Originally published in Powell Goldstein LLP's Health Alert, May 2007
On April 26, 2007, the Centers for Medicare and Medicaid Services (CMS) issued a memorandum to state survey agency directors clarifying the regulatory requirements for hospitals’ emergency capabilities. Specifically, CMS indicated that with the exception of critical access hospitals, under the Medicare Conditions of Participation hospitals must have written policies for the evaluation of medical emergencies, provision of initial treatment, and suitable referral of patients. These requirements apply independent of whether or not the hospitals have emergency departments.
To meet the requirements for appraising medical emergencies and providing initial treatment, a registered nurse qualified to determine when a patient needs emergency care and to provide such treatment must be available at all times. Also, a physician must always be available, either onsite or on-call, to directly evaluate and initially treat emergency cases or direct onsite staff in such assessments and initial treatment.
The Conditions of Participation have particular requirements pertaining to appropriate referrals of emergency patients. The nurses and physicians who respond to emergency cases must be able to recognize when a patient’s needs exceed the hospital’s resources, necessitating referral to a facility with the capabilities to treat the patient’s condition. The hospital staff must also conduct the referral properly by arranging transportation and sending along the patient’s medical information.
CMS’ memorandum addressed hospitals’ use of 911 to transfer emergency patients. Although the Conditions of Participation do not prohibit using 911 for such transfers, CMS stated that calling 911 does not necessarily meet the hospitals’ responsibilities to transfer patients to appropriate facilities and to be certain that the necessary medical information accompanies the patient. CMS further warned that a hospital policy or practice that depends upon calling 911 so that Emergency Medical Services performs the hospital’s mandatory assessment and initial emergency treatment services would be a condition-level noncompliance with the applicable Condition of Participation.
This CMS guidance follows its termination of its Medicare provider agreement with West Texas Hospital in Abilene, Texas on March 31, 2007. On January 23, 2007, a patient died after staff at the physician-owned surgery specialty hospital called 911 when the patient exhibited respiratory distress. During the investigation of that incident, Senator Charles Grassley (R-Iowa), Senator Max Baucus (D-Mont.), and Congressman Pete Stark (DCalif.) questioned why the hospital was relying on 911 for its emergency cases.
CMS’ memorandum noted that the Emergency Medical Treatment and Labor Act (EMTALA) definition of "emergency" can be a useful reference when determining compliance with regulatory mandates regarding emergency services, even though EMTALA is not binding on hospitals without dedicated emergency departments.
Hospitals should review their policies and procedures to be certain that they comply with CMS’ interpretation of the applicable Conditions of Participation as reflected in this recent memorandum. You can view the memorandum by clicking here.
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