Page 88 - Flipbook January Board

Regulatory Visit Update

Department of Health

Unannounced patient complaint visit 12/19/18- Unsubstantiated

DEP visit on 11/6/18- resulted in one finding in Radiation Oncology

and response submitted 12/21/18

New DOH regulation: Patient Test Results Information Act (Act 112)

The new law states that “if an entity performing diagnostic imaging services detects an abnormality,
the entity must directly notify patients or their designee no later than 20 days after the date of

service.”

• Due to the vague details of this requirement and questions from multiple

organizations, sanctions delayed one year (now effective 12/2019)

Joint Commission

Hospital survey action plan monitoring in progress and on target

Quality Audit Teams in planning stage with upcoming meeting to

finalize details for implementation

Other

Recruitment/interviews for Director position underway