A report issued on Thursday by the Office of the Inspector General of the Department of Health and Human Services is calling on the agency to require that physician-owned specialty hospitals be able to handle medical emergencies.
The recommendations came after a review of 109 hospitals last year by the OIG. The study found that fewer of one-third of all physician-owned specialty hospitals have physicians onsite at all times, and two-thirds of the facilities use protocols to call 9-1-1 as part of their emergency response procedures.
The OIG report calls on the Centers for Medicare & Medicaid Services to stiffen emergency care requirements for specialty hospitals.
"We recommend that CMS ensure that hospitals have the capabilities to provide for the appraisal and initial treatment of emergencies and that they are not relying on 9-1-1 as a substitute for their own ability to provide these services," the report concluded.
The report highlights emergency care shortcomings at specialty hospitals and, if acted on by CMS or Congress, could increase the financial requirements such facilities face to continue operations.
The report was hailed by senators Charles Grassley (R-Iowa) and Max Baucus (D-Mont.), who requested a review by the Inspector General in March 2006. They are ranking members of the Senate Committee on Finance, which is responsible for Medicare legislation and oversight.
"This new report documents the significant and potentially life-threatening shortcomings of physician-owned specialty hospitals when it comes to emergency services," Grassley said. "Congress needs to take action to stem the trend before the situation becomes irreversible."
Grassley suggested that the lack of service capabilities put community hospitals at a disadvantage.
"It's fair to ask whether taxpayers should continue to support the erosion of community hospitals," he said. "Community hospitals are a pillar of our nation's healthcare system, and people rely on their full range of services, especially emergency care, to be there when a healthcare crisis strikes."
Baucus noted that all hospitals participating in the Medicare program are required to provide for round-the-clock clinical staffing and implementation of written procedures.
"It's unbelievable that a facility that calls itself a hospital would, at times, not even have a doctor on call or a nurse on duty," Baucus said. "It is unacceptable that these facilities are not designed or equipped to handle emergencies. Medicare dollars for hospitalizations should not be spent on facilities that most people wouldn't even call a hospital."
Physician-owned specialty hospitals primarily perform cardiac, orthopedic or surgical procedures; they are partially or wholly owned by physician investors. Two recent deaths at these facilities raised concerns, as both patients died after elective procedures; neither facility had a physician on duty, and both called 9-1-1 to transfer patients to community facilities.
In the OIG survey, 7 percent of specialty hospitals did not have a nurse on duty or a physician on call during eight days sampled by OIG investigators. Hospitals were least likely to meet these staffing requirements on weekends.
In addition, administrators report less than one-third of specialty hospitals have a physician onsite around the clock. Lack of physician coverage is especially true at specialty facilities that don't have emergency departments. More than half of the facilities have only one emergency bed.
The OIG suggests that hospitals meet the current Medicare conditions of participation that require a registered nurse to be on duty 24 hours a day, seven days a week, and a physician to be on call if one is not onsite.
OIG said it would forward information on the eight hospitals that did not meet the staffing conditions for Medicare participation and the 37 hospitals that use 9-1-1 to obtain medical assistance.