The Joint Commission on Accreditation of Healthcare Organizations has agreed to revise its proposed accreditation standard for patient restraints after HCFA determined the standard didn't go far enough to protect patients.
In rejecting the Joint Commission's proposed standard, HCFA has dealt the agency and the hospital industry an expensive reversal.
In its regulation HCFA said that a licensed practitioner must evaluate a patient within an hour of the patient's being placed in restraints; the JCAHO proposed that the standard for accreditation be that patients be examined every four hours while in restraints. HCFA held its ground.
The use of patient restraints has turned into one of the hot-button quality-of-care issues over the last year. The Joint Commission proposed its accreditation standard earlier this month (May 8, p. 17).
The rejected JCAHO proposal was intended to be a way for hospitals to comply with HCFA's new regulation requiring evaluation within an hour. HCFA published its regulation on July 2, 1999, and it went into effect on Aug. 2, 1999, without a public comment period.
Under the deeming relationship between HCFA and the JCAHO, hospitals that meet the JCAHO's standards automatically qualify for the Medicare program.
The hospital industry has said HCFA's regulation is unrealistic, too expensive and impractical. The JCAHO argued that it would be sufficient for hospitals and other healthcare organizations to have patients in restraints examined by a licensed practitioner every four hours.
"I am not persuaded by this argument," wrote Robert A. Streimer, deputy director of HCFA's office of clinical standards and quality, in a May 9 letter to Dennis O'Leary, M.D., JCAHO president and chief executive officer. "We will not accept Joint Commission accreditation as equaling the Federal requirement" insofar as the proposed restraint standard is concerned, Streimer wrote.
He instructed O'Leary to have hospitals meet the federal one-hour rule if they wished to be deemed in compliance for Medicare conditions of participation.
The Joint Commission said last week it will add to its current standards that hospitals seeking deemed status must adhere to HCFA's one-hour rule. JCAHO had said from the start that if HCFA did not sign off on its proposed alternative, it would enforce the HCFA rule.
The standards will be effective Jan. 1, 2001.
The Joint Commission hasn't gotten much reaction from hospitals, spokeswoman Charlene Hill said.
"HCFA hasn't come out yet with how to implement the rule, so they're still waiting to hear from HCFA," she said.
Carmela Coyle, vice president of the American Hospital Association, said: "We are disappointed at HCFA's unwillingness to accept the clinically based standards offered by the Joint Commission. They involved consumers, provider organizations and clinicians in a very thoughtful process."
HCFA's process was not clinically based, she said. "It's not supported by medical evidence."