THE WEEK OF NOVEMBER 28, 2022

CONTRIBUTE CONTENT TO THE PULSE

Your response to THE PULSE has been overwhelmingly positive. To continue providing membership with a quality product, we need your help. Member centers and vendors are urged to contribute content. This is your newsletter- be a part of it!

For it to reach its full potential, your contributions to content are needed.

Please send your questions and comments to the Editor, specific to these recurring columns: 

• SURVEY SNIPPETS
• WHAT’S ON YOUR MIND
• WE HEAR YOU

Please send your questions and comments to

Jeff: jshanton@jssurgctr.com

IT’S TIME TO RENEW YOUR NJAASC MEMBERSHIP!

Please be aware that 2023 NJAASC dues renewal letters have gone out to the membership.

NJAASC would like to thank all of you for your support this past year. We have even bigger plans for 2023, and we need your continued help to make it happen.

If you have any questions about your membership renewal or have not received a letter, please contact Kelly Biddle: kbiddle@njpsi.com.

We also have a membership renewal giveaway!

May a New Jersey physician pay for non-emergency medical transportation for his/her patients? 

A New Jersey physician may pay for non-emergency medical transportation so long as all appliable laws, rules and regulations are adhered to. Typically, providing a free or discounted service to a patient which would lead to the

generation of business payable by a federal healthcare program would violate the Antikickback Statute and the New Jersey Board of Medical Examiners (“BME”) rules. However, the Antikickback Statute provides certain safe harbor exceptions, including free or discounted transportation so long as certain criteria are met. To provide free or discounted transportation under the safe harbor exception, a physician must meet the following criteria: i) establish a policy for providing such free or discounted transportation that is applied consistently and uniformly and is not related to volume or value of a federal healthcare program, ii) the services are only offered to established patients of the physician, iii) such transportation is not air, luxury or ambulance level transportation, iv) the free or discounted transportation is for the purpose of receiving necessary medical services/supplies, v) physician does not market or advertise its free or discounted transportation, vi) the patient is within 25 miles of the where the services/supplies are to be provided, and vii) the physician does not shift the cost of the free transportation to any federal healthcare program or any other person. The New Jersey Board of Medical Examiners does not have the same clearcut exception to its rule regarding physician gifts. Per the BME a licensee shall not give or receive a gift of more than a nominal value or fee, which would be seen as promoting the licensee's business. The BME does state that a physician has discretion to waiver/modify a patient's fees. It is therefore arguable that providing free transportation is permissible in New Jersey, as a physician has the ability to waive a patient's fees under the BME. 

Source: 43 CFR Part 1001.952(bb) 

John Fanburg

Brach Eichler

jfanburg@bracheichler.com

With so many healthcare organizations moving to web- or cloud-based solutions for their systems and applications, there needs to be very specific policies and procedures around how users (to the systems and applications) are being managed, and how their access is secured

The Health Insurance Portability and Accountability Act (HIPAA) requires safeguards to be implemented to ensure the Confidentiality, Integrity, and Availability of ePHI at all times, and, of course, covers remote access to healthcare networks, EHRs, and ePHI. 

On a very basic level your organization MUST know who has remote access to systems and applications containing ePHI, what security measures are in place when accessing remotely and are they HIPAA compliant, whether the remote access is through company-owned devices, and who is monitoring and reviewing user activity on a regular basis. Some systems and applications allow users to access from any device at any time – is this necessary? This goes back to “role-based access” and “minimum necessary.” If users do not need to access systems and applications on weekends, evenings, or from home, put restrictions on when and where access is allowed.  

Dawn Meglino

HIPAA Compliance Specialist, CHPSE, CCSA, CCAP

DMeglino@ANATOMYIT.COM

When surveyors visit your center, they will look to ensure that the governing body has reviewed certain requirements. This is to be done at least annually. The best way to achieve this it to hold the annual meeting at the same time every year, i.e., 4th quarter every year. Do not review and approve these sporadically, as it will make it harder to prove that the Board complied with this requirement. It also delays the survey process, and that is never good.

The list of requirements is:

1. Patient’s rights

2. Delegated administrative responsibilities

3. Key programs:

a. The quality management and improvement program (QAPI)

b. The infection prevention and improvement program

c. The safety program

4. The organization’s policies and procedures

5. The appointment and reappointment processes

6. The scope of procedures performed and/or services provided

7. Revisions are made as needed to maintain compliance

When reviewing the key programs, don’t forget the risk assessments that are required for the development of the programs.

Ann Geier, MS, RN, CNOR(E), CASC

Ambulatory Healthcare Strategies

AGeier@AH-Strategies.com

From a center:



Peer Review needs to be meaningful and not just a medical record review:

• Review all events
• Tracking and trending
• Perform peer review on physician assistants, nurse practitioners, and certified registered nurse anesthetists, as well.

If you’ve been surveyed recently, the phrase “interim life safety measures” may ring a bell. Interim Life Safety Measures (ILSM) are the administrative actions taken to temporarily compensate for the hazards posed by construction activities, or any time the fire protection features of the facility are compromised. These activities can be in the center, or perhaps the building; even outside projects can cause changes to emergency response procedures. ISLM’s are intended to provide a level of fire safety comparable to that described in the 2012 edition of NFPA 101 Life Safety Code. Egress changes, locations of fire extinguishers, impaired sprinkler and/or fire alarm -- all of these require varying levels of action in the form of staff training and awareness, or posting of a fire watch.

