CMS Issues Interpretive Guidelines for New Interoperability CoPs

By A.J. Plunkett

Review any policies you updated to meet the requirements under the new Information Management standard to reflect that The Joint Commission (TJC) has already updated the language in its new elements of performance (EP).

Also note that CMS has finally updated its interpretive guidelines for its own surveyors, with four new tags for Appendix A for hospitals and two new tags for Appendix W for critical access hospitals (CAH) under the State Operations Manual.

The updates are all related to the final rules last year designed to improve interoperability of electronic medical records (EMR) and communication between healthcare providers for patients as they are admitted or discharged from hospital care.

The goal, according to CMS, is to improve care coordination by ensuring that important medical information is shared with primary care providers (PCP) when a patient shows up at the emergency department or is admitted into the hospital, as well as sharing information with providers after a patient is discharged.

TJC revises newest IM standard

The revision by TJC is likely based on CMS feedback, according to Kurt Patton, MS, RPh, founder of Patton Healthcare Consulting and former director of accreditation services with TJC, as outlined in the consultant’s May newsletter to clients.

“The TJC change is noted in IM.02.02.07, EP 5, which discusses notifications the hospital must send to aftercare providers. The content changes are minimal but perhaps the breadth and scope of what surveyors will be examining may be more detailed,” advised Patton. “In last month’s wording, your EMR system needed to send notifications to post-acute service providers ‘as applicable’ and now the requirement says to ‘all applicable.’ ”

“There is a second change to send notifications to other medical providers and the wording change is the addition of the phrase ‘as well as any of the following” and then it includes the same list of primary care practitioners, primary care group or practice, and other practitioners or practice groups the patient identifies as primarily responsible for their care,” said Patton.

“So, if your patient has a PCP and a cardiologist or other specialist the patient identifies as primarily responsible for their care, you would want to ensure that both providers receive the aftercare notice,” Patton advised clients.

CMS issues interpretive guidelines

The CMS Quality, Safety and Oversight group memo, QSO-21-18-Hospitals/CAHs, was published on May 7, and state survey agency surveyors were supposed to have been educated on the new guidelines within 30 days of the memo’s release.

“The QSO memo makes it clear that hospitals and critical access hospitals have to send notice to other providers for emergency room visits and admissions, external transfers, and discharges,” Patton told clients.

All the new guidance for hospital surveys is under the Conditions of Participation (CoP) for medical records; for CAHs, the guidance is under the CoPs for clinical records.

“The first CMS tag touched is A-0470 and it requires notice be sent for registration as an inpatient or emergency room patient to external providers. CMS points out that this may require two notices, one stating that the patient has registered for treatment in the ED, and a second notice stating the patient has been admitted to the hospital. CMS also makes it clear in their guidance that emergency room notice must be sent regardless of the decision to admit or not,” he said.

The second tag is A-0471 and “requires notice be sent to post-acute providers when a patient is discharged from the hospital. The third tag addressed is A-1673 which contains the same registration in the ED or as an inpatient notice be sent but the guidance specifically refers to psychiatric hospitals. In this case, a specific consent must be obtained from the patient to send the notice to other providers. This contrasts with the general hospital guidance which included obtuse language stating the notice sent should ‘not be inconsistent with the patients expressed privacy preferences,’ ” noted Patton.

A fourth tag, A-1674, discusses how hospitals are expected to make a reasonable effort to ensure their systems are sending the required notices, noting that a patient may opt to send the information to a specialist other than their PCP. In addition, “This requirement does not limit the psychiatric hospital’s ability to notify additional entities based on hospital policy, such as ACO attribution lists,” according to the interpretive guidance.

Tags A-0470 and A-0471 correspond to the only two new CAH tags, C-1127 and C-1129.

Patton is advising clients to share the QSO memo with both their information technology department and hospital attorneys “to verify that you are ready to send these notices if using an EMR.”

A.J. Plunkett is editor of Inside Accreditation & Quality, an HCPro publication.