Posts Tagged ‘Hospitals’

Regulatory Reform

December 25th, 2014

gavel-214x300We met a major milestone in 2014 when we filed our final new set of regulations for Arizona’s 5,500 licensed healthcare facilities.  We’ve now completed our overhaul of the State’s regulations of hospitals, behavioral health inpatient facilities, nursing care institutions, recovery care centers, hospices, behavioral health residential facilities, assisted living facilities, outpatient surgical centers, outpatient treatment centers, adult day health care facilities, home health agencies, behavioral health specialized transitional facilities, substance abuse transitional facilities, behavioral health respite homes, adult behavioral health therapeutic homes, child care facilities and the regulatory standards for licensed professional midwives.

We worked hard with our partners to develop a better set of rules during this 4-year regulatory reform effort. The new model sets some prescriptive minimum standards – and requires facility operators to develop an additional set of policies and procedures to ensure patient and resident health & safety. Facilities are also required to measure patient and resident outcomes and adjust their policies and procedures as needed to improve outcomes.

If facilities have bad (preventable) outcomes – our survey teams will determine whether the facility wasn’t following its policies and procedures, had inadequate policies and procedures, or both- and require them to make needed improvements.

While the regulatory reform piece is complete, we still need to educate and train our survey teams and healthcare facilities on the new regulations. Because the final rules depend largely on outcomes and solid policies and procedures rather than just static standards – this effort won’t happen overnight. It’ll probably take all of 2015 to get everybody up to speed on the new expectations.

Regulatory Reform Finish Line

June 28th, 2013

We owe a big round of applause to our Licensing & Rulemaking teams- who’ve spent the better part of 2 years working with hundreds of folks from numerous associations and licensed facilities as part of our regulatory reform initiative. 

This afternoon we filed an overhaul of 20 Articles of regulations for healthcare institutions and behavioral health service agencies including hospitals, skilled nursing facilities, outpatient surgery and treatment centers, recovery care, adult therapeutic foster homes, assisted living, home health agencies, hospice facilities, DUI services; residential treatment centers and midwives.  A big thanks to the entire Licensing, Rulemaking, and Behavioral Health teams for making this effort a success.  These new rules will be driving Arizona toward better public health outcomes for years to come. 

All the rules have an October 1 implementation date, although most of the midwifery regulations kick in right away.  The delayed implementation date gives: 1) our licensees a chance to learn the new rules before they’re expected to comply with them; 2) our surveyors time to learn the new rules so we can survey to them properly; and 3) AHCCCS the time they need to figure out some reimbursement issues.  

The next step is to prepare for implementation of the new rules.  Check out our implementation website for the nuts and bolts of the upcoming implementation activities.  The state budget gave us extended “exempt” rulemaking authority through April of 2014…  meaning that we’ll be able to make additional revisions as we implement the new regulations and find areas that can use tweaking.


Regulatory Reform in the Home-Stretch

June 21st, 2013

Our Licensing & Rulemaking teams have spent the better part of 18 months working with hundreds of folks from numerous associations and licensed facilities as part of our regulatory reform initiative.  We’ve been overhauling 18 Articles of regulations for Healthcare Institutions and Behavioral Health Service Agencies including hospitals, skilled nursing facilities, outpatient surgery and treatment centers, recovery care, adult therapeutic foster homes, assisted living, home health agencies, hospice facilities, DUI services; residential treatment centers and midwives.  It’s been a long road- and we’re in the final-stretch now. 

Our teams are busy going through some final revisions to the 600 pages of new Rules, which we’ll be filing next week.  We’ll have an October 1 implementation date on each of the packages.  That’ll give our licensees a chance to learn the new rules before they’re expected to comply with them; it’ll give our surveyors time to learn the new rules so we can survey to them properly; and it’ll give AHCCCS the time that they need to figure out some reimbursement issues. 

