A new compliance reality when disaster strikes
A new compliance reality when disaster strikes
Concentrate on providing safest, best care
Quality managers involved in disaster planning and response should not be overly concerned with following the letter of compliance law if a disaster occurs, says Joe Cappiello, BSN, MA, vice president of accreditation field operations, for the Joint Commission on Accreditation of Healthcare Organizations (JCAHO).
"The emphasis is not so much on the written plan, because it becomes moot in minutes," he notes. "It’s the thoughtful process and communication that goes into the preparation, and the things you learn from drilling that allow you to adapt to situations that present themselves."
A disaster is not the time to wonder if you are in 100% compliance, he continues, "But we still expect that as a facility responds to a particular event there is a thought of how to provide the safest, best care, in the most reasonable environment possible. In the first minutes right after the disaster, when you are looking at survival and preservation of the facility, that’s hard, but when the dust sort of settles and you realize you have a large number of casualties, and you may have to expand to the surge facility outside of the medical center, you have to start thinking of how you can give the best care possible under such circumstances."
Key roles for quality
One of the key roles the quality manager can play, he says, "Is to help keep the ethical, moral, realistic compass pointed in the right direction. Act as a supporter for the staff as they start to think things through."
Government agencies clearly recognize that full compliance is not possible during disasters. Shortly after Katrina hit the Gulf coast, for example, the Centers for Medicare & Medicaid Services (CMS) acted to assure that Medicare, Medicaid, and the State Children’s Health Insurance Program (SCHIP) would flex to accommodate the emergency health care needs of beneficiaries and medical providers in the Hurricane Katrina-devastated states.
Many of the programs’ normal operating procedures were relaxed. For example, CMS announced that:
- Normal licensing requirements for doctors, nurses, and other health care professionals who cross state lines to provide emergency care in stricken areas would be waived as long as the provider was licensed in their home state.
- Health care providers that furnish medical services in good faith but cannot comply with normal program requirements because of Hurricane Katrina would be paid for services provided and would be exempt from sanctions for noncompliance, unless it was discovered that fraud or abuse occurred.
- Crisis services provided to Medicare and Medicaid patients who have been transferred to facilities not certified to participate in the programs would be paid.
- Programs would reimburse facilities for providing dialysis to patients with kidney failure in alternative settings.
- Normal prior authorization and out-of-network requirements also would be waived for enrollees of Medicare, Medicaid, or SCHIP managed care plans.
- Certain HIPAA privacy requirements would be waived so that health care providers could talk to family members about a patient’s condition even if that patient was unable to grant that permission to the provider.
- Hospitals and other facilities could be flexible in billing for beds that have been dedicated to other uses; for example, if a psychiatric unit bed was used for an acute care patient admitted during the crisis.
- Hospital emergency departments would not be held liable under the Emergency Medical Treatment and Labor Act for transferring patients to other facilities for assessment, if the original facility was in the area where a public health emergency had been declared.
In times like these, Cappiello concludes, it’s most important to keep things in perspective. "Just don’t throw the standards away and say all bets are off," he advises. "You still have a moral and ethical responsibility to provide the best possible care given the circumstances."
Quality managers involved in disaster planning and response should not be overly concerned with following the letter of compliance law if a disaster occurs, says Joe Cappiello, BSN, MA, vice president of accreditation field operations, for the Joint Commission on Accreditation of Healthcare Organizations (JCAHO).Subscribe Now for Access
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