1997.12.19: New Results-Oriented Medicare Rules Proposed for Hospitals

This is an archive page. The links are no longer being updated.

Date: Friday, December 19, 1997
FOR IMMEDIATE RELEASE
Contact: HCFA Press Office (202) 690-6145

NEW RESULTS-ORIENTED MEDICARE RULES PROPOSED FOR HOSPITALS

HHS Secretary Donna E. Shalala today announced proposed new rules for hospitals to help ensure the health and safety of Medicare and Medicaid beneficiaries, while eliminating many unnecessary administrative requirements in present regulations.

The proposed new rules will reform the "conditions of participation" that are used to determine a hospital's eligibility to participate in the Medicare and Medicaid programs.

"We are doing away with old requirements that focused on process rather than results, and instead we're telling hospitals they must monitor the quality of care they provide, improve that quality, and document that improvement," said Secretary Shalala.

The new regulations also include new proposals to ensure that hospitals and organ procurement organizations work collaboratively to avoid missing opportunities for organ donation.

The new conditions of participation focus on four areas:

Patient Assessment They require that new patients receive comprehensive assessment of their needs and written plans of care;

Quality Assessment They require hospitals to monitor the quality of care they provide in an objective way, focusing on things like patient satisfaction and medication errors;

Patient Rights They require hospitals to notify patients of their rights to: file grievances; have advance directives followed; participate in developing and implementing care plans; be free from verbal and physical abuse; and have privacy and confidentiality protected.

Performance Improvement They require hospitals to enact systematic plans for improving the quality of care, and to demonstrate that they are improving that quality.

Old rules that focused on whether hospitals had systems and procedures in place are being revised or eliminated, and replaced with rules that focus on the actual care delivered to patients, the hospital's overall performance, and the impact of hospital treatment on patients' health status. The new rules retain detailed requirements about how things must be done only where they are essential for patient health and safety. For example, the requirement that patients receive medications appropriately as prescribed remains basically unchanged.

"Our new system focuses on the actual care hospitals provide as the way to judge and improve quality, rather than bureaucratic rules and enforcement that focused on whether providers had required structures and procedures in place," said Nancy-Ann Min DeParle, administrator of the Health Care Financing Administration, which runs Medicare and Medicaid.

The new rules also consolidate and streamline old regulations in several areas. For example, they make clear that a hospital's governing body is responsible for the management, provision of care and compliance with the conditions of participation, but drop requirements on how the governing body must be structured. They consolidate requirements on staff qualifications, and eliminate rules that dictate medical staff organization and composition. And they update record system requirements to better reflect increasing automation and integration of patient care data, and to support quality assessment and improvement.

The new rules also allow Medicare and Medicaid payments to be cut off if a hospital refuses to permit examination of its facilities, operations, or records by state or federal investigators.

Other new requirements are aimed at enhancing hospitals' relationships with organ procurement organizations in order to encourage organ donation. They require:

that hospitals collaborate with organ procurement organizations (OPOs) to increase the identification of potential donors;

that hospitals collaborate with OPOs on how best to approach families to ask consent for organ donation

that hospitals which perform transplants report transplant data to HHS, the Organ Procurement and Transplant Network, and the Scientific Registry.

The organ donation provisions are intended to ensure that hospitals identify those deaths which might result in organ donation, so that families can be ensured the opportunity to donate. A new National Organ and Tissue Donation Initiative was launched by Vice President Al Gore and Secretary Shalala on Dec. 15., and the new Medicare requirements are one part of the initiative.

The proposed rules are published in today's Federal Register. Public comments will be accepted for 60 days and considered before final rules are enacted.

###

Note: HHS press releases are available on the World Wide Web at: www.dhhs.gov.