MEDICARE PUBLISHES NEW HOSPITAL REQUIREMENTS
HISTORY AND PHYSICAL EXAMINATIONS, AUTHENTICATION OF VERBAL ORDERS, SECURING MEDICATIONS, AND POSTANESTHESIA EVALUATIONS ADDRESSED

The Centers for Medicare & Medicaid Services (CMS) published a final rule revising requirements in the hospital conditions of participation (CoPs) for completion of history and physical examinations, authentication of verbal orders, securing medications, and completion of post anesthesia evaluations.  The new rule addresses concerns of the health care community that the old regulations were outdated and unduly burdensome.

 

“We always want to make sure that Medicare beneficiaries receive the best possible health care, and one important way to do that is to provide rules and guidelines that enable providers to operate smoothly and efficiently,” said CMS Acting Administrator Leslie V. Norwalk, Esq. “We think these changes will better serve the health care industry as a whole.”

 

The requirements of the regulation are:

• History and Physical (H&P) examination.  This requirement expands the timeframe for completion of the H&P and expands the number of permissible professional categories of individuals who may perform the H&P.

 

• Authentication of verbal orders.  This regulation requires that all orders, including verbal orders, must be dated, timed, and authenticated by the prescribing practitioner with a temporary exception.  For a five-year period beginning with the date of publication of the final rule, the regulation requires that all orders, including verbal orders, must be dated, timed, and authenticated promptly by the prescribing practitioner or another practitioner responsible for the care of the patient, even if the order did not originate with him or her. CMS believes this temporary revision to the authentication requirement will reduce burden and provide flexibility for hospitals until the advancement of health information technology is sufficient to allow the prescribing practitioner to authenticate his or her own orders promptly and efficiently.

 

In the absence of a State law specifying the timeframe for authentication of verbal orders, verbal orders need to be authenticated within 48 hours.  For the five-year period, verbal orders no longer need to be signed by the prescribing practitioner but can be authenticated by another practitioner responsible for the care of the patient.  This responds to public comments, reduces burden, and provides flexibility for hospitals in meeting the requirements for authentication of verbal orders.

 

Finally, this requirement clarifies and reinforces current regulations regarding minimizing the use of verbal orders, persons who may accept verbal orders, authentication of all orders for drugs and biologicals, and authentication of medical record entries.

 

• Security of Medications.  This regulation requires that all drugs and biologicals be kept in secure areas, and locked when appropriate.  This regulation addresses commenters concerns, maintains flexibility for hospitals in determining control of nonscheduled drugs and biologicals, and is more patient-focused and outcome-oriented.

 

• Postanesthesia evaluation.  This requirement permits the postanesthesia evaluation for inpatients to be completed and documented by any individual qualified to administer anesthesia instead of only the individual who administered the anesthesia.

 

This final rule will ensure that CMS requirements are consistent with current standards of practice, to provide hospitals and practitioners greater flexibility in meeting the needs of patients, and to reduce unnecessary regulatory burden for hospitals.

The final rule was published in the Federal Register on November 27, 2006.  It will become effective January 26.