Physician-owned specialty hospitals are largely unprepared to handle emergencies, according to a report from the Inspector General of the Department of Health and Human Services.
The IG's office reviewed written policies for managing medical emergencies, staffing schedules, and staffing policies for 8 days at 109 physician-owned facilities. Overall, 66 of these were surgical, 23 were orthopedic, and 20 were cardiac hospitals. Eighteen of the cardiac hospitals had an emergency department; only 11 of the 23 orthopedic hospitals and 31 of the surgical hospitals had an ED. Thirty-three of the 109 hospitals were in Texas, 15 were in Louisiana, 9 in Oklahoma, 9 in Kansas, and 8 in South Dakota. The rest were spread elsewhere.
While half of the physician-owned hospitals surveyed had an ED, more than half of those only had a single bed. Only 45% of had a physician on site at all times.
In all, 93% of the hospitals met Medicare staffing requirements: having a registered nurse on duty at all times and a physician on call at all times. But seven hospitals did not have an RN on duty, and one hospital did not have a physician on call or on duty on at least 1 of the 8 days.
Two-thirds of the hospitals told staff to call 911 in case of emergency. Although transferring a patient to another hospital's ED is acceptable, it might be a violation of Medicare conditions of participation if a hospital uses 911 to obtain medical assistance to stabilize a patient.
A hospital also is not in compliance if it uses 911 as a substitute for providing services required by Medicare, noted the IG.
Almost 25% of hospitals did not address in written policies the “appraisal of emergencies, initial treatment of emergencies, or referral and transfer of patients.”
The CMS issued a response saying it would look at current compliance through its routine hospital surveys. But as many as 42% of the 109 would not have been subject to CMS oversight, as they were accredited by the Joint Commission or the American Osteopathic Association. The CMS also said it would use its authority to require hospitals to have written policies and procedures on managing emergencies, but that would also consider whether regulatory changes are needed to establish specific requirements for equipment and staff qualifications.