Question

Healthcare managers must deal with three components of healthcare delivery: access to care, quality of care and the cost of care. With the move to a value based care model from fee for service, there is a stronger connection between quality of care and payment. Organizations that accredit healthcare facilities such as The Joint Commission focus on quality standards.   These organizations may also hold what is called “deemed status”. This means that the Centers for Medicare and Medicaid (CMS) will accept accreditation of a healthcare facility by an accrediting organization such as The Joint Commission as meeting the Conditions of Participation (CoPs). Healthcare organizations that meet the CoPs are eligible for reimbursement for the care of Medicare and Medicaid beneficiaries. Thus, the standards for accreditation include those that align with the CoPs. Managers must ensure that their organization meets these standards.

Identify at least two sections of the CoPs (e.g., patient rights, medical record services).

Explain how these sections are implemented in your selected health care facility.

Compare and discuss how these sections might be implemented differently in another type of health care facility.

Make recommendations for how your healthcare facility could make improvements to ensure meeting the CoPs.

In addition to the two CoPs that you have chosen, describe the Emergency Preparedness CoP, and how your health care facility will implement this standard.

Answer 1

we will focus on one of the most important agencies regarding regulatory compliance in the healthcare setting, which is the Centers for Medicare and Medicaid Services (CMS). CMS, previously known as the Health Care Financing Administration (HCFA) is a federal agency within the U.S. Department of Health and Human Services, and their primary missions are to work in partnership with state governments to administer Medicare and Medicaid services, State Children’s Health Insurance Programs (SCHIP) and police health insurance portability rules and standards (i.e. oversight of HIPAA). Through the CMS survey and certifications processes, a wide array of healthcare providers have their quality standards assessed, and these include acute care and long term care facilities as well as clinical laboratory settings (under the Clinical Laboratory Improvement Amendments, or CLIA).

As part of this duty, CMS has developed Conditions of Participation (CoPs) and Conditions for Coverage (CfCs), which healthcare organizations must meet in order to participate in Medicare and Medicaid programs. The goal of these health and safety standards is to improve quality and protect the health and safety of patients and clients. At the same time, they ensure that standards of healthcare accrediting organizations (such as the Joint Commission), which are recognized and deemed by CMS, meet or exceed the standards that they set forth