CMS Proposed Teleradiology Standards Also would amend TJC Contract Standard in Leadership chapter What hospitals need to know. Addition to Slides July 2010

2 Speaker Sue Dill Calloway RN, Esq. CPHRM AD, BA, BSN, MSN, JD President 5447 Fawnbrook Lane Dublin, Ohio

3 Credentialing and Privileging (C&P)  Direct care through a telemedical link:  Standard MS describes several options for C&P LIPs who are responsible for the care, treatment, and services of the patient through a telemedical link  Interpretive services through a telemedical link:  EP 9 in this standard describes the circumstances under which a hospital can accept the C&P decisions of a TJC ambulatory care hospital for licensed independent practitioners providing interpretive services through a telemedical link

4 Operations LD Contract Definition  Definition of contractual agreement: An agreement with any organization, group, agency, or individual for services or personnel to be provided by, to, or on behalf of the organization.  Such agreements are defined in a contract or in some other form of written agreement;  Such as a letter of agreement, memorandum of understanding, contract, contracted services, contractual services, or written agreement.

5 Operations Contracts LD LD Standard: Care and treatment provided through contractual agreement are provided safely and effectively,  EP1. Clinical leaders and MS have an opportunity to provide advice about the sources of clinical services that are to be provided through contracts,

Operations Contracts LD  July 15, 2010 TJC manual was to be changed related to tele-intepretive reading and hospitals using TJC for deemed status-use of contract in lieu of credentialing and privileging is not acceptable (CMS requires full C&P at this time and different from TJC Standard)  TJC also issues MS on telemedicine  Next CMS proposed in May 26, 2010 Federal Register to revised CoP for CAH and PPS hospitals  After CMS proposes changes TJC delayed these changes until March

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CMS Proposes Changes  Stay tuned because CMS is now proposing less burdensome telemedicine credentialing rules  Would allow hospitals to rely on information provided from another location to base C&P decisions regarding physicians and practitioners who use telemedicine at their facility  CMS realizes that credentialing process is difficult for small hospitals that lack resources to conduct traditional credentialing for physicians that provide telemedicine services  Would need to amend MS by-laws 8

CMS Proposes Changes  The new rule would still allow hospitals to use a third party credentialing verification organization to compile and verify the credentials of practitioners applying for privileges  The hospital's governing body would still responsible for making all privileging decisions  Physician would still need to hold a license in the state where the hospital receiving the telemedicine service is located  Comment period ends July 26, 2010  Source: Federal Register May 26,

CMS Telemedicine Privileges Rules  Hospital A has large group of radiologist who want to provide teleradiology services to Hospital B, a small community hospital  Hospital A must and does participate in Medicare (can’t rely on information from non-hospital entities)  The practitioners has privileges at Hospital A and they give Hospital B a list of the practitioners privileges from Hospital A  Each practitioner must hold a state license in the state of the originating site (Hospital A) and licensed by or recognized by the state whose patients are receiving the service 10

CMS Telemedicine Privileges Rules  Hospital A reviews the practitioners performance and sends Hospital B the results to be used in the periodic performance review of the practitioners/radiologists  This information must include any adverse events that result from the telemedicine services  Hospital A is required to evaluate the quality and appropriateness of the diagnosis and treatment furnished by its own staff to a CAH hospital  Board is to ensure there is this agreement and that the agreement says distant hospital (A) is meeting these requirements 11

CMS Telemedicine Privileges Rules  Hospital A and B need an agreement between them and this must state that Hospital A (the distant hospital) has to conduct credentialing of telemedicine in accordance with CoPs  No distinction made between teleradiology and teleinterpretive service  Board (Hospital B) will grant privileges according to the MS recommendations which can rely on the information from Hospital A now (now an option or can continue traditional method)  CMS has regulations in both Board and MS sections 12