As an added bonus- the state budget that was signed by the Governor on Monday gives us extended “exempt” rulemaking authority through April of 2014…  meaning that we’ll be able to make additional revisions as we implement the new regulations and find areas that can use tweaking.

Licensing’s Stakeholder Cornucopia

April 29th, 2013

Our Licensing and Rulemaking teams spent virtually all week hearing from hundreds of Stakeholders from numerous associations and licensees about our ongoing regulatory reform effort.  Our team met with representatives from:  Adult Day Health Care Facilities;  Assisted Living FacilitiesHome Health Agencies; Hospices; Hospitals; Nursing Care Institutions; Outpatient Surgical Centers; Outpatient Treatment Centers; Recovery Care Centers; Adult Therapeutic Foster Homes; DUI Services; Level 1 Residential Treatment CentersLevel 1 Sub-Acute Facilities; Level 3 BH Residential Agencies; Level 4 Transitional Agencies; and Rural Substance Abuse Transitional Agencies

Most of the meetings went fairly well, with representatives providing us with specific and mostly constructive feedback which we’ll use to help construct better regulations.  Some meetings were more helpful than others.  The meetings in which folks gave us specific and targeted feedback regarding discrete parts of our draft rules were, of course, the most productive. 

We’ve posted our draft rules for Healthcare Institutions and Behavioral Health Service Agencies on our website.  Folks can continue to provide written comments and feedback via the respective on-line surveys on the Healthcare Institutions and Behavioral Health Service Agencies websites through May 5.


Regulatory Reform Update

January 22nd, 2013

We’re continuing to make significant progress in our licensing regulatory reform efforts.  Our overall goal is to simplify and streamline our regulations so they align with our strategic plan and map to improve public health outcomes.  The new regulations will more acutely focus on health and safety criteria- and will put more emphasis on outcomes.  We’ve held numerous meetings with representatives from the medical community, the behavioral health system, advocates and other affected stakeholders to help us reform our regulations for Inpatient Behavioral Health Facilities, Residential Facilities, DUI Services, Domestic Violence Offender Treatment Programs, Outpatient Treatment Centers, Nursing Care Institutions, Assisted Living Facilities and Hospitals.  Public comments are being solicited through online surveys.  

In all, 18 Articles of regulations are being overhauled.  Draft Articles and online surveys can be found at the Health Care Institution and Behavioral Health Service Agency webpages.  By April 1st final drafts will be posted on our website for another round of comments.  The completed rules will be submitted to the Secretary of State by July 1, 2013. Thanks to all who have helped to advance the licensing of integrated health in Arizona!

Preventing Healthcare Associated Infections: An AZ Winnable Battle

January 4th, 2013

Healthcare-associated infections are a critical public health challenge in Arizona and in the US. Healthcare associated infections (HAIs) are acquired during healthcare treatment and can be devastating and even deadly- and they’re largely preventable. You may have seen the article in last week’s Republic about dirty needles and their link to transmission of viruses and drug-resistant superbugs. The article mentions a recent Arizona incident in which unsafe injection practices at a pain management clinic- which had been investigated by our disease detectives in AZ’s public health system and summarized in an MMWR article last Summer.

Arizona’s public health system takes a layered approach to preventing HAI’s in our state.  It starts with our Licensing team- who regulates the healthcare institutions where care is given.  Our regulations set the standards that prevent infections and our teams of surveyors do routine checks and complaint investigations to make sure facilities are in compliance with our standards.  We already have solid infection control regulations for hospitals and nursing homes…  but our current Rulemaking for healthcare institutions will be establishing new infection control standards across the board that’ll be applied consistently across all health care institutions in the second half of 2013.

At another level, our Medical Facilities Licensing team and our HAI Program collaborate to ensure the safety of patients in Arizona by jointly providing technical assistance and guidance to licensed healthcare facilities in response to identified infection control breaches. Through our HAI Program and our HAI Advisory Committee– we generate guidance documents for all healthcare facilities and promote best practices for infection control and injection safety like materials produced through the CDC’s One and Only Campaign and our No Place Like Home initiative which is Arizona’s approach to the national Partnership for Patients: Better Care, Lower Costs project.

