Friday, October 12, 2007

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.


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