Advance Directives: Ensuring Compliance with CMS and TJC

Event Information
Product Format
Prerecorded Event
Sue Dill Calloway, RN, MSN, JD
Conference Date
Wed, Apr 04, 2018
120 minutes
Product Description

Complying with the Hospital Visitation CoPs on Advance Directives

If the Centers for Medicare & Medicaid Services (CMS) or the Joint Commission (TJC) showed up tomorrow at your door, would you be in compliance with the advance directive requirements? Advance care planning refers to making decisions regarding the care a patient wants to receive if they become unable to speak for themselves.

Did you know there was a federal law that addresses advance directives that all hospitals must be in compliance with? CMS made revisions to the hospital visitation conditions of participation (CoP) regulation, which included changes to advance directives and visitation advance directives. The CMS hospital CoP standards require that the information about the hospital’s advance directive policy be provided to inpatients, and to the three categories of outpatients: observation, emergency department patients, and same-day surgery patients. Staff will have to determine whether there are any patient representatives including support person or patient advocates and those with visitation advance directives. The standard changed what a hospital must do if a patient has no advance directives on file and a support person shows up. These are interesting changes to the CMS hospital CoP manual.

Did you also know that CMS reimburses some physicians for advance care planning? It was a big step for the 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 reduces the cost of end-of-life care without increasing mortality.

Did you know better end-of-life care can reduce readmissions? Do you know the four rights provided to patient representatives? Hospitals need to do this right, or they can face a wrongful death or medical malpractice case.

Join this session, where healthcare consultant Sue Dill Calloway 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. Sue will provide a detailed account of advance directives such as living will, durable power of attorney (DPOA), organ donation, mental health declaration, organ donor cards, patient advocates, and do not resuscitate (DNR) orders. She will discuss the rights of patient representatives such as DPOA, support persons, parents, or guardians.

This session will discuss the Institute for Healthcare Improvement (IHI) conversation starter kit regarding discussions about end-of-life care, which has been downloaded over 100,000 times. Sue will also discuss 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 session will discuss case law, organization position statements on DNR, and other federal laws on advance directives. The session will cover the CMS-issued a memo, outlining the number of deficiencies received by hospitals regarding advance directives. The session will also discuss Joint Commission visitation standard, which is found in the patient centered care standard.

Session Objectives

This session will cover:

  • Requirements of the CMS CoPs for advance directives for hospitals
  • CMS’s decision to now pay physicians to do advance care planning
  • The Joint Commission’s standards on advance directives
  • What is required of hospitals under the federal law called the Patient Self Determination Act
  • CMS-issued deficiency report that shows the number of hospitals out of compliance with the advance directive standards
  • Information on the hospital’s advance directive policies that must be given to inpatients, ED, observation, and same-day surgery patients under the CMS CoP hospital manual

Session Highlights

  • Introduction
  • One-third of patients have advance directives
  • CMS pays for advance care planning
  • CMS CoP on advance directives
    • Tag 132
    • Must be given to inpatients, ED, observation, and same-day surgery patients
    • Visitation advance directive
    • Patient representative and new patient rights
    • Number of deficiencies
  • Joint Commission standards on advance directives
  • Federal law on Patient Self Determination Act
  • Community education requirement
  • Documenting advance directives under Record of Care chapter
  • Case law update
  • Asking patients about end of life wishes
  • Resources from advance care planning
  • Toolkit CriSTAL to identify dying patients
    • Checklist with 29 predictors
  • Requirements of the Patient Self Determination Act federal law
  • Informed consent requirements
  • Living wills, DPOA, DNR orders, mental health declarations, organ donor
  • Assisted suicide
  • Professional organization position statements on DNR:
    • Association of periOperative Registered Nurses (AORN)
    • American College of Surgeons (ACS)
    • American Society of Anesthesiologists (ASA)
    • American Society of PeriAnesthesia Nurses (ASPAN)
    • American College of Emergency Physicians (ACEP)
    • Emergency Nurses Association ENA etc.
  • Joint Commission tracer
  • Joint Commission standard under rights and responsibilities of the individual (RI) and record of care, treatment, and services (RC) chapters
  • Visitation advance directive under CMS and TJC visitation standard
  • Resources

Session Agenda

  • Advance directives
    • Types
  • Toolkit CriSTAL to identify dying patient
  • Roadmap guide CMAJ
  • Roadmap guide end of life care
  • Case law related to advance directives
  • End of life planning
  • Federal laws on advance directive
  • Patient Self Determination Act (PSDA)
  • CMS hospital Conditions of Participation (CoPs)
  • CMS Critical Access Hospital (CAH) on advance directives
  • Joint Commission tracer
  • TJC advance directive standards: What hospitals should know
  • Organizations position statements
  • Ambulatory Surgery Centers (ASC): Conditions for Coverage (CfC)

Who Should Attend

  • Chief nursing officer (CNO)
  • Compliance officers
  • Ethics committee
  • Social workers
  • Discharge planners
  • Consumer advocate
  • Nurse educator
  • Chief financial officer
  • All nurses with direct patient care
  • Registration staff
  • Ethicist
  • Ethic committee members
  • Physicians
  • Chief medical officer (CMO)
  • Nurse managers
  • Nurse supervisors
  • Risk managers
  • Quality improvement director
  • Joint Commission coordinator
  • Hospital legal counsel
  • Director of  registration
  • Palliative care physicians
  • Behavioral health staff
  • Psychiatrist
  • Patient safety officer
  • Outpatient and emergency department managers
  • OR director
  • Hospice unit staff
  • Physicians including any physician who is doing advance care planning

Ask a question at the Q&A session following the live event and get advice unique to your situation, directly from our expert speaker.

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About Our Speaker

Sue Dill Calloway - Hospital Coding Expert

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...   More Info
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