The next layer is our network of public health disease detectives.  Our Healthcare-Associated Infections Program and the counties conduct  epidemiologic investigations when we get reports of unsafe injection practices affecting multiple patients. For example…  last year we investigated 3 separate instances of unsafe injection practices- exposing 327 people to disease and resulting in 3 infections.  Each of the investigations identified unsafe injection practices like: 1) Re-inserting a used syringe into a medication vial; 2) Using a single-dose vial for more than one patient; 3) Diluting medicine beyond the manufacturer’s recommendations; 4) Improper use of personal protective equipment prior to spinal/lumbar injections; and 5)  Illegal contamination of needles/syringes and injectable reagents.

Many of the gaps in infection control have roots at the national level.  A national drug shortage on many reagents and medications (including appropriate concentrations and single-use vial sizes) has compelled some healthcare practitioners to search for alternate solutions to ensure availability and to use medications as economically as possible. Some practices, like using single-dose vials for multiple patients, may be considered an industry standard in some fields and may still be taught and practiced, despite CDC injection safety guidelines inclusion in Standard Precautions since 2007. Many of these challenges can be safely addressed through medication repackaging into single-dose vials by a licensed compounding pharmacy appropriately applying the U.S. Pharmacopeia standards.

In short- healthcare associated infections remain a public health problem nationally and in Arizona- but by continuing to effectively use our licensing survey teams, effectively using the network of disease detectives we have in our county and state public health system, and by leveraging the work of our HAI Advisory Committee, the One and Only Campaign, and Arizona’s No Place Like Home Initiative- preventing healthcare associated infections remains a Winnable Battle.


RSV on the Upswing in AZ

December 12th, 2012

We’re off to an early start with the flu and RSV season this year with more cases reported in November than in previous seasons. Respiratory syncytial virus (or RSV) is a respiratory virus that mainly affects little kids and circulates during the winter. There’s no vaccine for RSV- but for those babies that are at highest risk (premature infants), doctors can give a preventive treatment throughout the season. The number of cases is still pretty small (about 100 so far this year), but we’ve had a 40% increase in cases over last year. That doesn’t always mean that there will be more cases this season, but it may just be a sign that our cases will happen earlier. 

Once RSV infections begin to increase we usually have high levels for a few months. Doctors who give RSV antibody to high-risk infants might want to start incorporate this info into their treatment plans soon- and it’s time for hospitals to start thinking about implementing their RSV prevention plans. Our flu numbers have also been high for this season (cases this week double from last week), so now is the perfect time to go out and get your flu shot. If you want to keep a watch on the numbers, our flu and RSV website has a host of useful information including periodic reports.


Evidence-Based Decision-Making: A Key Regulatory Benchmark

November 19th, 2012

The role of a surveyor can be a difficult one. Our team of licensing surveyors need to maintain neutrality as regulators and be able to apply the Arizona Administrative Code (otherwise known as “the rules”) to a wide variety of facilities within the healthcare system.  Part of our surveillance includes investigating complaints– which can be generated from an array of internal and external sources.  When the complaints come because of TV or other media coverage- it can pose unique challenges for our team.  But…  no matter where the complaint comes from, our job is to use facts and evidence to drive our investigation, decision-making, and interventions. 

There are 3 forms of evidence that we use to substantiate an allegation made in a complaint: 1) observation; 2) documentation; and 3) interviews. Two of these forms of evidence need to be present before we find that a complaint is “substantiated”.  By using these tried and true evidence-based tools we put ourselves in the best position to identify real health and safety problems without jumping to conclusions.

