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View All ProductsHealthStream leverages medical professional development in healthcare by providing staff training programs
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Learn MoreIn 2017, 37% of U.S. healthcare spending, estimated to be $3.5 trillion, or $10,739 per benefiÂciary, could be attributed to Medicare or Medicaid—a largÂer share than the 34% covered by private health insurance (CMS, 2018). It is no wonder that the federal government has established standards that must be met to qualify for inclusion and reimbursement under these public healthcare programs.
The purpose of the article from which this blog post excerpt is taken is to define the Conditions of Participation (CoPs) and to examine new ways healthcare organizations can use assessments and training from HealthStream to ensure staff understand and are adhering to policies that support compliance.
Let’s look at a hypothetical case demonstrating what’s at stake in CoPs compliance. A mid-sized, 250-bed hospital in an urban area has just undergone a CMS survey; this organization derives about 70 percent of its annual revenue from Medicare and Medicaid patients. Hospitals are required to be compliant with the Federal requirements set forth in the Medicare Conditions of Participation in order to receive payments from Medicare and Medicaid (42 CFR Part 482). The survey team is made up of at least one RN and others with expertise to determine compliance. Each specific Standard is assigned to one member of the survey team.
In addition to reviewing documentation, surveyors observe staff behavior and conduct staff interviews. They also interview patients and caregivers. The surveyor assigned §482.13 Condition of Participation: Patient’s Rights (which should be coordinated by one surveyor with all others assessing for compliance as part of their assignment) reviews the organization’s policy. She discovers that the policy is vague and has no original creation date, nor a review date. Furthermore, in interviewing several patients and caregivers, she finds that they are unable to tell her what the hospital has told them about their rights. Upon further interviewing, she notes that patients are unfamiliar with how to file a grievance.
These findings will be included as part of the Exit Conference. The organization is informed it will receive a “statement of deficiencies” (Form CMS 2567) within 10 working days. The document specifies the deficiencies and what the organization is doing to remedy them. In addition, the organization is informed that the results are made public within 90 days. Following receipt of the written report, the organization must submit a corrective plan within 10 days that is approved by the State agency or CMS regional office. Each organization will have a unique plan, which must address its survey findings. Failure to submit an acceptable plan of correction, including reasonable time period, may result in termination of the provider.
This is just one example of how an organization’s failure to comply with the Conditions of Participation can negatively impact an organization’s bottom line and put the source of a majority of its care reimbursement in jeopardy.
This blog post is the first in a series excerpting the HealthStream article, Using Assessments and Training to Improve Conditions of Participation, by Debbie Newsholme, Senior Director of Content Development and Compliance Solutions, HealthStream. This article also includes:
HealthStream’s learning management system and comprehensive suite of competency management tools empower your healthcare workforce to deliver the best patient care.
View All Learning & PerformanceHealthStream offers performance learning management solutions to help develop your healthcare staff into leaders and reduce turnover.
View All ProductsHealthStream works with healthcare organizations to create engaging and high-quality training videos for your staff and management.
View All ProductsImprove care quality and save money by making informed decisions about your healthcare facility and staff with HealthStream's reporting analytics solution.
View All ProductsHealthStream's proven methods for the improvement and overall engagement of your healthcare staff foster a positive workplace and increase retention rates.
View All ProductsWhen you enact HealthStream's quality compliance solutions, you can do so with the confidence your healthcare organization will meet all standards of care.
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View All ProductsDevelop next-level people for next-level care by prioritizing quality and safety improvements.
View All ProductsStandardize policy and procedure management with an automated, customized, and centralized system.
View All ProductsEstablish a culture of belonging with education supporting DEI, wellness, engagement, and leadership development.
View All ProductsHealthStream offers professional training and education on how to best optimize your reimbursement process within your healthcare organization.
View All ReimbursementStreamline the revenue cycle management process and protect your bottom line with expert-backed education.
View All ProductsLearn about our advanced resuscitation training solutions. Our solutions are designed to help improve patient outcomes.
View All ResuscitationIn all areas of resuscitation, from neonatal to elderly care, clinical deterioration is a risk that can be avoided with the help of HealthStream's training programs.
View All ProductsNurture the skills of your nurses and medical staff to help mold them into effective leaders with development training from HealthStream.
View All ProductsExpand the decision-making skills and effectiveness of your healthcare workforce with HealthStream's clinical development programs and services.
View All Clinical DevelopmentMake sure your clinicians have the support they need to provide competent care with clinical competency training and development from HealthStream.
View All ProductsHealthStream’s learning management system and comprehensive suite of competency management tools empower your healthcare workforce to deliver the best patient care.
View All ProductsThe suite of healthcare onboarding solutions available from HealthStream aids in nurse retention and improved patient outcomes.
View All ProductsGive your healthcare staff the decision support and skills training they need with the online products available from HealthStream.
View All ProductsHealthStream leverages medical professional development in healthcare by providing staff training programs
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