More on Policy and Legislation

CMS proposes rule to reduce antibiotic overuse, improve infection control

New rule could save hospitals close to $300 million annually, applies to hospitals that participate in Medicare and Medicaid, CMS says.

Susan Morse, Managing Editor

CMS Headquarters-Windsor Mill, MD.CMS Headquarters-Windsor Mill, MD.

The Centers for Medicare and Medicaid Services on Monday proposed a new rule intended to reduce overuse of antibiotics, implement comprehensive requirements for infection prevention and prohibit discrimination.

The proposal applies to the 6,228 hospitals and critical access hospitals that participate in Medicare or Medicaid, CMS said.

CMS estimates that these new requirements could save hospitals up to $284 million annually, while also improving care and potentially saving lives.

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The proposed rule has a 60-day comment period.

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Hospitals, including critical access facilities, would be required to have hospital-wide programs in place for infection prevention and control, as well as antibiotic stewardship programs for the appropriate use of antibiotics.

The rule would mandate designated leaders of the infection prevention and control program, and also for the antibiotic stewardship program.

It establishes and implements a policy prohibiting discrimination on the basis of race, color, religion, national origin, sex (including gender identity), sexual orientation, age, or disability.

"This rule marks the first time that CMS has proposed explicitly to prohibit hospitals that accept Medicare and Medicaid from discriminating against patients," said Cara James, Ph.D., director of the CMS Office of Minority Health. "We know that barriers still remain in accessing quality care for communities that have been traditionally excluded or underserved. This proposal reinforces the principle that access to needed health services should not be blocked because of discriminatory practices."

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The proposed rule would make revisions to the current requirements including: changing the term "licensed independent practitioner" to simply "licensed practitioner" so that hospitals may use physician assistants to the extent of their educational preparation and scope of practice, as determined by state law; and require that a hospital's Quality Assessment and Performance Improvement program incorporate quality indicator data related to hospital readmissions and hospital-acquired conditions.

For nursing services, it would allow a hospital to establish a policy that would specify which outpatient departments would not be required to have a registered nurse physically present as well as the alternative staffing plans that would be established under such a policy.

It would require that each patient's medical record contain information to justify all admissions and continued hospitalizations, support the diagnoses, describe the patient's progress and responses to medications and services, and document all inpatient stays and outpatient visits to reflect all services provided to the patient.

It would also require that all patient medical records document discharge and transfer summaries, including any patient discharge instructions.

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The rule clarifies that patients should be able to access their medical records in a form and format of their choosing, whether electronically or in a hard copy format, if readily producible in that format.

The rule eliminates the CAH disclosure of ownership requirement in order to remove a redundancy in regulations.

It requires that a  patient nutritional needs be met and allows dietitians and nutrition professionals to work to their full scope of practice.

It also requires critical access hospitals to implement and maintain a Quality Assessment and Performance Improvement program to collect data to identify opportunities for improvement and develop corrective plans. Other hospitals participating in Medicare or Medicaid already maintain these types of programs.

Hospitals have taken significant steps to improve safety and quality in the past several years, CMS said.

Already, efforts to reduce healthcare-associated infections have resulted in reducing healthcare costs by nearly $20 billion and saving 87,000 lives, according to Kate Goodrich, M.D. director, Center for Clinical Standards and Quality at CMS.

"This proposal further supports hospitals' safety and quality efforts by requiring all Medicare and Medicaid hospitals to have designated leaders in charge of specialized programs to prevent infections, improve antibiotic use, and follow nationally recognized guidelines," she said. 

Twitter: @SusanJMorse