OIG Report Slams Specialty Hospital Ability to Handle Medical Emergencies

The Department of Health and Human Services (HHS) Office of Inspector General (OIG) is releasing a report today on the ability of physician-owned specialty hospitals to handle medical emergencies. The report, titled, “Physician-Owned Specialty Hospitals’ Ability to Manage Medical Emergencies,” (Daniel R. Levinson, Inspector General, January 2008, OEI-02-06-00310) assesses 109 physician-owned specialty hospitals.

The agency reports that this investigation comes in response to the two recent deaths that occurred at specialty hospitals. In both instances, according to the agency’s report, a patient experienced complications following elective surgery. Neither hospital had a physician on duty at the time the emergency occurred, and both hospitals called 911. The patients were then transferred to community hospitals, where they were both pronounced dead.

The Senate Finance Committee requested that the OIG conduct an evaluation of patient care and safety in physician-owned specialty hospitals. This study focuses on emergency departments, staffing patterns and written policies for managing medical emergencies. The study relies on four primary sources of data: 1.) a review of physician and nurse staffing schedules for 8 sampled days, 2.) a review of hospitals’ staffing policies, 3.) a review of hospitals’ policies for managing medical emergencies, and 4.) structured interviews with administrators at each hospital.

The study is based on data from 109 physician-owned specialty hospitals identified from a list provided by the Centers for Medicare & Medicaid Services (CMS).

Findings:

--About half of all physician-owned specialty hospitals have emergency departments, the majority of which have only one emergency bed.

--Not all physician-owned specialty hospitals had nurses on duty and physicians on call during the eight sampled days.

--Administrators report that less than one-third of physician-owned specialty hospitals have physicians onsite at all times.

--Two-thirds of physician-owned specialty hospitals use 9-1-1 as part of their emergency response procedures.

--Some physician-owned specialty hospitals lack basic information in their written policies about managing medical emergencies.

The OIG recommends that CMS:

--Develop a system to identify and regularly track physician-owned specialty hospitals.

--Ensure that hospitals meet the current Medicare CoPs that require a registered nurse to be on duty 24 hours a day, 7 days a week and a physician to be on call if one is not onsite.

--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.

--Require hospitals to include necessary information in their written policies for managing a medical emergency, such as the use of emergency response equipment and the life-saving protocols to be followed.

“CMS concurred with all four of our recommendations,” the report reads.

In response to the first recommendation, CMS stated that it will add information to CMS’s provider enrollment form and the new Provider Enrollment and Chain-Operated System.

In response to the second recommendation, CMS indicated that it currently examines hospital compliance with all Medicare CoPs through its routine hospital surveys. CMS does not conduct these surveys for the 42 percent of hospitals that are accredited by either the Joint Commission or the American Osteopathic Association. However, CMS investigates all credible complaints, including complaints against accredited hospitals. CMS stated that it will ensure that both accreditation organizations are aware of our findings.

In response to the third recommendation, CMS stated that it issued a program memorandum to State Survey Agencies during the period that we were conducting the study that reiterates its requirements for hospitals and addresses medical emergency requirements. CMS circulated this memorandum to the national accreditation organizations and made it available to the public through its Web site.

Finally, CMS concurred in principle with the fourth recommendation. CMS stated that it will consider whether regulatory changes to create more specific requirements for equipment and staff qualifications would be appropriate.

The OIG also reports that CMS currently does not have a system in place to track physician-owned specialty hospitals or to identify newly enrolled physician-owned specialty hospitals.

Source: HHS OIG Report: “Physician-Owned Specialty Hospitals’ Ability to Manage Medical Emergencies,” (Daniel R. Levinson, Inspector General, January 2008, OEI-02-06-00310)

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