In a departure from its usual policies, the Joint Commission on Accreditation of Healthcare Organizations issued a new accreditation standard for the use of restraints and seclusion last week that differs from what HCFA wants to see in all U.S. hospitals.
Under the standard, to go into effect Jan. 1, 2001, restraints and seclusion should be used only in emergencies and as a last resort for psychiatric and substance-abuse patients.
The standard also requires that restrained and secluded patients be monitored continuously and assessed every 15 minutes, and that staff be educated in de-escalation and mediation techniques.
The Joint Commission did not adopt HCFA's new Medicare regulation requiring a physician to evaluate the patient within one hour, saying its new standard would achieve the same result.
HCFA published its interim final rules on July 2, 1999, and they went into effect on Aug. 2, 1999. Many healthcare operators said they didn't even hear about them until they were already in effect. A lengthy comment period usually precedes ample notification time before regulations take effect.
The regulations were rushed through in response to reports of numerous deaths of patients in restraints. The hospital community reacted quickly, calling the HCFA regulations too expensive and impractical, especially the requirement to have a physician personally evaluate the patient within one hour.
The American Hospital Association tried but failed to get a court injunction to halt the federal regulations. "We are firmly opposed to the one-hour rule and have indicated so in letters to HCFA," said Don Nielsen, M.D., AHA senior vice president of quality leadership.
Any hospital accredited by the Joint Commission is deemed to meet the conditions of participation for Medicare and other federal health insurance programs.
It's not clear how HCFA will react to the discrepancy between its regulations and JCAHO's standard.
"Obviously, hospitals would like to comply with one set of standards and not be surveyed under two sets of standards with differing interpretations," Nielsen said.
HCFA staffers have indicated to Nielsen that HCFA will not accept the Joint Commission's standard, he said. Nielsen said he wonders whether this move is a prelude to separate surveys: one for JCAHO and another for HCFA.
If HCFA rejects the JCAHO's standard, then the commission will enforce the strict HCFA regulation, said JCAHO President and Chief Executive Officer Dennis O'Leary, M.D., in a written statement.