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The Joint Commission Revises Its Interpretation of Respiratory Care Orders

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December 1, 2009

Back in August we notified our members of CMS’ interpretation of the Hospital Conditions of Participation Standard that requires respiratory care orders to be written only on, and in accordance with, the orders of a doctor of medicine or osteopathy (MD/DO).

CMS stated at the time that nurse practitioners and physician assistants could also write orders if they were eligible to do so under state law and the physician had delegated authority for them to do so. But, under that scenario, the physician would have to co-sign the order in a timely manner based on established hospital policies. The Joint Commission, however, held fast to their interpretation of the standard that only a MD/DO could write respiratory care orders. The differences in interpretation have caused confusion and the AARC has received numerous inquires since we published the CMS clarification.

We are pleased to report that the Joint Commission is now on the same page as CMS. In hopes of resolving the issue, the Government Affairs staff went back to CMS asking that they contact the Joint Commission to discuss CMS’ interpretation of the standard. Once again, our diligence has paid off. In the Joint Commission’s online newsletter, dated October 28, 2009, they have published a clarification of respiratory care orders. It states:

“Element of performance 7 under the 2010 hospital standard LD.04.01.05 requires all respiratory care services to be ordered by a physician. The Centers for Medicare & Medicaid Services (CMS) permits non-physician practitioners to write such orders provided it is within the scope of their license. The Joint Commission will also recognize respiratory orders written by eligible non-physician practitioners as meeting the requirement. However, if a physician delegates responsibility for writing orders to an eligible non-physician practitioner (such as a physician assistant or nurse practitioner), the responsible physician must co-sign the order.”