1 / 16

Health Care Quality & Safety February 26, 2013

Health Care Quality & Safety February 26, 2013. Thomas E. Hamilton, Director Survey & Certification Group Centers for Medicare & Medicaid Services Essential Role of Territorial Leadership. Medicare & Medicaid Participation is … Conditional. Conditions of Participation (CoPs)

lei
Download Presentation

Health Care Quality & Safety February 26, 2013

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Health Care Quality & Safety February 26, 2013 Thomas E. Hamilton, Director Survey & Certification Group Centers for Medicare & Medicaid Services Essential Role of Territorial Leadership

  2. Medicare & Medicaid Participation is … Conditional • Conditions of Participation (CoPs) • Hospitals … 42 CFR 482 • Nursing Homes … 42 CFR 483 • Dialysis Facilities … 42 CFR 494 • Ambulatory Surgical Centers … 42 CFR 416 • Clinical Laboratories … 42 CFR 493 • Essential Quality of Care & Safety Requirements • Governance • Staffing and Credentialing • Practice Standards – safe environment, informed patients, … • QAPI – Internal Quality Assessment + Performance Improvement

  3. Why Survey &Certification?? • Quality Assurance - Medicare + Parts of Medicaid • 200,000 Providers, 100,000 Onsite Surveys + Investigations - 7,000 Surveyors

  4. Clinical Laboratories Test TypeDesirable Range • Creatinine …. (0.5 - 1.6) • Uric Acid ……. (3.5 – 8.4) • Calcium …….. (8.6 – 10.6) • Albumin ……... (3.7 – 5.2) • Globulin …….. (1.4 – 4.5)

  5. Health Care – What Could Possibly Go Wrong?

  6. Up, Up, and Awry!! • Wrong Site Surgeries • Healthcare-Associated Infections • Medication Errors … Complications “If your remember, I did say there might be side effects…”

  7. Today’s Health Care • Highly Complex and Sophisticated • More Dependent on … Teamwork • Performed by … Human Beings • “To Err is Human” – Institute of Medicine • Human Factors Engineering • Focus on the System

  8. What Might Governors Do? • Hospital Governance • Leadership + Management • Finance • Funding • Local Funds • Medicaid Matching Funds • Medicaid Certified Public Expenditures • Medicaid Expansion • Billing Systems • Coding Systems (e.g., Medicare coding) • Private Insurance

  9. Is Your Board Sending the Wrong Signals ?

  10. Keeping Informed Systems – Require Regular Reporting on: • Hospital Finances, Billing, Liabilities • Quality (e.g., Check the CMS “Compare” websites) • Involvement in National Initiatives – Examples: • Value-Based Purchasing • http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/hospital-value-based-purchasing/index.html?redirect=/hospital-value-based-purchasing/ • Partnership for Patients • http://innovation.cms.gov/initiatives/Partnership-for-Patients/ • http://hret-hen.org/ • Institute for Healthcare Improvement • http://www.ihi.org

  11. Keeping Informed With 4. Governance + Leadership • http://www.governanceinstitute.com Welcome the Bad News Bearers • To Avoid becoming a Bad News Bear • QAPI 5. CMS and Accrediting Organization Surveys • Instruct Providers to Alert You on Every Survey • Immediate Jeopardy – 23 Days to Medicare Termination • “Condition” Level Deficiency – 90 Days + Onsite Revisit • Other “Standard” Level Deficiencies – Plan of Correction

  12. Thank You • Attention to Health Care Quality • Attention to Access to Health Care • Efforts to Expand both Access + Quality

More Related