, it is a mandatory step for hospitals to update the patients’ records and the documents, whether good or bad, regularly and systematically.

The Outdated and Updated changes in Condition of Participation

1. Bulging out exhausted systems

The last time CMS updated the guidelines of CoP was more than 30 years ago. It was a much-awaited change in the industry; the reason being an exalting increase in the percentage of patients' receiving home healthcare. Therefore, the changes in the policies and regulations were implemented to serve patients with the latest medical care plan requirements and to eliminate the used-up policies from the hospital environment.

2. Incompetent use of paper-based HHA system

CMS has made it impractical today to use the paper-based system in the hospitals which were being incessantly used from the last 30 years. The efficient use of electronic health record (EHR) in the organization will be beneficial for the Nurse Practitioners together with the members of the interdisciplinary care team.

The updated alterations by CoP will help the practitioners to document, allocate, and capture the assessment information of the patients as well as the relevant drugs.

3. Need for refinement in the Patient Driven Groupings Model (PDGM)

PGDM is not new in the industry but a reformed model of Home Health Groupings Model (HHGS) which was proposed and then dropped by CMS in 2017. The latest proposed model is subjected to cut down and halves the 60-day unit program to a 30-day program which is a remarkable change made by CMS.

The object behind it was to curb the cost of care and amplify the value of care.  The Medicare program has reformed interpretive guidelines for CoP by making significant changes in the model.

4. Required removal of two Outcomes and Assessment Information Set (OASIS) based measures

The program has decided to remove “influenza Immunization Received for Current Flu Season” measure and the “Pneumococcal Polysaccharide Vaccine Ever Received” measure from the Home Health Value-Based Purchasing Model.

5. Inadequate Nurse Staff

The main agenda behind updating cop standards besides serving patients was to ease up the burden of nurse practitioners and other medical practitioners through organized and efficient regulatory rules. A new study revealed that the shortage in nurse staffing has directly increased the patient mortality rate by 7%.  Therefore, it has been estimated that by 2020, there will be increased by 80% to balance the nurse-patient ratio.

To summarize it all, the latest updates are vital for the medical practitioners as well as the related hospitals to meticulously follow and inculcate the latest CoP standards to be in compliance with the Medicare program and HIPAA.

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