Transcript PHAM Contributors Meeting

A “Fireside” Chat with CDPH
Dr. Steven Otto
Chief Medical Consultant
CDPH / L&C
Email: [email protected]
Phone: 916-552-8672
California Department of Public Health
Radiology Supervision
• A new final rule at 416.49(b)(2) has
changed the requirements for the
supervision of radiologic services.
• The individual basically will have the same
responsibilities as existed for the
supervising radiologist as to safety,
badges, etc. Now will NOT have to
actually be a radiologist, but one who is
qualified to be responsible.
Radiology Supervision
2nd Round of Surveys
• Generally, we have noticed marked
improvement over the initial round 3 years
ago.
• The actual regulations have changed in
multiple areas, particularly Infection
Control and Anesthesia
2nd Round of Surveys
• Check the Appendix L of the State
Operating Manual periodically (at least
twice a year) to see any changes. This is
available anytime free of charge on the
CMS website.
• Surveyors are all similarly trained, but are
individuals in their approaches.
2nd Round of Surveys
• Uniformity of the Survey Process includes:
• Common training and certification of
surveyors
• The depth of findings is also partially
dependent upon the training and level of
the surveyor
– i.e. a physician vs. HFEN
– i.e. an infection control consultant vs. HFEN
2nd Round of Surveys
Disputing a Finding
• The actual dispute of any findings would
be directly with CMS after they have
received and accepted the survey results
collected by CDPH, who is the official
“agent” of CMS in California.
• Informal discussion can occur between the
survey Team and the facility, usually
during the exit conference
Disputing a Finding
• The 2567 is NOT the forum for disputing a
finding, but rather to put forward the
facility’s Plan of Correction for deficiencies
which were cited.
• A critical point: You will always be held to
“do what you said you were going to do” –
what is in your policies and procedures
must be followed, and they must reflect
the appropriate standards
Waivers
• A waiver is basically permission to provide
an alternative approach to a proscribed
regulation
• Waivers may ONLY be granted directly by
CMS, as CDPH has no authority to grant
any waiver of Federal reguations.
• Application would be directly to CMS
Infection Control
• CMS considers the following as accepted
national guidelines:
– AORN
– APIC
– CDC
– SHEA
– AAMI
Infection Control
• Q-0241, §416.51(a) Standard: Sanitary
Environment
• The ASC must provide a functional and
sanitary environment for the provision of
surgical services by adhering to
professionally acceptable standards of
practice.
Infection Control
• The following are more specialty-related
guidelines which may be applicable:
– AAMI (reprocessing)
– WHO (mimics CDC generally)
• You may specify different guidelines for
different areas – just make sure you have
documented those choices and adjusted your
policies and procedures accordingly
Infection Control
• Failure to adopt or identify a nationally
recognized guideline will lead directly to a
Conditions of Participation deficiency
Infection Control
Anesthesia
•
§416.42(a) - Standard: Anesthetic
Risk and Evaluation (2): Before discharge
from the ASC, each patient must be
evaluated by a physician or by an
anesthetist as defined at §410.69(b) of
this chapter, in accordance with applicable
State health and safety laws, standards of
practice, and ASC policy, for proper
anesthesia recovery.
Anesthesia
• The regulations (as well as ASA
standards) would require either a
physician or anesthesia provider to
physically remain in the facility until the
patient is physically discharged (left) from
the facility
Anesthesia
Cross-Reporting Between
Agencies
• CDPH does report significant findings in
an ASC (i.e. Immediate Jeopardy) directly
to the Medical Board of California, which is
the actual licensor of an ASC.
• CDPH does report sub-standard or
criminal behavior on the part of a provider
directly to the Medical Board of California
Cross-Reporting
• CDPH may also report the actions of a RN
to the BRNA if warranted
Cross-Reporting
Hospital Privileges
• A question was asked regarding if an
anesthesiologist on staff at an ASC had to
have admitting privileges at a local
hospital if a transfer agreement was not in
place.
– If that physician is ONLY providing anesthesia
services and has not surgical privileges, such
as pain management, privileges would not be
required
Anesthesia Limitations
• A question was asked regarding if there
were limitations on which patients could
receive services at an ASC based on
medical conditions?
– Every ASC is charged with formulating their
own P&P regarding which patients and
conditions may receive services. The
surveyor guidelines suggest some national
standards guideline basis be established.
Anesthesia Limitations
– The most commonly used basis are the ASA
Cardiac status guidelines. Most facilities will
allow scheduling of patients up through an
ASA Category III condition on a fairly routine
basis.
– The evaluation and decisions are documented
primarily in the Pre-Anesthesia evaluation,
which must be signed by a Physician, and
must be individualized and unique to each
patient.
California Department
of Public Health
Thank you for your attention and participation