The Joint Commission (aka JCAHO, universally pronounced “Jayco” and thusly spelled in this post) is a group of fuddy-duddies who, since they apparently can’t get real jobs in health care, go around inspecting hospitals and making up increasingly onerous and byzantine rules in order to punish legitimate health care workers. For years this rogue agency (which is a private sector organization) has terrorized hospital administrators, nurses, and doctors, coming up with more and more ridiculous mandates that only serve to make health care more costly and unwieldy. When they show up at your hospital, you start to hear the nervous whispers in the background: “Jayco is here. Watch out.” I remember at my former institution our EP nurses taped the red sharps bucket to the wall (with scotch tape!) because some Jayco rule prohibited that sharps buckets could be sitting on a counter top. Break one rule and your hospital could be shut down to become a empty ruin, much like an abandoned TB sanitorium — or so one would think based on how hospitals react to a surprise Jayco visit.
The rule that bugs me the most states that before doing a procedure there must be a “current” History and Physical (H&P) in the chart. Current means done within 30 days. If the office note is more than 30 days old, the physician must write out a new H&P before the procedure can be done. Why this H&P is necessary is not explained. Why a 30 day old H&P is ok but a 31 day old H&P is no good is not clear either. If a doctor at hospital A has a procedure at hospital B with an out of date H&P, he must leave hospital A 30 minutes earlier than he would otherwise in order to do the H&P, and then wait at hospital B for the patient to be put on the table and prepped, potentially without any other work at hospital B; i.e. wasting his/her time. Not very efficient! In the case of my practice, the office notes from our EMR system are extremely detailed and well-formatted. If this office note is out of date, my hastily scribbled note, lacking all details, becomes the official H&P note — basically a useless note, but meeting the time window mandated by Jayco. This rule affects my life nearly every day, slowing me down, and adding nothing to patient care. By the way, even though this updated H&P is compulsory, you can not bill for the H&P. It is considered a part of the procedure. Great!
In a busy practice it is very difficult to get an elective procedure scheduled within 30 days of an office visit. I am realistic enough to know that Jayco won’t go away any time soon. I would like them to lighten up on this one rule. Extend the definition of a current H&P to 60 days, and probably 90% of these H&P updates would become unnecessary. This would tremendously speed up my day, get patients their procedures on time, and overall improve efficiency. Seems like a good compromise to me.