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.