Joint Commission: Palliative care should be open to all; first certifications announced

Joint Commission: Palliative care should be open to all; first certifications announced:

As interest in palliative care grows among the public and the healthcare profession, The Joint Commission has acknowledged the field's importance by creating a new recognition program. Hospitals that demonstrate a focus on patient-centered inpatient care during all stages of a serious illness can now apply to receive The Joint Commission's Advanced Certification for Palliative Care.

The Joint Commission yesterday announced its first palliative care certifications to five hospitals: Regions Hospital in St. Paul, Minn.; Strong Memorial Hospital in Rochester, N.Y.; Mt. Sinai Medical Center in New York City; St. Joseph Mercy Oakland in Pontiac, Mich.; and Connecticut Hospice, Inc., in Branford.

Palliative care is the field of medicine dedicated to improving patients' quality of life by focusing on pain control, symptom management and stress relief. This treatment model is designed for patients of all ages at any stage of a serious illness.

Michele Sacco, executive director of palliative care certification at The Joint Commission, hopes the certification program will clear up some misconceptions about palliative care while inspiring hospitals to formalize policies for good care they may be providing already.

"Palliative care is not synonymous with hospice care for the terminally ill," Sacco told FierceHealthcare. "We think hospitals should make palliative care available to any patient with any diagnosis of a serious illness, regardless of prognosis." Even providers may not always understand the distinction between palliative care and hospice, though awareness is growing, she said.

According to David Eickemeyer, associate director of certification at The Joint Commission, hospital interest in palliative care certification has been high. "We thought the program would take longer than it did to launch, but these five hospitals could receive certification quickly because they have been doing palliative care for a long time," he said in a FierceHealthcare interview.

At Regions Hospital, the palliative care program started in 2005 as an outgrowth of the hospital's hospitalist program. "We developed a systematic but compassionate strategy for the many patients coming in with significant morbidity," Jim Risser, medical director of the Regions palliative care team, told FierceHealthcare. "We felt good about our program and now have had that confirmed by the Joint Commission's outside review."

The Joint Commission has 21 palliative care applications in house from 13 different states, Eickemeyer said. Additionally, he expects 20 more applications in April as part of a Livestrong Foundation grant program that will offer financial assistance to applicants. He estimates that more than 1600 U.S. hospitals currently have palliative care programs

For more information:
- read the Joint Commission's announcement
- see the Joint Commissions certification requirements (.pdf)
- check out the Livestrong Foundation's grant program

Nursing care moving to outpatient model

Nursing care moving to outpatient model:

The number of skilled nursing facilities and nursing homes is on the decline with the introduction of in-home care, which is aimed at cutting costs, according to The New York Times.

Despite the aging population, the number of nursing homes--which have relied heavily on Medicare and Medicaid dollars--has shrunk by almost 350 during the past six years. Meanwhile, the number of in-home nursing programs nationwide has doubled since 2007, from 42 programs in 22 states in 2007 to 84 programs in 29 states today, the article noted.

"It used to be that if you needed some kind of long-term care, the only way you could get that service was in a nursing home, with 24-hour nursing care," Jason A. Helgerson, who directs New York's Medicaid program, told the Times. "That meant we were institutionalizing service for people, many of whom didn't need 24-hour nursing care. If a person can get a service like home healthcare or Meals on Wheels, they can stay in an apartment and thrive in that environment."

The move from institutionalized care, as Helgerson called it, to managed care is one that stems from nationwide initiatives to cut costs while improving care.

In the newer model of care, a team of doctors, social workers, physical and occupational therapists and other specialists provides managed care for patients in the comfort of their own home or at adult day-care centers. Studies indicate that the managed care model can not only save money over the traditional nursing home approach but also improves patient outcomes.

With fixed monthly fees for each participant, center operators of the Program of All-Inclusive Care for the Elderly--better known as PACE--are incentivized to offer preventative care rather than fee-for-service care that have traditionally relied on hospitalizations for payments. The idea is simple: keep patients out of the hospital and save some money and keep the patients happy.

