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RSS Feed RSS By: Michael Kulczycki, Executive Director, Ambulatory Health Care

Information on all things ambulatory from The Joint Commission

Eliminating Reuse of Blood Glucose Monitoring Devices

Dec 13, 2017 | Comments (0) | 331 Views

WaldowskiBy Lisa Waldowski 
Infection Control Specialist 
Standards Interpretation Group 
The Joint Commission is urging all ambulatory care providers to take extra precautions regarding what we all might consider a fairly mundane device… namely, the humble glucometer (or blood glucose monitoring device).  

Lancets, finger-stick devices and glucometers designed for use by a single patient should never be used for more than one patient. According to the Centers for Disease Control and Prevention (CDC), outbreaks of hepatitis B virus (HBV) infection associated with blood glucose monitoring have been identified with increasing regularity, particularly in health care settings in which patients require assistance with monitoring blood glucose. 
The Centers for Medicare & Medicaid Services (CMS) and the U.S. Food and Drug Administration (FDA) prohibit the reuse of lancets, finger-stick devices and manufacturer-stated single patient use blood glucose meters on multiple patients due to the risk of transmitting blood-borne pathogens, including hepatitis B, hepatitis C, and HIV viruses. 

In the last 10 years there have been at least 15 outbreaks of HBV infection associated with providers failing to follow basic principles of infection control when assisting patients with blood glucose monitoring.  

Here are five simple steps ambulatory providers can take to avoid these hazards: 

  • Review your organization’s glucometer device and/or finger-stick device usage instructions. 

  • Never allow usage by more than one patient.

  • If the glucometer is used for more than one patient, as stated in the manufacturer’s instructions, the device should be cleaned and disinfected after every patient use with cleaning/disinfection products applied as stated by the manufacturer. If the manufacturer does not specify how the device should be cleaned and disinfected, then it should not be used by more than one patient. 

  • Conduct staff education, training and competency assessment on glucose monitoring that addresses equipment, devices and supplies utilized by staff. 

  • Provide staff with appropriate products and supplies for cleaning and disinfecting blood glucose monitoring equipment, as stated in the manufacturer’s instructions. 

Additional resources to guide your efforts: 


The Joint Commission. “Stop unsafe practices: Minimizing the risk of exposure to bloodborne pathogens when performing waived testing.” The Joint Commission Perspectives. 2017; 37(8):8-9. 

Joint Commission Podcast

The Joint Commission. “Preventing reuse of devices used for blood glucose monitoring” Quick Safety. November 2017; Issue 38. 

The Joint Commission Selected by Covered California for Medical Home Status

Nov 29, 2017 | Comments (0) | 124 Views

By Kristen Witalka

Senior Business Development Specialist17.AHC_Kristen

Ambulatory Care Services

Covered California has selected The Joint Commission as an approved accrediting body to fulfill its Primary Care Medical Home (PCMH) Certification incentive, with the goal of improving access to quality care for all patients – including ambulatory care patients – impacted by its health insurance plans.

This new recognition means California-specific ambulatory care organizations, hospitals, and critical access hospitals offering primary care services can use Joint Commission’s PCMH Certification to fulfill Covered California’s new incentive toward delivering improved quality of care to enrolled patients and improving access to primary care.   It’s worth noting that more than 20 primary care practices are already qualified to participate in Covered California by virtue of their PCMH certification through The Joint Commission’s Ambulatory Care Program.

Covered California is the nation’s largest state-based insurance exchange, serving more than 2.5 million patients through 11 contracted health insurance plans. By creating a new health insurance marketplace, Covered California’s mission is to improve health care quality and access to care, promote better health, lower costs, and reduce health disparities.

