CMS Sets Requirement for Hospitals Without 24/7 Physician Coverage

From the Iowa Hospital Association

IHA has received several questions from hospitals regarding a new Centers for Medicare & Medicaid Services (CMS) requirement aimed at patient safety and emergency services. The requirement, effective October 1, mandates that all hospitals, including inpatient acute (whether Prospective Payment System or exempt), Critical Access Hospitals, long-term care, psychiatric, rehabilitation, children’s and cancer hospitals, that do not have physicians available on the premises 24 hours per day, seven days per week (24/7) inform patients of that limitation prior to patients receiving an inpatient or outpatient service.

CMS does not plan to prescribe specific language for the notice, but its discussion of the requirement indicates the notice must specifically state the hospital does not have physicians on the premises 24/7. The notice also must describe how the hospital will meet any emergency service needs when a doctor is not on the premises. The disclosure would be required at the point of registration or preadmission testing.

CMS does not intend to provide standard language for the new disclosure notice, but the notice still requires federal Office of Management and Budget (OMB) review and clearance under the Paperwork Reduction Act. Hospitals subject to the requirement (those that do not have 24/7 physician coverage on site) will need to create a disclosure notice and a plan for distributing the notice at all inpatient admissions and outpatient encounters.

Available information suggests hospitals simply need to provide the notice to each patient, without obtaining patient signatures documenting individual receipt. Hospital policies and procedures must be documented. However, the American Hospital Association cautions against finalizing the notice and procedures until CMS receives OMB clearance and issues provider manual instructions.

CMS has already completed the first part of the clearance process by soliciting public comment on the proposed disclosure requirement. CMS has yet to publish another notice with a 30- day comment period directly to OMB. It is expected that instructions will not be circulated to hospitals until the instructions receive OMB clearance, which is still pending.

California ED data

This week’s San Diego Union Tribune features a story of one doctor’s attempt to encourage hospitals to come clean with ED wait-time figures as a step toward improving traffic flow. Dr. Roneet Lev, an emergency physician at Scripps Mercy in Hillcrest, leads the Emergency Medicine Oversight Commission of the San Diego County Medical Society. She recently persuaded 19 hospitals to share emergency room procedures and statistics.

Also in California, the site of the Office of Statewide Health Planning and Development posts numbers from hospitals on the annual number of patients who enter the ED without being seen. It also asks facilities to disclose the number of hours per month they were on diversion. All you have to do is type in the city or name of the hospital you’re researching. 

Firefighters, police push for city’s help treating drug-resistant infection.

From the Fresno Bee

The Fresno City Council agreed Tuesday that a drug-resistant staph infection afflicting some city firefighters should be considered a work-related injury for firefighters and police officers.

Some firefighters are upset they’re forced to pay health insurance co-payments and use their sick time to recover from the infections they believe they contracted at work.

If treated as work-related illness, the city’s workers’ compensation insurance would cover those bills and pay the firefighters for lost work time.

The council voted 6-1 to direct city staff to write a policy making all cases of methicillin-resistant Staphylococcus aureaus a work-related illness for firefighters and police officers. The council must approve the policy in a separate vote.

CPAP for CHF instead of ETT?

From USA Today

For more than 30 years, paramedics have been saving the lives of these patients by inserting, through the vocal cords, a breathing tube about the width of a small garden hose and then pushing air into the lungs with an inflatable bag. Called intubating, it’s the street version of a hospital’s mechanical ventilator.

But the aggressive treatment is very uncomfortable for those on the receiving end, and it carries the risk of dangerous infection. So a device more commonly found in the hospital is making its way into the nation’s ambulances, including Harper’s rig in Houston.

Harper asks firefighters to bring him the breathing device known as CPAP, for continuous positive airway pressure. The football-size device with long plastic tubing and a plastic mask is being used now by emergency crews in seven other big cities, including Miami and Boston. Another 16, including Atlanta and Philadelphia, plan to put the device in ambulances soon, this month’s Journal of Emergency Medical Services (JEMS) reports.