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) 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

Why Survey & Certification ?? Quality Assurance - Medicare + Parts of Medicaid 200,000 Providers, 100,000 Onsite Surveys + Investigations - 7,000 Surveyors Hospitals (Acute, Psychiatric, Organ Transplant, Critical Access) Nursing Homes Clinical Laboratories Home Health Dialysis Facilities Hospice Outpatient Physical Therapy Comprehensive Outpatient Rehab. Rural Health Clinics Ambulatory Surgical Centers Organ Procurement (OPOs) ICFs-IID Accrediting Organizations Clinical Laboratories

Test Type Desirable Range Creatinine …. ( ) Uric Acid ……. (3.5 – 8.4) Calcium …….. (8.6 – 10.6) Albumin ……... (3.7 – 5.2) Globulin …….. (1.4 – 4.5)

Health Care – What Could Possibly Go Wrong?

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

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

What Might Governors Do? 1.Hospital Governance 2.Leadership + Management 3.Finance Funding »Local Funds »Medicaid Matching Funds »Medicaid Certified Public Expenditures »Medicaid Expansion Billing Systems »Coding Systems (e.g., Medicare coding) »Private Insurance

Is Your Board Sending the Wrong Signals ?

Keeping Informed Systems – Require Regular Reporting on: 1.Hospital Finances, Billing, Liabilities 2.Quality (e.g., Check the CMS “Compare” websites) 3.Involvement in National Initiatives – Examples: Value-Based Purchasing – Medicare/Quality-Initiatives-Patient-Assessment-Instruments/hospital-value- based-purchasing/index.html?redirect=/hospital-value-based-purchasing/ Partnership for Patients – – Institute for Healthcare Improvement –

Keeping Informed With 4. Governance + Leadership – 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

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