Action Alerts

JCAHO Says All H&Ps Done Prior to Admission Must Be Updated!
March 2005

The Joint Commission on Accreditation of Healthcare Organizations (“JCAHO”) recently made several announcements regarding its new interpretation of history and physical (“H&P”) examination requirements, but you may have missed the most significant change. JCAHO now requires all H&Ps done prior to admission to be updated – regardless of when they are completed.

The rules on H&Ps have always been complicated by the fact that JCAHO has different requirements than those found in the CMS Conditions of Participation. Until late in 2004, hospitals could rely on the compromise that satisfied both JCAHO and CMS: an H&P had to be done within 24 hours of admission and an H&P done up to 30 days prior to admission could be used so long as those more than 7 days old were updated. This was a blend of the two rules as outlined in CMS’s interpretive guidelines to the Conditions of Participation. 

On December 3, 2004, JCAHO published a frequently asked question (“FAQ”) on its website stating that Standard PC.2.120, EP 6, would now be interpreted differently. The FAQ states:

The H&P must be performed within 24 hours of the inpatient admission … or you can utilize one that was performed up to 30 days prior to the inpatient admission or the outpatient services …

In 2004 at PC.2.120 EP 7 an update … is required at the time of admission when using an H&P that was performed before admission. This is different than in 2003 when the update was only needed when there were significant changes or the H&P was 8 - 30 days old as required by CMS.

This made clear that the old rule, which did not require H&Ps done within 7 days prior to admission to have an update, is obsolete. But because JCAHO states that “The H&P must be performed within 24 hours of the inpatient admission…”, some people interpreted this to mean that an H&P done within 24 hours prior to admission would be acceptable without an update. This is not the case.

The JCAHO Standards Interpretation Group has told QMCG that all H&Ps done prior to admission must be updated – regardless of when they are completed. QMCG specifically asked whether H&Ps done within 24 hours prior to admission must be updated at or after admission and the Standards Interpretation Group stated: “Yes” and clarified that “Any H&P that is performed prior to admission, must be updated.”

What does this mean for hospitals? Catherine Ballard and Marty Baxter, attorneys with QMCG’s affiliated firm of Bricker & Eckler, LLP say: “JCAHO is taking a hard line. Even if the history and physical is only a few hours old it must be updated at the time of admission or within 24 hours thereafter.” This could be a significant change for hospitals and physicians as it is common for a physician to conduct an H&P at the physician’s office when an admission is planned for later that day. Now, JCAHO would require an update to such an H&P. Further, most medical staff bylaws have language matching the old rule. Ms. Ballard and Ms. Baxter further state: “Hospitals are going to need to look at the language in their medical staff bylaws and add language regarding this new update requirement. And, hospitals are going to need to educate their medical staffs on this change.”