As Gene Lindsey, president and CEO of Atrius Health, noted, managed care with global payments is a "big experiment." As the nation's healthcare system tests out at-home care, adult day center programs and Pioneer Accountable Care Organizations, like Atrius Health, only time will tell if the experiment with work.

For more information:
- read the New York Times special report
- check out the FierceHealthcare interview with Atrius Health

CMS releases Stage 2 Meaningful Use proposals

CMS releases Stage 2 Meaningful Use proposals:
Officials with the Centers for Medicare & Medicaid Services (CMS) and the Office of the National Coordinator for Health IT (ONC) today announced the proposed requirements for Stage 2 Meaningful Use and 2014 certification of electronic health records at the Healthcare Information and Management Systems Society's annual conference in Las Vegas.
The officials said they expected the notices of proposed rulemaking (NPRM) for the two sets of regulations to be published this week in the Federal Register. Following a 60-day comment period, the final rule is scheduled for release this summer.
The Stage 2 Meaningful Use rules and EHR certification standards largely reflect the recommendations made last year by the Health IT Policy Committee and the Health IT Standards Committee, said National Coordinator for Health IT Farzad Mostashari, speaking to an overflow crowd.
The proposed regulations, he said, emphasize the need for greater interoperability among systems and health information exchange. "We can't wait five years to get standards-based exchange," he said. On the Meaningful Use side, this means that organizations will have to exchange data across organizational boundaries and disparate EHRs.
According to Mostashari, other areas that receive enhanced focus in these NPRMs include patient engagement, patient safety and increased flexibility in the design of applications.
Overall, the proposals continue to push both hospitals and physicians to improve quality and efficiency through the use of health IT. "We've stayed the course," Mostashari said. "We're continuing what was in Stage 1 [of Meaningful Use] and making it better."
The proposed Stage 2 regulations will keep some Stage 1 criteria unchanged, revise others, and include new requirements. Some highlights cited include:

• Patients must be given the opportunity to view, download and transmit their medical records online.
• The number of decision support elements that must be used will increase.
• Data must be submitted to public health agencies, where possible.
• Viewing of images will be on the optional menu of criteria.
• Clinical quality measures for Meaningful Use will be aligned with those in other programs that involve quality reporting, including Medicare's Physician Quality Reporting System, the shared savings program for accountable care organizations, medical homes and the Joint Commission's quality program.
• Eligible professionals will be able to report data in batches.
• Physician groups of a certain size can report quality data for their groups.
• Connections to registries will be required, including cancer registries
• CMS will do prospective reporting of "payment adjustments" for those who don't show Meaningful Use by 2015.

On the EHR certification side, some of the proposals included:

• EHRs must include the Direct protocol for secure clinical messaging.
• Vendors will have to begin incorporating standard clinical terminologies into their products. Mostashari cited SNOMED, LOINC, and RXNorm, as examples, but it was unclear whether EHRs must have all of those for 2014 certification. RXNorm for medications must be included, said Steve Posnack, the director of ONC's federal policy division.
• There will be new vendor requirements for usability, partly to give more flexibility to specialists who need "scope of practice" exclusions to meet the Meaningful Use criteria.
• The definition of a certified EHR no longer will be based on meeting 100 percent of a set list of criteria. Instead, the criteria will be revised so that they enable providers to meet the requirements they have chosen to meet for Meaningful Use. That means that specialists who don't use certain aspects of primary care EHRs can qualify for Meaningful Use by using EHRs that are certified to meet the needs of their specialties.
• Beyond satisfying "base EHR" requirements, such as patient demographics, problems, clinical decision support, and computerized physician order entry, EHRs or EHR modules can be certified if they have the capability to help providers achieve the core criteria for their stage of Meaningful Use (with exclusions for specialists) and only those optional menu items that the providers who use those applications have chosen.