What Hospitals Should Do to Prepare for Joint Commission’s New Maternal Health Standards by July 1, 2020 and Manage Enterprise Risk: Overview and Checklist
This Bulletin is brought to you by AHLA’s Hospitals and Health Systems Practice Group.
- March 27, 2020
- Delphine O’Rourke , Goodwin Procter LLP
Less than a year after Representative Anna Eshoo declared that “[t]he United States is the most dangerous place in the developed world to deliver a baby,” during a hearing on maternal health, the majority of U.S. hospitals will need to comply with new requirements to address maternal mortality and morbidity.[1] Every year, more than 700 American women die of complications related to pregnancy.[2] At least 60% of those deaths are preventable.[3] Another 50,000 or more women suffer from life-threatening complications of pregnancy.[4]
On August 23, 2019, The Joint Commission introduced two new standards and 13 elements of performance (EPs) to improve the quality and safety of perinatal care in accredited hospitals.[5] The maternal standards require organizations to look at their processes and procedures surrounding the care of women experiencing hemorrhage, severe hypertension, and/or preeclampsia.[6] Setting forth the rationale for the maternal standards, The Joint Commission explained, “[t]hat prevention, early recognition, and timely treatment for maternal hemorrhage and severe hypertension/preeclampsia had the highest impact in states working on decreasing maternal complications.”[7]
The new standards are Medicare Conditions of Participation (CoP), which facilities must comply with to receive funding from the Medicare and Medicaid programs, the most important sources of funding for the majority of birthing centers in the United States.[8] To help hospitals prepare to meet the maternal standards and the 13 EPs, The Joint Commission issued a new R3 Report that provides the guidelines, requirements, rationale, and reference for each EP.[9]
The Joint Commission developed the maternal standards in collaboration with a range of experts including: recommendations from The Alliance for Innovation on Maternal Health (AIM) program’s maternal safety bundles that provide best practices for maternity health; advice from the American College of Obstetricians and Gynecologists (ACOG), California Maternal Quality Care Collaborative (CMQCC); consultation with a Technical Advisory Panel (TAP) of subject matter experts in maternal health; and consultations with a Standards Review Panel (SRP) of clinicians and administrators who provided an insider’s perspective.[10]
The prepublication version of the standards is available online until June 30, 2020 and can subsequently be accessed in the E-dition or standards manual. The standards will appear under the Provision of Care, Treatment and Services (PC) chapter at PC.06.01.01 (Reduce the likelihood of harm related to maternal hemorrhage) and PC.06.01.03 (Reduce the likelihood of harm related to severe hypertension/preeclampsia) in the Comprehensive Accreditation Manual for Hospitals.[11]
Joint Commission-accredited hospitals must comply by July 1, 2020 and are only three months away from an accreditation deadline. The new maternal standards present an important opportunity for hospitals to improve care for mother and babies in their own facilities and accelerate the pace of change in the United States.
Forward-thinking hospitals and health systems will recognize that the new standards create an opportunity for facilities to message their own programs to improve prenatal care. Better care of mothers and babies will improve clinical outcomes, attract patients, increase political capital in the community, and play an important role in addressing health disparities. Whether the new standards will be a reach for a facility or will have little impact on a sophisticated academic center, hospitals should maximize the potential for positive media coverage and public attention that the maternal standards will generate.
Many hospitals and health systems are already working to advance better health for women and mothers. An example of such collective strategies is the use of obstetric hemorrhage bundles.[12] A patient safety bundle is a set of evidence-based recommendations for practice and care process known to improve outcomes. Use of standardized and comprehensive obstetric safety bundles “has been shown to demonstrate signification reductions in maternal morbidity.”[13]
The impact of the maternal standards will likely extend beyond Joint Commission accreditation. The Joint Commission’s directives are long overdue and just the start of a much-needed regulatory framework to ensure meaningful improvements in maternal and fetal health. The standards are a good start and hospitals should consider them a floor, but definitely not a ceiling.
To manage enterprise risk, hospitals should consider compliance and documentation of such compliance with the standards as part of the minimum standard of care for labor and delivery that physicians, nurses, and other hospital personnel must meet. Ensuring that all personnel understand both the requirements and proper written documentation in the patients’ electronic health records will be critical. Failure to recognize and address maternal and/or fetal distress as well as failure to adequately follow-up after delivery are medical errors that often lead to medical malpractice actions. Birth injuries are tragic for the families, difficult for hospital personnel that cared for the patients, and expose hospitals and families to often crippling financial risk.
Improving maternal and fetal health is not only a clinical imperative, it is also critical to our health care system’s transition to patient-centered care, to addressing social determinants of health, and to decreasing inequalities in reproductive health care. Maternal and fetal mortality and morbidity disproportionally afflicts minorities, and particularly African-Americans.[14] “Black mothers are three times as likely as white mothers to die,” according to the Joint Commission guidance.[15] American health care providers now recognize the critical role that they can and must play in ending the racial bias and racism that have contributed to the current crisis.
With only three months left to comply with The Joint Commission standards and the focus on COVID-19, it is important that compliance teams not lose sight of the July 1, 2020 deadline and check or double-check that they are ready to go live.
The United States currently ranks 65th among industrialized nations in terms of maternal mortality. American mothers and babies deserve better.[16]
Access a summary checklist to assist implementation teams comply with the two maternal standards and 13 EPs by July 1, 2020 as well as additional suggestions to limit enterprise risk.[17] The checklist is not a substitute for legal advice and should be customized for each facility.