WASHINGTON – The Centers for Medicare & Medicaid Services are continuing to ratchet up the pressure on specialty hospitals, requiring them to improve their ability to treat patients with emergency conditions.
However, some critics of the small, typically for-profit hospitals said they didn’t believe the agency went far enough in requiring a standard for services.
CMS issued its guidance Thursday in a survey and certification letter, which was announced at the annual meeting between CMS and the directors of the state agencies that contract with CMS to survey hospitals and other providers and suppliers for adhering to quality standards.
The guidance states that all hospitals, including specialty hospitals and other facilities that don’t have emergency departments, must be able to evaluate patients, provide initial treatment, and refer or transfer patients that require more care than they can provide.
“Any hospital participating in Medicare, regardless of the type of hospital and apart from whether (it) has an emergency department, must have the capability to provide basic emergency care interventions,” said Leslie V. Norwalk, acting administrator for CMS.
Survey and certification letters guide state surveyors who inspect facilities to see if they meet all conditions for participating in the Medicare program.
CMS recently issued a proposed rule under the inpatient prospective payment system that would require a facility to notify patients in writing if it did not have a physician “in the hospital” to provide round-the-clock emergency care.
Under existing conditions for participation in the Medicare program, hospitals cannot rely on “911” emergency services that enable transfers to facilities offering a higher level of care as a substitute for their ability to provide emergency services.
That statement was spurred by a case earlier this year in which a 44-year-old man had to be transferred from 14-bed West Texas Hospital, Abilene, when the hospital's staff placed an emergency "911" call after the patient went into respiratory shock.
The guidance implements a step of the plan that CMS reported to Congress last August, in its “Strategic and Implementing Plan for Specialty Hospitals.” CMS issued the plan to comply with provisions of the Deficit Reduction Act of 2005.
CMS said other steps it has taken regarding specialty hospitals includes revising payment systems for inpatient and ambulatory surgical systems; requiring more transparency in disclosing ownership interests in specialty facilities; forcing specialty hospitals to disclose their emergency capabilities; obligating specialty hospitals to accept appropriate transfers of emergency patients; and making changes to enrollment forms to capture the type of hospital.
Critics say CMS didn’t go far enough.
“I appreciate that CMS did something to address a problem plaguing specialty hospitals, but I just don’t think it’s enough,” said Sen. Chuck Grassley (R-Iowa) in a statement. “Reminding hospitals of their responsibilities for emergency services under the Medicare program is a reasonable first step.
“The agency needs to examine their own procedures for determining if a hospital complies with Medicare’s conditions of participation and make appropriate changes to make sure they know when a hospital does or doesn’t comply,” Grassley added. “CMS also ought to look at the current requirements for emergency services capabilities to see if they need to be strengthened.”
Otherwise, CMS is taking steps in the right direction by requesting comments on whether these emergency services requirements should be strengthened in the fiscal year 2008.Medicare hospital inpatient prospective payment system proposed rule.