Focusing on facts and evidence (and not allowing one’s self to be driven by media coverage) is a good start…  but there are a few things that both surveyors and healthcare professionals can do to keep focus on providing a healthy and safe environment. Keep good records, document, sign and store up to date data, maintain consistent supervision for those that require it, follow your agency’s policies and procedures without fail, report what’s required, be proactive (not reactive), and seek out ongoing education in your field.  Don’t cut corners when it comes to care… and don’t be afraid to admit a mistake or that you do not have all the answers. 

So, if you happen to hear or see a TV story about a facility, keep in perspective that the story might focus on anecdotes and what the reporter thinks they know or even just their opinion- not necessarily what the evidence demonstrates.  In a time when information is disseminated second by second rather than day by day, let’s remember that we all share the same goal, to promote Health and Wellness for all Arizonans, which includes providing surveyors, community, clients and staff accurate and factual information.

Curious about the real scoop on how all of our licensed facilities are doing?  Check out our AZ Care Check website which has the details about our evidence-based investigations and surveys.

Our New Strategic Plan

October 17th, 2012

The vision of the Department is to ideally achieve a state of Health and Wellness for all Arizonans and our mission is to promote, protect, and improve the health and wellness of individuals and communities in Arizona. The updated mission and vision statements are helping us build public health value in-house as well as in the community.  The format was modernized and ADHS is making an effort to educate our partners and reinvigorate staff on our goals.

We’re among the largest and most complex of state agencies. With over 1,600 employees and an annual budget of more than $1.8B, we provide a wide variety of services and a diversity of programs housed within its five divisions: behavioral health; licensing; planning and operations; public health prevention; and public health preparedness. The two-fold mission of public health services includes prevention and preparedness for the state. The public behavioral health system oversees services for 150,000 enrolled clients and the state’s only public psychiatric hospital, the Arizona State Hospital. The division for licensing is charged with certification of nursing homes, assisted living and child care centers, hospitals and other health care facilities. The division for planning and operations oversees the budget, procurement, audit and special investigations, information technology, workforce development, rule-making, human resources, policy, continuous quality improvement, and accreditation.

Our strategic priorities are the pathways we use to achieve targeted improvements in public health outcomes. We’re committed to moving along with our partners in local health departments toward voluntary public health accreditation. The work towards accreditation will require the agency to look at the statewide public health system as a whole, collaborate with stakeholders, and provide evidence that our work meets the ten essential public health services. The ten essential services were set as a national standard in 1994 by a steering committee consisting of all US Public Health Service agencies and representatives from other major public health organizations. Accreditation focuses on quality, transparency, and partnerships. Through the accreditation process, our leadership will identify strengths, weaknesses, and opportunities for continuing to build public health infrastructure in a way that will best align our resources with key priorities.

Our new updated Strategic Plan lays out the framework for how we’ll use quality improvement, lean methodologies, best practices, and strategic alignment to achieve our vision of “Health and Wellness for All Arizonans

Interim AD for Licensing

May 10th, 2012

 Colby Bower will serve as our Interim Assistant Director for Licensing while we recruit and hire a permanent Assistant Director.  Colby has been serving as our Legislative Affairs chief for the last couple of years.

Colby fills several of the criteria that we needed for the interim post: 1) He’s a good risk manager and has a good understanding of the importance of Stakeholder relations; 2) He understands the matrix of our statutes and rules- and knows that we need to exercise our authority through the prism of public health; 3) He’s good with people; and 4) Now that the legislative session is over- he’ll have the time needed to invest in the program.  Our Operations folks are busy doing all of the IT, finance and legal things to get Colby the authority and tools he’ll need in his post.

We’ve already announced our recruitment for a permanent Assistant Director.  I blogged about the recruitment yesterday, including a hot link to the job announcement on ADOA’s website.  Our goal is to complete the recruitment process and hire a permanent AD this summer.


Join me in welcoming and thanking Colby for his willing to fill this important post while we go through the full recruiting process!