TJC AND CMS NEWS FOR THE BEHAVIORAL HEALTHCARE INDUSTRY
November 2020
Greetings to Our Colleagues in Behavioral Health!
As Thanksgiving approaches, we hope you’re able to make plans for a safe and healthy holiday in this challenging time.

Joint Commission surveys have resumed and reached peak activity in October: 496 onsite surveys and 185 virtual surveys. Now, like everyone else, TJC is dealing with the COVID-19 peaks and grappling with getting surveys done in a safe and healthy manner.

At the same time, it’s important to maintain ongoing compliance and survey readiness as full survey activity will resume once again in the not-too-distant future.

So, this month we’re providing some important information to assist you with continuous readiness. Our first article covers TJC’s updated approach to the Credentialing and Privileging tracer – important info for 2021.

Our second article covers the change in the 90% flu vaccination goal requirement and, more importantly, what you still need to have in place for your flu vaccination program. 

We value your feedback on the newsletter. Please send us your comments and tell us what topics you would like to see in future issues. We look forward to hearing from you! Also, feel free to forward this newsletter to your colleagues.

Lastly, best regards to you and yours for a safe, healthy, and Happy Holiday Season! Our newsletter will return in January 2021.   
Anne Barrins
President/CEO
In This Issue:
Joint Commission Credentialing & Privileging Tracer: Focus for 2021
Joint Commission Flu Vaccination Requirement: 90% Goal Eliminated
New Clients
Tip of the Month
JOINT COMMISSION CREDENTIALING & PRIVELEGING TRACER: FOCUS FOR 2021
As we head into 2021, watch for a more consistent surveyor approach to the Joint Commission Credentialing & Privileging Tracer. In the past, this session has been somewhat surveyor dependent and, thus, has varied in its level of scrutiny.

Seems that’s about to change. TJC is establishing a more consistent format for this session. In addition, surveyors will be using a standardized tool for the Credentialing & Privileging Tracer. So, what should you expect from this session going forward? Let’s take a look and discuss some potential pitfalls.

First, there’s an opening discussion about the hospital’s credentialing and privileging process. In addition, surveyors cover three key areas during this 60 minute session ...
JOINT COMMISSION FLU VACCINATION REQUIREMENTS: 90% GOAL ELIMINATED
The Joint Commission recently announced elimination of the requirement for a 90% flu vaccination goal effective January 1, 2021. Currently, Infection Control standard IC.02.04.01 Element of Performance # 5 requires organizations to set “incremental influenza vaccination goals, consistent with achieving the 90% rate established in the National Influenza Initiatives for 2020.”

Rationale for this change is that in August the Health and Human Services Dept. removed the 90% goal in its publication “Healthy People 2030”.

Although the 90% vaccination goal is being eliminated, it’s important to note the rest of the Joint Commission flu vaccination requirements remain in effect.

In its announcement, TJC stated ...
NEW CLIENTS
Barrins & Associates is pleased to welcome two new clients:
Delta Specialty Hospital in Memphis, TN and Behavioral Crossroads Recovery in Egg Harbor Township, NJ. We are pleased to work with these organizations on regulatory readiness!
Time to be Survey-Ready Again!
The Joint Commission is conducting both virtual and onsite surveys. So, it’s time once again to be survey-ready. Contact us now and and we’ll help you prepare for the “new normal” in the 2020 survey process.  
1-877-546-7206
TIP OF THE MONTH
TJC has published the 2021 National Patient Safety Goals. Check out the Hospital
and Behavioral Health NPSGs for the latest versions.
Why Choose Barrins & Associates?
“Our Barrins & Associates consultant was a great addition to our team as we recently prepared for a survey at one of our hospitals. Her regulatory acumen was outstanding as were her insights and recommendations around safety culture. She helped us develop solutions for both the short and long term that will greatly benefit our hospital.”
Anne Kelly, EdD, BSN
Chief Quality and Compliance Officer
Franklin, Tennessee
Barrins & Associates provides Joint Commission and CMS consulting services for the Behavioral Healthcare industry. Our clients include psychiatric hospitals and freestanding Behavioral Healthcare organizations. We specialize in providing Survey Preparation and Continuous Survey Readiness services for the Behavioral Healthcare industry. Barrins & Associates was founded by Anne Barrins who was a Joint Commission surveyor for 13 years.