Joint Commission updates network ethics standards
Joint Commission updates network ethics standards
Revisions ensure a more patient-focused approach.
New ethics standards implemented this year by the Joint Commission on Accreditation of Healthcare Organizations are placing greater emphasis on a patient's right to choose and refuse treatment from a managed care organization.
Specifically, the standards will increase health care networks' responsibility for protecting the rights of their patients to choose, and even refuse, medical treatment; require the network to clearly define and implement a process for appealing and resolving patient plan disagreements; and will hold the network responsible for implementing standards at all levels, including individual practitioner sites.
"When we survey the network, we go out and visit its components, hospital, physician's office, etc. and see how they are implementing the network's requirements on them to have ethical business practices," says Carole Patterson, Joint Commission deputy director and acting director for standards. "Occasionally, we will find components that haven't heard of them yet, in which case the network has a communication problem and will be cited for it."
The 1998-2000 edition of the Comprehensive Accreditation Manual for Health Care Networks contains mostly minor revisions but ones that will, hopefully, reinforce the commission's position that the network must act to protect the integrity of the care it provides to patients, Patterson says.
For example, revisions to the language of standard RI 5.1 clarify that this standard, which requires the network to inform patients of the consequences of refusing a certain medical treatment, will be surveyed at any setting where clinical care is rendered. The 1996 manual only required evaluation at the network or component level.
(See chart, p. 106, which summarizes the Joint Commission's network ethics standards and the network levels at which they will be surveyed.)
Another revision to RI 1.3 mandates that network clinical sites and practitioners must provide patients with sufficient information to enable their knowledgeable involvement in clinical decision making.
In other changes, standard RI 1.2 has been revised to include detailed information on the network's responsibility to resolve disagreements between the network and members, including information on members' rights to appeal network decisions.
The network must, specifically, implement a plan for educating members about how to apply for reconsideration of care. An additional bullet to the statement of intent for RI 1.2 now also requires the network to inform patients of their right to refuse treatment.
The revised standards went into effect July 1, 1998, says Patterson. Any network surveyed between July 1, 1998 and July 1, 2000, should follow the standards as outlined in this manual, unless it is announced otherwise in Joint Commission Perspectives, the Joint Commission's official bimonthly newsletter to administrators and chief executives.
One network standard has also made its way into the Joint Commissions' manuals for other health care organizations, notes Patterson: "The standard concerning the integrity of clinical decision making, making sure your physicians are acting in the best interest of the patient (standard RI 1.1). This is known as the 'anti-gag rule standard'. It was originally developed for the network manual, but it was decided that it should be placed in the other manuals as well. Now, it is in all of them."
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