Why Medicare Requires Evidence-Based Order Sets

ProVation Order Sets screen shotSince July 2012, Medicare requires evidence-based orders sets for hospitals participating in Medicare who employ order sets. The rule is part of the Conditions of Participation issued by The Centers for Medicare and Medicaid Services (CMS) at the United States Department of Health and Human Services. The requirement was introduced without much fanfare or controversy, but it added a significant regulatory burden to healthcare providers that utilize order sets. Medicare favors evidence-based order sets because timely maintenance of evidence-based order sets helps hospitals improve outcomes and provide higher quality of care.

While CMS does not require the use of order sets, it does require that hospitals that use order sets or pre-printed or electronic standing orders or protocols follow nationally recognized and evidence-based guidelines and recommendations. Because new evidence and revised guidelines and recommendations appear on a regular basis, these hospitals must update their order sets continually. For providers, that means a continual drain on internal resources. Leveraging evidence-based order sets from a third party can help hospitals meet the requirement while implementing evidence-based practices that will pay dividends in the new era of value-base reimbursement.

For example, in June of this year UpToDate issued a Practice Changing Update regarding chemohormonal therapy for metastatic prostate cancer. Almost immediately, this new recommendation was incorporated into ProVation Order Sets, powered by UpToDate Decision Support. By comparison, updating and approving internally maintained order sets following a practice changing update can take months to complete.

While order sets can be established and maintained by hospital staff, this is a time-consuming challenge. Nearly two million new scholarly articles appear each year and practice recommendations evolve continually. The demands on internal staff time are substantial, in some cases unmanageable.

With ProVation Order Sets, maintaining and updating order sets is systematized through sophisticated online content management, including the One-Click Update feature. With One-Click Update, alerts are sent to order set administrators whenever order sets have been impacted by UpToDate Practice Changing Updates or FDA safety alerts. Web-based review provides easy and efficient sign-off for changes.


To learn more about how evidence-based order sets can improve your bottom line, download The Return on Investment of Evidence-Based Order Sets today.