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View All ProductsHealthStream works with healthcare organizations to create engaging and high-quality training videos for your staff and management.
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View All ProductsHealthStream's proven methods for the improvement and overall engagement of your healthcare staff foster a positive workplace and increase retention rates.
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View All ProductsIn all areas of resuscitation, from neonatal to elderly care, clinical deterioration is a risk that can be avoided with the help of HealthStream's training programs.
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View All ProductsHealthcare scheduling software designed to optimize staffing requirements & elevate patient care
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View All ProductsMitigate risk and elevate your quality of care. Improving both clinical and business outcomes starts with a smarter, more integrated approach to regulatory training, continuing education and quality management.
Learn MoreCoPs are qualifications developed by CMS that healthcare organizations must meet in order to begin and continue participating in federally funded healthcare programs (Medicare, Medicaid, CHIPS, etc.). These standards involve health and safety guidelines that protect all beneficiaries by improving quality and enforcing patient rights. CoPs apply to all healthcare organizations that participate in federally funded healthcare programs.
Prior to 1986, CoPs were primarily focused on “structure over process measures… such as staff qualifications, written policies and procedures, and committee structure, which were usually specified at the standard level” (McGeary, 1990).
For example, a typical provision was a medical staff meetings standard calling for regular efforts to review, analyze, and evaluate clinical work, using an adequate evaluation method. Explanatory evidence for surveyors included attendance records for meetings involving reviews of clinical practice at least monthly. Conditions were revised in 1986 as part of the Reagan Era’s push for deregulation. Changes involved “eliminating prescriptive requirements specifying credentials or committees, departments, and other organizational arrangements. They were replaced with more general statements of desired performance or outcome in order to increase administrative flexibility” (McGeary, 1990). At the same time, more emphasis was placed on such measures as “infection control and surgical and anesthesia services. In addition, quality assurance was made a separate condition” (McGeary, 1990).
CoPs were established to align state licensure requirements and declare minimal health and safety requirements across healthcare organizations throughout the country.
As many as a third of hospitals, especially those in rural areas, did not participate in the voluntary accreditation program of the Joint Commission on Accreditation of Hospitals. Even though a goal of Medicare was to maximize healthcare access, it was evident that existing accreditation programs would not guarantee minimum health and safety conditions in all hospitals (McGeary, 1990). Therefore, the establishment of Medicare included requirements about “the maintenance of clinical records, medical staff bylaws, a 24-hour nursing service supervised by a registered nurse, utilization review planning, institutional planning and capital.
Non-compliance with CoPs can be serious. For example, “If conditions of participation are not met, various sanctions may be imposed upon the provider, including a corrective action plan, monetary sanctions, and increased reporting requirements. While a provider may eventually be excluded from the federal healthcare program, exclusion is relatively rare and only occurs if the provider fails to become substantially compliant during the corrective period” (Lauer et al, 2011).
Lauer, K., Ohta, J., and Hargreaves, A., “Violations of Payment/Participation Conditions as Predicates for False Claims,” Health Law Litigation, Spring/Summer 2011, Vol. 9 No. 2, Retrieved at https://www.lw.com/thoughtLeadership/violations-of-payment-participation-conditions-as-predicates-for-false-claims
McGeary, M., Medicare Conditions Of Participation And Accreditation For Hospitals in Medicare: A Strategy for Quality Assurance: VOLUME II Sources and Methods; 1990, Retrieved at https://www.ncbi.nlm.nih.gov/books/NBK235473/
This blog post continues a series excerpting the HealthStream article, Using Assessments and Training to Improve Conditions of Participation, by Debbie Newsholme, Senior Director of Content Development and Compliance Solutions, HealthStream. This article also includes:
To learn more about improving CoPs compliance in healthcare, download the article.
Expand the decision-making skills and effectiveness of your healthcare workforce with HealthStream's clinical development programs and services.
View All Clinical DevelopmentMake sure your clinicians have the support they need to provide competent care with clinical competency training and development from HealthStream.
View All ProductsThe suite of healthcare onboarding solutions available from HealthStream aids in nurse retention and improved patient outcomes.
View All ProductsGive your healthcare staff the decision support and skills training they need with the online products available from HealthStream.
View All ProductsHealthStream's solutions allow your healthcare workforce to be confident and competent with the knowledge they are upholding the highest of standards.
View All ProductsHealthStream’s learning management system and comprehensive suite of competency management tools empower your healthcare workforce to deliver the best patient care.
View All ProductsDelivers everything you need to request, gather, and validate information about a provider to create a single source of truth for downstream processes.
View All CredentialingExperience standardized and centralized healthcare credentialing, privileging, and enrollment that is smarter and faster than ever before.
View All ProductsAutomated, web-based provider credentialing and enrollment software for growing medical groups.
View All ProductsNCQA-certified CVO verification services for initial and re-credentialing files in an overflow or full-service capacity for healthcare organizations.
View All ProductsSearch, review, and add providers into the Epic provider master file with our Epic app integration, Provider Validate.
View All ProductsHealthStream’s learning management system and comprehensive suite of competency management tools empower your healthcare workforce to deliver the best patient care.
View All Learning & PerformanceHealthStream offers performance learning management solutions to help develop your healthcare staff into leaders and reduce turnover.
View All ProductsHealthStream works with healthcare organizations to create engaging and high-quality training videos for your staff and management.
View All ProductsImprove care quality and save money by making informed decisions about your healthcare facility and staff with HealthStream's reporting analytics solution.
View All ProductsHealthStream's proven methods for the improvement and overall engagement of your healthcare staff foster a positive workplace and increase retention rates.
View All ProductsThe leadership development program from HealthStream helps mold your high-potential healthcare employees into proven leaders.
View All ProductsWhen you enact HealthStream's quality compliance solutions, you can do so with the confidence your healthcare organization will meet all standards of care.
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View All ProductsBy increasing your healthcare staff's focus on quality and safety with HealthStream, they can help to reduce medical errors and readmission rates.
View All ProductsLearn about what HealthStream's healthcare policy management software and how it can help aid your organization efforts.
View All ProductsHealthStream's education helps address diversity, equity, and inclusion within your organization, as well as promoting health equity in the communities you serve.
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View All ResuscitationIn all areas of resuscitation, from neonatal to elderly care, clinical deterioration is a risk that can be avoided with the help of HealthStream's training programs.
View All ProductsHealthStream's EMS Program offers a comprehensive, CAPCE accredited EMS course library that meets National Registry annual recertification.
View All ProductsNurture the skills of your nurses and medical staff to help mold them into effective leaders with development training from HealthStream.
View All ProductsMake sure your healthcare staff can schedule out appointments and work schedules with ease using HealthStream's line of software solutions.
View All Scheduling & Capacity ManagementHealthcare scheduling software designed to optimize staffing requirements & elevate patient care
View All ProductsPrecisely align staffing and needed resources to enable efficient patient flow and high-quality, cost-effective patient care.
View All ProductsHealthStream’s free nurse schedule app, NurseGrid™, is built to help you care for your staff and engage with their specific needs.
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