Covered California incorporates the following practices:

  • all patients either selected or are provisionally assigned to a primary care physician
  • providers incorporate advanced models of primary care into their patient care networks
  • hospitals and physicians exchange patient information so they are notified if patients are hospitalized
  • health disparities are tracked among all patients by racial/ethnic group and gender
  • programs are developed to proactively identify and manage at-risk enrollees


Basics of Primary Care Medical Home Certification

Launched July 2011, PCMH certification for Joint Commission accredited organizations focuses on care coordination, access to care, and how effectively a primary care clinician and interdisciplinary team work in partnership with the patient. PCMH certification is a three-year award and is an optional review built into the on-site accreditation survey process. Joint Commission’s PCMH Certification offers the following features:

  • no special application or document submission requirements
  • evaluation of compliance with PCMH standards as part of the regular on-site accreditation survey (unless the organization or provider requests a separate off-cycle extension survey)
  • surveyors who provide on-site tools, tips, and suggestions to achieve compliance

For more information, please review Covered California  for insights on their new recognition, the Joint Commission’s PCMH Certification website, or contact


Project REFRESH Debuts New Accreditation Survey Report - Jan. 1, 2018!

Nov 15, 2017 | Comments (0) | 1127 Views

Kay KruseBy Kay Kruse
Project Director, Business Transformation
Accreditation & Certification Operations

The Joint Commission’s Ambulatory Care customers told us their survey reports were often confusing to navigate. They asked us to redesign the survey report to make it more user-friendly and easier-to-understand. Our customers asked that the report highlight the most relevant information about their Ambulatory Care survey outcomes, and the required follow-up activities. Among other customer requests were:

  • prioritize and group survey findings by severity

  • highlight CMS Condition-Level and Standard-Level Findings

  • offer report sorting/filtering 

  • remove repetitive text

We’ve listened and – and through the ongoing efforts of Project REFRESH – will introduce a new accreditation survey report format that will be implemented for ambulatory care surveys conducted after Jan. 1, 2018.

Simplified Accreditation Survey Report 
The Joint Commission worked with Ambulatory Care Customer Advisory Groups, Ambulatory Care Surveyors and our Central Office staff to prepare a new Accreditation Survey Report. This new report will provide easy-to-read tables to succinctly deliver key information, in response to organizations’ request for simplicity. In addition to a PDF version, the new report will be provided in a downloadable Excel file.


The new survey report is organized into six sections, here are highlights from some of the new sections:

Cover Page
The cover page contains the name and address of the organization; the type of survey conducted, the programs surveyed (if applicable) and the organization’s on-site survey dates.

Executive Summary
This new portion of the survey report provides summary information by program, including:

  • programs surveyed and on-site survey dates

  • the accreditation decision

  • post-survey activity

  • follow-up time frames and submission due dates

What’s Next – Follow-Up Activity  
This new area displays each standard and Element of Performance (EP) with its required follow-up activity. Also included on this page are The Joint Commission and CMS Conditions for Coverage (CfCs) associated with the Requirements for Improvement (RFIs) contained in the report (as applicable for ambulatory surgery centers choosing Joint Commission’s deemed status option).

Survey Findings
The SAFER Matrix – which debuted earlier in 2017 – is included in this section. If the survey was conducted to satisfy CMS deeming requirements, a CMS summary table is provided. The standards and EPs are displayed alphabetically by chapter.  Multiple observations associated with a single EP are numbered.

Want to Learn More?
For questions regarding the new format for your Ambulatory Care Accreditation Survey Report, please contact Kay Kruse at

Emergency Management Final Rule Impacts Specific Ambulatory Customers

Nov 01, 2017 | Comments (0) | 1243 Views

17.BergeroBy Lynne Bergero
Project Director
Standards and Survey Methods

In September 2016, The Centers for Medicaid and Medicare Services (CMS) issued the Emergency Management Final Rule, a set of emergency preparedness and response regulations that applies to 17 health care settings, including ambulatory organizations.  

Ambulatory surgical centers (ASCs), Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs) that are currently accredited by The Joint Commission are already substantially compliant with most of these CMS requirements.  

However, The Joint Commission has developed revisions to emergency management standards addressing deemed status programs, including ASCs. To support consistency in practice and preparedness across more accredited ambulatory settings subject to federal emergency management regulations, The Joint Commission has also included enhanced requirements for FQHCs and RHCs.  

