medicare publishes proposed rule updating hospital conditions of
the centers for medicare & medicaid services (cms) announced on
thursday a proposed rule to alleviate hospitals of overly burdensome
regulations and allow doctors and nurses to focus more time and energy
on patient care.
the proposed rule would revise requirements in the hospital conditions
of participation (cops) for completion of history and physical (h&p)
examinations, authentication of verbal orders, securing medications, and
completion of post anesthesia evaluations.
"based on extensive input from health professionals and the health care
community, we are proposing to revise some specific aspects of our
regulations to provide better support of the delivery of high-quality,
up-to-date care at a lower cost," said cms administrator mark b.
mcclellan, m.d., ph.d.
these revisions were contained in the notice of proposed rule making
(nprm) published december 19, 1997, entitled "medicare and medicaid
programs; hospital conditions of participation; provider agreements and
supplier approval," which contained extensive revisions to the entire
set of hospital cops. other changes in the hospital cops are coming,
building on these steps to avoid unnecessary burdens while promoting
"to keep up with changes in effective medical practice, we believe it
is in the interest of the health care community as a whole for us to
move forward with these changes," mcclellan said.
the revised requirements include:
the proposed requirement would expand the number of permissible
practitioners who may perform the h&p and the time frame for its
authentication of verbal orders:
this regulation would require that all orders, including verbal orders,
must be dated, timed, and authenticated by a practitioner responsible
for the care of the patient. during a five year transition period from
publication of the final rule, it would allow all orders, including
verbal orders, to be dated, timed and authenticated by the prescribing
practitioner or another practitioner responsible for the care of the
patient. this would respond to public comments, reduce burden, and
provide flexibility for hospitals in meeting the requirements for
authentication of verbal orders. cms expects that sunsetting this
flexibility after a five year period is sufficient time for the adoption
of changes in health care information technology to make it easy for
prescribing practitioners to authenticate all of their own orders in a
timely fashion. additionally, the proposed rule states that in the
absence of a state law specifying the timeframe for authentication of
verbal orders, verbal orders would need to be authenticated within 48
hours. finally, this requirement clarifies and reinforces current
regulations regarding who may accept verbal orders, authentication of
all orders for drugs and biologicals, and authentication of medical
security of medications:
this regulation requires that all drugs and biologicals be kept in
secure areas, or locked when appropriate, to prevent unauthorized
persons from obtaining access. this regulation addresses community
concerns, provides flexibility for hospitals in determining control of
nonscheduled drugs and biologicals, and is more patient-focused and
outcome-oriented than the current requirement.
post anesthesia evaluation:
this requirement permits the post anesthesia evaluation for inpatients
to be completed and documented by any individual qualified to administer anesthesia. the current cop requires that the individual who administers the anesthesia do this evaluation.
the intent of this proposed rule is to ensure that our requirements are
consistent with current standards of practice, to provide hospitals and
practitioners greater flexibility in meeting the needs of patients, and
to reduce unnecessary regulatory burden for hospitals.
the proposed rule can be viewed at:
the full cms press release can be found at: