The Mihalik Blog

Joint Commission Update

I’m taking a brief hiatus from blogging while Michael Alcenius fills you in on some changes with Joint Commission standards.  I’ve known Michael for many years—since he and I both worked at the Joint Commission in the Department of Standards in the early 1990’s.  Michael held a number of positions with the Joint Commission over the years but now, he’s in the private sector applying his standards knowledge in another way.  Without further delay, here’s Michael…

I attended the recent JCAHO Executive Briefings in Garden Grove, CA and walked away with a fairly thorough understanding of what to expect in the years to come.  The standards-based agenda addressed upcoming changes for 2008 and also touched on real and potential updates for 2009.  In addition, faculty touched on changes in the Joint Commission Leadership, survey process, and Manual organization.  In a nutshell, here we go….

·        The corporate name “Joint Commission on Accreditation of Healthcare Organizations” has been shortened to “The Joint Commission.”

·        JAYCO (the JCAHO extranet site) has been renamed - The Joint Commission Connect.

·        Dr. Mark Chassin, MD is replacing the retiring (retiring from his position, not referring to his personality) Dr. O’Leary as president in 2008.

·        A standards improvement initiative is once again “reorganizing, clarifying, and refining” standards and “simplifying” scoring.

·        Strategic Surveillance System (S3) – A performance based risk assessment will be accessible on the secure extranet site as of mid year.  Though not required, it is a good tool for focusing improvement efforts.  Surveyors do not have access to the tool.  There is no additional cost and it does not impact your accreditation decision in any way.

·        The automated sentinel event reporting system available January 2007 is now mandatory.

·        A Life Safety Code Specialist surveyor will be added to all hospital surveys in 2008 for one day unless square footage is over 750,000 – in that situation, 2 days.

·        Currently, an unannounced survey can occur anytime within the year that it is due.  In the future it will occur 18 to 39 months after the previous full survey.  Labs will have a 12 to 24 month window.  Poorer performing organizations will be surveyed earlier.

·        I suggest you develop a “ready to go” binder or box.  Designate backups for leadership if not available.

·        Also, make sure you verify the identity of your surveyors on your extranet site when they show up.

Next time I’ll get to the standards-based issues, so stay tuned.

Michael Alcenius, CPHQ

Director - Quality and Risk Management

Lovelace Westside Hospital

Albuquerque, NM

End Results System

It’s been nearly 100 years since Ernest Codman publicized his “End Results System” in which he advocated that physicians and hospitals should publicize the results of their patient care activities so that patients would have a rational basis for selecting physicians and hospitals. Although implementing the End Results System was one of the reasons for the founding of the American College of Surgeons, what was eventually developed was the “hospital standardization program” which focused on structure and process and not on performance.

I thought of this yesterday as I taught NCQA’s educational program on Physician and Hospital Quality (to be repeated in October in Phoenix).  After nearly 100 years, Codman’s idea is finally coming to fruition. 

By the end of the year, approximately 40 health plans will have been surveyed under NCQA’s voluntary standards for Physician and Hospital Quality, part of its Quality Plus initiative.  The other components of Quality Plus: Care Management and Health Improvement and Member Connections have been integrated into the Health Plan accreditation standards. 

The extent to which the physician and hospital performance data will actually be used by consumers is unknown but the early results aren’t encouraging.  One of the participants indicated that her million-member health plan saw only 35 hits on the physician performance reporting page of its website in the first eight months of this year! 

While we may not yet have figured out how to increase use of the available data, and while the measures themselves are currently evolving rapidly, it’s all part of the learning curve. 

A bit of advice for those of you considering applying for distinction in Physician and Hospital Quality:  Promote NCQA’s Physician Recognition Programs for Diabetes, Heart/Stroke, and Physician Practice Connections.  Doing so gets you automatic credit for a slew of the PHQ standards.  If you need assistance in getting ready for a PHQ survey, just email me. 

Potpourri: DM, CM, and a Great Restaurant

Most of the time the topics for my columns draw from whatever projects I’m involved in at the time.  At this point I’m preparing to teach a number of NCQA education programs including: Physician and Hospital Quality, in both the DC area and Phoenix; Quality Plus; and Introduction to NCQA Accreditation for MCOs and MBHOs.

I’m also working on helping several organizations prepare for Disease Management Accreditation, in addition to my usual activities which include accreditation preparation for MCOs and MBHOs, and Quality Improvement consultation. 

Having buried my head in NCQA’s Disease Management standards for weeks now, I have a few thoughts about preparation activities. 

