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11
New Joint Commission standard requires
closer monitoring of hospital contractors
By Gary W. Herschman and Alexandra Miller Khorover
Effective January 1, 2008, The
Joint Commission implemented a
new leadership standard, LD 3.50,
which requires hospital leadership to affir-
matively monitor patient care, treatment,
and services that are provided through
contractual arrangements. This new stan-
dard is important because in order to sat-
isfy LD 3.50:
n hospital leadership must implement
policies and practices to ensure that
outside contractors provide patient care,
treatment, and services safely and ef-
fectively; and
n it may be necessary to amend existing
contracts and to include certain provisions
in new contracts.
The standard
LD 3.50 requires that patient care, treat-
ment, and services provided through con-
tractual agreements be provided safely and
effectively. The purpose of LD 3.50 is to en-
sure that patients receive high-quality care,
regardless of whether services are provided
directly by the hospital or through contrac-
tual agreements with outside providers.
Note that LD 3.50 applies only to agreements
for the “provision of care, treatment, and
services provided to hospital patients.”
The elements of performance for LD 3.50 are
designed to ensure that hospital leadership is
actively involved in monitoring and overseeing
the care and services rendered by outside provid-
ers to hospital patients. Leaders must be actively
involved not only in negotiating and approving
initial contracts, but also in monitoring each
contractor’s on-going performance, taking ap-
propriate action to correct any deficiencies, and
terminating the contract if necessary.
The Joint Commission does not prescribe
specific parameters for monitoring con-
tracted services. A hospital is free to develop
an oversight structure which is appropriate
to its institution and addresses the rel-
evant patient care and safety issues. Such
mechanisms may include a wide variety of
activities, including (without limitation),
audits of contracted services, direct obser-
vation, review of performance standards
and indicators, review and monitoring of
credentials and accreditation status, and
review of patient satisfaction surveys and risk
management issues.
Practical recommendations
In order to demonstrate a hospital’s compli-
ance with the requirements of LD 3.50, we
recommend that hospitals consider taking the
following actions:
1. Develop and enact a written policy which
describes the methods by which hospital
leadership monitors patient care, treat-
ment, and services provided through
contractual arrangements.
2. Written agreements with contractors pro-
viding patient care, treatment, or services
should include (and existing contracts
should be amended or updated if neces-
sary to include) the following:
n A comprehensive list of all services
to be provided by the contractor,
including a list of performance-based
expectations, goals, objectives, and
benchmarks.
n Additional requirements with respect to
risk reduction, patient safety, and staff
competence.
n A requirement that all contractor staff
be properly licensed, privileged, and
credentialed.
n A requirement that all services be pro-
vided in a safe and effective manner.
n A requirement to comply with all appli-
cable hospital policies and procedures;
state, local, and federal laws and regula-
tions (including without limitation
Medicare); and all requirements of The
Joint Commission.
n A requirement that the contractor
provide to the hospital written reports
regarding its services on a regular basis
(e.g., monthly, quarterly, etc.).
n To the extent possible, the right of the
hospital to terminate the agreement
without cause and without liability upon
the provision of reasonable notice, but
at a minimum, the right to immediately
terminate the agreement in the event
that the contractor’s actions adversely
impact patient care and safety.