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Surgical hospitals must treat emergency patients
CMS: Calling 911 can't be a substitute
In the aftermath of reports that some surgical hospitals called 911 when patients developed complications, the Centers for Medicare & Medicaid Services (CMS) has issued a Survey & Certification letter clarifying that all hospitals are required to appraise medical emergencies, provide initial treatment, and provide referral when appropriate, regardless of whether the hospital has an emergency department.
A hospital is not in compliance with the Medicare conditions of participation (CoPs) if it relies on 911 services as a substitute for the hospital's ability to provide emergency services, according to CMS. The guidance does not apply to critical access hospitals (CAHs).
Additionally, CMS has issued its proposed hospital inpatient payment rule for 2008. Under the proposal, 745 new severity-adjusted diagnosis related groups (DRGs) would replace the current 538 DRGs. Under the proposal, surgical hospitals and other hospitals that treat fewer severely ill patients would probably see decreases in reimbursement. The Physician Hospitals of America (PHA) association, which represents specialty hospitals, supports the proposal. "PHA agrees that hospitals providing services to more complex patients should be reimbursed in a manner that reflects the nature of that care," the association said in a prepared statement. "We continue to support CMS' efforts to make hospital payments more rational."
The proposal also has new requirements for disclosure of physician ownership for specialty hospitals. They include:
PHA's response is that all hospitals, regardless of ownership, should disclose the financial arrangements between themselves and physicians, says Molly Gutierrez, executive director. Also, all hospitals should have to disclose whether they have 24/7 physician coverage, she says.
The proposed rule can be accessed at www.cms.hhs.gov.