There are a number of elements where the required data sources for the survey are reports or materials.  However, organizations would benefit from having corresponding policies and procedures—what NCQA calls a documented process—in addition to the reports and materials.  Examples of elements where I think that a documented process adds value to the preparation activities include SY 3A, SY 3B, and SY 3C.  These elements relate to Patient Information for Patients, Practitioners, and Clients, respectively.  SY 5A, Reviewing Services and Data to identify opportunities to improve patient safety is another one.  A written process for Identifying Special Needs Patients, OP 3A, is also a very good idea.

 

To keep all this information organized, I recommend that the work plan include specific tasks for each data source for each element.  Doing this will make it less likely that a data source will be forgotten.  I’ve attached an example of a work plan that will also enable you to keep track of your potential overall score by updating your score for each element on an ongoing basis.  Excel will automatically calculate the “Potential Score” by multiplying the “Point Value” by the “Score.”

On a different note, I continue to hear plans, especially smaller plans, voice concerns about the resources required to come into compliance with the Web-based requirements in the 2007 MCO standards.  If you’re feeling the pinch, you’re not alone.  Over the next few months I hope to include some suggestions of cost-effective ways to address some of these standards.  If you have any ideas you would like to share please use the blog’s feedback function or send me an email. 

Finally, on a totally different note.  I had the opportunity to return to one of my favorite restaurants, Bari Ristorante e Enoteca in Memphis.  The food is sophisticated and delicious.  The service is friendly and efficient.  The overall atmosphere is comfortable and welcoming.  I only regret that I had three evenings for dinner in Memphis —each of them at Bari!!

Less Work—More Work

In the last column, I described some of the major changes for PPOs resulting from NCQA’s change to a single set of Health Plan Accreditation standards and guidelines.

One of the big advantages of the move to a single program is that, for most of the standards, a PPO plan can be reviewed using the same ISS tool as an MCO plan if both plans are administered the same.  This is a significant improvement in preparation time.

In the “more work” column however, is the elimination of credit for URAC accredited PPOs by 2009.

Through the 2008 standards year, a PPO that holds full accreditation from URAC at the time of its NCQA Accreditation Survey under the standards for the Accreditation of PPO Plans gets a score of 100% on a number of standards without any evaluation by the NCQA survey team.

Full credit is given for all elements of the following standards:

UM 1: Utilization Management Structure

UM 2: Clinical Criteria for UM Decisions

UM 3: Communication Services

UM 4: Appropriate Professionals

UM 5: Timeliness of UM Decisions

UM 6: Clinical Information

UM 7: Denial Notices

UM 15: Delegation of UM (for delegation agreements in place at the time of the URAC review)

If you have particular topics of interest that you’d like me to address, just send me an email. 

The Future is Here: MCO and PPO Accreditation Combined

I know that a number of recent columns have focused on NCQA’s upcoming standards changes.  This one continues the trend with news that will be of particular interest to PPOs and to organizations that currently have separate MCO and PPO accreditations.

NCQA has retired its PPO and MCO Standards and Guidelines and replaced the two manuals and accreditation programs with a single one!

In a prior column I outlined some of the major changes for MCOs for 2007 and promised to discuss 2008.  Some of the 2008 changes were highlighted in two recent columns that you can find here and here.

The focus of this column is the effect the 2008 standards will have on PPOs. 

NCQA has added a number of new standards to the PPO program, including:

§         QI 7: Complex Case Management

§         QI 8: Disease Management

§         QI 9: Clinical Practice Guidelines

§         QI 11: Continuity and Coordination Between Medical and Behavioral Healthcare

§         QI 12: Medical Records

§         CR 6: Practitioner Site Visits

§         MEM 7: Health Information Line

§         MEM 8: Encouraging Wellness and Prevention

New elements to existing PPO standards include:

§         QI 4, Element C: SCP Availability

§         QI 4, Element D: BHP Availability

§         QI 10: Element A: Opportunities for Improvement in Continuity and Coordination of Medical Care

§         QI 10, Element B: Notification of PCP Termination

§         UM 4, Element C: Practitioner Review of Non-BH Denials

§         UM 4, Element D: Practitioner Review of BH Denials

§         UM 4, Element F: Affirmative Statement About Incentives

Also for 2008, PPOs are required to submit HEDIS and CAHPS data.  With the increase in the number of measures, HEDIS and CAHPS account for nearly 40% of the accreditation outcome, with higher percentages to come in the future. 

There have been a host of other changes to the existing standards, some of which I’ll highlight in future columns.