Need for Better Emergency Planning

The purpose of the new regulations is to improve preparedness of ambulatory care organizations so that they can respond as effectively as possible to emergencies.  Disasters in the community can damage individual facilities and disrupt care to hundreds or thousands of patients for days, weeks, or months.  Recent disasters this summer in the US only reinforce this point.  Therefore, these regulations hold many health care organizations to a higher standard for communication and coordination across the continuum of care and including safety partners such as:

  • health departments

  • health care coalitions

  • fire department

  • utility providers

  • government agencies

These communication and coordination efforts can extend the capabilities of an ambulatory care organization to care for its own patients, facilitate its assistance to other health care organizations, and support situational awareness for decisions regarding maintaining services, closing the organization, re-opening post-disaster, and more.


The CMS Emergency Management Final Rule is structured to address key areas of preparedness and response: 

  • an emergency plan, including any supporting policies and procedures

  • a communication plan, which can be part of or separate from the Emergency Plan

  • training and testing within integrated healthcare systems, an optional requirement that applies to organizations that participate in a larger health system’s integrated emergency management program

New EPs – Effective Nov. 2017

The enhanced ambulatory care standards have been approved by CMS and will be effective for ambulatory care surveys beginning November 15, 2017.  These new elements of performance (EPs) are all contained in the Emergency Management (EM) chapter and are designed to address the more complex disaster planning environment. The new EPs require that the emergency management plan:

  • be reviewed and updated on an annual basis

  • address collaboration with local, tribal, regional, state, and federal emergency management officials

  • establish Continuity of Operations, with focus on succession planning, delegation of authority, and continuity of communications and facilities  

Of these areas, Continuity of Operations may present the most systemic change. It’s an essential component of emergency management planning with the general goal of recovery and restoration of the organization as a functioning entity following a disaster. Continuity of operations planning focuses on protecting the physical plant, information technology systems, business and financial operations, and other infrastructure from direct disruption or damage so that the ambulatory care provider can continue to function throughout or shortly after an emergency.  

Policies & Procedures

Existing Joint Commission Emergency Management and Leadership standards sufficiently cover the need for policies for ambulatory care providers, but new EPs for detailed CMS procedures were developed to address: 

  • communication with external sources of assistance for emergency response – applicable to ASCs  only

  • sheltering in place – applicable to ASCs only

  • federal waivers for declared disasters – applicable to ASCs only

  • role of volunteers and integration of federal health care workers

  • scope of responsibilities for evacuated patients

Communications Plan

The communications plan EPs list specific individuals and entities for which the ambulatory care provider must maintain contact information, including: 

  • patients and  families

  • staff, physicians, and other potential response partners or sources of assistance

  • contractors and vendors

  • relevant federal, state, tribal, regional, and local emergency preparedness staff 

In many cases, ongoing collaborative partnerships will be based on factors such as:  

  • the community and patient population served by the ASC, FQHC, or RHC organization

  • ways community partners can coordinate with the ambulatory care organization during disasters

  • the organization’s role in community response

In addition, back-up communication mechanisms are required so that if primary systems fail, the ambulatory care organization can continue to communicate information about coordination of staff, continuity of operations, closure, reopening, and so forth.

Training & Testing

The new EPs specify that the ambulatory care provider must train staff in emergency management procedures annually, and document the training. 

CMS expects organizations to reach out to the larger health care coalitions or health departments in their communities to participate in emergency management planning activities and community-wide disaster exercises. For some ambulatory care providers, there may be no relevant opportunities to participate in exercises. Regardless, ambulatory care providers must attempt to reach out to participate in community exercises, and document these attempts and their outcomes. 

Integrated Healthcare Systems Option

If the ASC, FQHC, or RHC organization is a member of a health care system that has an integrated emergency preparedness program for its members, and the organization chooses to participate in it, the organization must participate in planning, training, exercises, and other preparedness and response activities specified in the new EPs.  

Depending on the organization’s risks, services, and capabilities, some aspects of integration with the system may be at an early stage rather than an advanced stage. However, because disasters can occur at any time, the organization must be prepared to activate communication channels with the system to coordinate any essential patient care, safety, or continuity of operation processes.      

