History and Physicals: Meeting Hospital CoPs in 2023 — Virtual Event

Audience

chief medical officers, chief nursing officers, compliance officers, emergency department personnel, TJC coordinators, medical records staff, quality improvement personnel, risk managers and legal counsel

The following program content was provided by the speaker.

Overview

The Centers for Medicare & Medicaid Services made a change effective Nov. 29, 2019, indicating that healthy outpatients may not be required to have a history and physical. This event will outline the policy, medical staff and board approval, revised medical staff bylaws, and more.

Attendees of this program will learn what is required to be in the H&P and how to meet compliance with the CMS hospital Conditions of Participation, The Joint Commission and DNV standards. CMS has five sections addressing H&Ps for acute and critical access hospitals, and hospitals must ensure their policies and procedures meet the requirements. Medical staff by-laws also must comply with the regulations and interpretive guidelines and standards. Information on medical records deficiencies, as well as what CMS identifies during a medical record review, will be covered.

Objectives

Upon completion of this program, participants will be able to:

• recall that CMS has H&P requirements in the hospital CoPs that all hospitals that accept Medicare must follow
• identify TJC and DNV standards on H&P
• describe that the hospital must have medical staff by-laws and policies that include the requirements for H&Ps
• discuss what hospitals must do to implement the new rule that H&Ps do not need to be done on healthy outpatients

Speaker

Laura A. Dixon, J.D., RN, CPHRM, most recently served as the Director of Risk Management and Patient Safety for the Colorado Region of Kaiser Permanente. Before joining Kaiser, she served as the Director, Facility Patient Safety and Risk Management and Operations for COPIC from 2014 to 2020. In her role, Dixon provided patient safety and risk management consultation and training to facilities, practitioners and staff in multiple states.

Dixon has more than 20 years of clinical experience in acute care facilities, including critical care, coronary care, perioperative services and pain management. Before joining COPIC, she served as the Director, Western Region, Patient Safety and Risk Management for The Doctors Company in Napa, Calif. In this capacity, she provided patient safety and risk management consultation to the physicians and staff for the western U.S. As a registered nurse and attorney, Dixon holds a Bachelor of Science from Regis University in Denver; a Doctor of Jurisprudence from Drake University College of Law in Des Moines, Iowa; and a registered nurse diploma from Saint Luke’s School Professional Nursing in Cedar Rapids, Iowa. She is licensed to practice law in Colorado and California.

This educational activity is provided by MHA Health Institute in collaboration with the Georgia Hospital Association.