Anthony Riehl, CFI, CESI

Healthcare Life Safety Consultants

anthony@hlsconsultantsllc.com

Enhancing your medication safety program

I think the biggest area towards enhancing medication safety is identifying drugs that can have dangerous effects if given incorrectly. We call these “high alert” medications. You should have a list posted in all drug

storage areas of those drugs on your formulary, along with the safety strategies you have in place. Your accrediting agency is focusing very heavily on this high alert, drug list, as wellas how you manage these medications and the strategies you choose. It does not necessarily require labeling everything, but a strategy for enhancing the safety of these medications. A master list can be found at ismp.org.

I’d like to talk about specific safety strategies with two medications. The first is IV phenylephrine found on the anesthesia carts and sometimes in your crash cart. The vial is 100 times more potent than the dose that’s needed to be administered. If it was given undiluted, it could be fatal. I’ve been recommending a simple step -- a secondary container that must be accessed possibly with a lid -- to prevent inadvertent preparation of the drug. A simple specimen cup labeled “ Caution Phenylephrine” placed on the anesthesia cart prevents this mistake from happening.

The second drug is IV Phenergan (promethazine), often used as a second line agent for postop nausea and vomiting in the recovery room. ISMP has reported that patients have experienced extreme harm, even loss of limbs, when this medication is given as an IV push. They recommend healthcare facilities around the country strongly consider eliminating it from their formulary. You should have this discussion with your anesthesia providers to determine if other options are available. They may want to consider adding IV droperido, l which is an excellent drug in small doses to treat refractory PONV in the recovery room. 

IF PROMETHAZINE remains on formulary and it can’t be eliminated, then labeling of the bins in the locations with large lettering “administer IM only” should be implemented. 

I’ll have further safety strategies in newsletters to come. We’d love to hear from you on what you’ve done to enhance your safety program.

John Karwoski, RPh, MBA,

President and Founder

John@jdjconsulting.net   

jdjconsulting.net

Q: When we are adding new certificates or documents that have expired in personnel files to someone’s file, can we discard the old document and throw it away or do we need to save it?

A: The NJ retention records will tell you how long to keep certain records. I had a surveyor tell me once that she did not want to see 5 years’ worth of certificates

and should keep only the last 2 years’, unless something one of a kind that does not renew.

Q: Can the Administrator and the Medical Director be the same person as long as they have both job descriptions?

A: No. My question back would be: how can the person have two full-time jobs?

These are two full-time positions with separate qualifications and job responsibilities.

• 8:43A-5 for Administrator
• 8:43A-7 for Medical Director

Stefani Mozgai

NJDOH

Q: Our pediatric hospital organization recently lifted preoperative testing on asymptomatic patients. Has NJ lifted any such requirements?

A: No. Again- ED 20-016-revised is still in effect until NJDOH gets around to revising the ED,which they tell us they are working on. Either: Fully- vaccinated or, if not, test and quarantine.

Q:  My HR person, who does the reporting to NHSN, said that covered employees require two boosters, plus be fully vaccinated to be considered up to date. Is that true?

A: Not in New Jersey. You go by the Governor’s various EOs 283, 290, 294 which define “up-to-date” as fully vaccinated and one booster. Indeed NHSN (per conversation with them) is really only concerned with gathering information on staff fully-vaccinated, and that will be the only statistic publicly reported.

Scheduling is an essential component of the billing process from both a patient flow and billing perspective. Scheduling conflicts can lead to cancelled procedures, which translate to lost revenue. If a scheduler fails to confirm the availability of key resources (e.g., implant, piece of required equipment), additional revenue may be lost if operating rooms are left sitting idle due

to last-minute cancellations. Fortunately, technology exists that helps ASCs automate their scheduling process, with some systems allowing automated information sharing between a physician’s office and the ASC.

Kathryn Boylan

SISFIRST

Kboylan@sisfirst.com

Did you know that implementing technology in the procurement process improves vendor relationships?

We’ve compiled a list of why technology helps:  

Better Collaboration  

Digitizing the procurement cycle will enable better communication with vendors. 

Streamlined Platform  

Ability to house all vital information on a single platform.

Easy Vendor Onboarding  

Procurement software makes finding vendors easier by compiling lists of potential vendors.  

Quick Payments  

Quickly make payments and obtain the incentives that accompany quick payments.  

Contract Compliance  

E-procurement solutions ensure your vendors comply with all the contract terms and conditions.  

Jillian Dickerson

HYBRENT

hello@hybrent.com

Physician burnout continues to be one of the major causes of unhappiness among providers. Today, spending more time on administrative tasks and less on patient care is a sore point for most providers. Dictation apps developed with physician needs and workflow management can go a long way to saving physician time. Administrators need to choose a dictation and chart management vendor carefully to ensure their center’s workflow needs are addressed, overall productivity is improved and there is training and support available.

A smartphone-based app should have at minimum the following attributes:

1. Ability to track pending and completed dictations easily.
2. Review, edit and e-sign op reports with just a few clicks.
3. No need to dictate patient information, as it can pull the same from scheduling software.

Sanjay Kaul

MEDOFFICEPRO

skaul@medofficepro.com

414 River View Plaza Trenton, N.J. 08611 •  (609) 503-7696  • info@njaasc.org

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