Web Resources

I encourage you to review the following resources for additional background information regarding the Emergency Management Final Rule: 

Professional associations also periodically post Emergency Management resources to support compliance with regulatory requirements. Follow the links below to a starting point for resources from the Ambulatory Surgery Center Association (ASCA) and National Association for Community Health Centers (NACHC):

First Integrated Care Certified Organization Shares Tips for Streamlining Processes

Oct 18, 2017 | Comments (0) | 653 Views

By Michael Kulczycki
Executive Director, Ambulatory Health Care Program

The term “integrated care” is thrown around a lot in health care, but the recent emphasis on population health has made integration absolutely essential in providing safe care.

Last year, Parrish Medical Center of Titusville, Fla., received well-deserved attention for becoming the first hospital in the U.S. to earn integrated care certification (ICC) from The Joint Commission. For an organization or system that provides and coordinates care across different health care settings, this certification highlights:

  • information sharing

  • handoffs

  • IT integration 

  • risk sharing

  • patient-centered care


Parrish Medical Center is a 210-bed, not-for-profit public medical center in North Brevard County, Florida.  In late 2016, Parrish was reviewed initially for ICC certification for hospital and ambulatory care. In August, The Joint Commission conducted an extension survey for Parrish adding home health and skilled nursing to its ICC. Now four certified components partner together in delivering integrated care for Parrish: acute care, ambulatory care, home health, and skilled nursing.

A year into its 36-month integrated care certification, Parrish’s Edwin Loftin, Vice President Acute Care Services/CNO, notes that the organization had already been doing much of what is required for certification. Completing the certification evaluation last year merely documented their existing best practices.

Loftin explains, “As we all know, such an effort requires buy-in from the whole team. Unless ambulatory providers are truly integrated – not just affiliated – with their partner organization, it’s impossible to achieve the kind of care our patients deserve.”

Perfecting Transitions

Since Parrish Medical Center was already Joint Commission accredited, the first part of the ICC process was complete. The Joint Commission requires that an organization have only one component or program (the hospital, critical access hospital or psychiatric hospital, ambulatory setting, physician network, nursing care center, or home care) already accredited to apply for integrated care certification. 

Regardless of whether every part of the system is accredited or just one, it’s essential that every entity is communicating well. It’s been proven time and again that poor communication, especially during patient care transitions, results in adverse events. The certification process helped Parrish standardize:

  • hospital to ambulatory admission and vice versa

  • timelines for sending information between settings of care 

This really comes into play when process improvement efforts must span both the ambulatory and hospital settings, addressing areas like:

  • osteoporosis-associated fractures 

  • referral for tobacco cessation services 

  • radiation therapy and adjuvant chemotherapy after lumpectomy for breast cancer

Thriving During the ICC Survey

When The Joint Commission’s certification reviewers visit, they’ll want to “trace” the patient’s experience between sites and settings of care.

Reviewers will want to ensure high engagement between ambulatory providers, referring physicians and the hospital, often referred to as the “medical neighborhood”. One way of promoting strong engagement is by auditing pertinent data sets. These aren’t typically included in the general referral request, but speak volumes about the level of care coordination.

Pertinent data sets address:

  • the name of the clinical condition or diagnosis

  • description of how pertinent data set conclusions were achieved, including any supporting references

  • additional relevant patient information that’s included in the patient record

Certification Standards Specifics 

Parrish Medical Center actually found the process to be pretty seamless and the specific certification standards aligned with the processes already in place. 

Integrated care standards simply covered:

  • program organization

  • defined leadership

  • clear mission, vision and goals

  • identified scope of service

  • communication processes ensuring quality care throughout the hospital and ambulatory journey

  • support of population-based care

  • sufficient providers to meet patient needs

Parrish is no longer the only organization certified for integrated care by The Joint Commission, but its experience seems universal to many healthcare organizations focused on providing integrated care to select patient populations. If your organization could benefit from ICC certification, like Parrish, please email us for more information. If you’d like to learn about Parrish’s ICC journey, I encourage you to request this ICC white paper.

We’re always glad to hear from you… please stay in touch!