MC Proposed changes to Hospital COP re Anesthesia

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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

high-quality care.

"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:

h&p examination:

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

record entries.

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:

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