Advance Directives: Ensuring Compliance with CMS and TJC

Product Id : HE167
Instructor : Sue Dill Calloway
Dec 11, 2019 1:00 PM ET | 12:00 PM CT | 10:00 AM PT | 120 Minutes

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If CMS or The Joint Commission showed up tomorrow at your door would you be in compliance with the advance directive requirements? Did you know there was a federal law that addresses advance directives that all hospitals must be in compliance? Did you know that CMS reimburses some physicians for advance care planning? Did you know better end-of-life care can reduce readmissions? Hospitals need to do this right or they can face a wrongful death or medical malpractice case.

Advance care planning is making decisions about the care a patient wants to receive if they become unable to speak for themselves. It was a big step for CMS to allow physicians to be compensated for advanced care planning. Providers are spending time discussing advance directives and end of life care and they deserve to be paid for it. It is essential that practitioners have an understanding of the CMS advance directive requirements when doing advanced care planning. Advance care planning reduced the cost of end-of-life care without increasing mortality.

Have you heard of the $16.5 million dollar case in which the plaintiff won because of the failure of the physician and hospital to follow a patient’s advance directives? Many experts are advocating that his is a new wave of lawsuits if a hospital fails to honor the advance directive. Another recent case involved a brain dead girl who is moved from a California hospital and a pregnant woman that was brain dead who had been life support until the husband obtained a court order. Do you ask every inpatient if they have any advance directives and do you discuss end of life wishes?

This webinar will discuss the CMS hospital Cops on advance directives along with the Joint Commission standards to help hospitals ensure compliance with the standards. Hospitals have received a high number of deficiencies in this area. This program will cover in detail advance directives such as living will, durable power of attorney, organ donation, mental health declaration, organ donor cards, patient advocates  and do not resuscitate orders. It will discuss rights of patient representatives such as DPOA, support persons, parents, or guardians. It will discuss the IHI conversation starter kit regarding discussions about end of life care since it has been downloaded over 100,000 times. Also discussed will be asking patients about end of life wishes, resources on advance care planning and a toolkit CriSTAL to identify dying patients. The checklist has 29 predictors.

The program will discuss case law, organization position statements on DNR (do not resuscitate) and other federal laws on advance directives. CMS made revisions to the hospital visitation CoP regulation which included changes to advance directives and visitation advance directives. CMS has issued a memo which will be discussed outlining the number of deficiencies received by hospitals regarding advance directives. The program will discuss Joint Commission visitation standard which is found in the patient centered care standard. 

The CMS hospital CoP standards require that the information about the hospital’s advance directive policy be provided to inpatients, and three categories of outpatients; observation, emergency department patients and same day surgery patients. Staff will have to determine if there are any patient representatives including support person or patient advocates and those with visitation advance directives. Do you know the four rights provided to patient representatives? The standard changed with regard to what a hospital must do if a patient who has no advance directives on file and a support person shows up. These are very interesting changes to the CMS hospital CoP manual.

Session Highlights:

  • Recall  that the CMS Conditions of Participation has requirements for advance directives for hospitals
  • Discuss that CMS will now pay physicians to do advance care planning
  • Describe that the Joint Commission has standards on advance directives
  • Explain what is required of hospitals under the federal law called the Patient Self Determination Act
  • Discuss the CMS has now issued a deficiency report that shows the number of hospitals out of compliance with the advance directive standards
  • Discuss that information on the hospital’s advance directive policies must be given to inpatients, ED, observation, and same day surgery patients under the CMS CoP hospital manual

Who Should Attend?

  • Chief Nursing Officer (CNO) and Nursing Staff, 
  • Chief Medical Officer (CMO)
  • Chief Financial Officer
  • Compliance Officers
  • Hospital Legal Counsel
  • Ethics Committee Members
  • Social Workers
  • Discharge Planners
  • Physicians
  • Patient Safety Officer
  • Risk Managers
Speaker Profile:

Sue Dill Calloway, RN, MSN, JD, is the president of Patient Safety and Healthcare Consulting and Education company with a focus on medical-legal education especially Joint Commission and the CMS hospital CoPs regulatory compliance. She also lectures on legal, risk management and patient safety issues. She was a director for risk management and patient safety for five years for the Doctors Company. She was the past VP of legal services at a community hospital in addition to being the privacy officer and the compliance officer. She was a medical malpractice defense attorney for ten years. She has 3 nursing degrees in addition to a law degree.

She is a well-known lecturer and the first one in the country to be a certified professional in CMS. She also teaches the course for the CMS certification program. She has written 102 books and thousands of articles.

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