September 8, 2010

Medicare changes could hurt small rural hospitals

By Tina Foreman
Farmer Staff Writer

A new policy from the Centers for Medicare and Medicaid Services (CMS) could be disastrous for small hospitals and clinics like McKenzie County Healthcare Systems (MCHS) if the ruling can’t be overturned.
“In 2010 CMS started a new policy that requires that a supervising physician or non-physician practitioner (NPP) be physically present and immediately available at all times when Medicare beneficiaries receive outpatient therapeutic services,” says Dan Kelly, MCHS CEO. CMS offers no clinical or quality basis for its new and burdensome supervision requirements.  In fact, the agency admits that it has no evidence that patient safety or quality of care has been compromised in past years due to inadequate or ineffective supervision.”
For many rural hospitals, like MCHS, this new rule is counterproductive, and quite frankly, many administrators feel that doctors have more important things to do than sit around and supervise.
“You still get a physician or provider that’s standing there, and I’m going to be a little callous and say, twiddling their thumbs waiting for something to happen,” said Kelly. “People don’t realize how difficult it is to be a rural physician and then they (CMS) adds to this burden. CMS is going to make this untenable, and it’s quite-frankly going to close a lot of our facilities.”
Rep. Earl Pomeroy invited the director of the Centers for Medicare and Medicaid Services to North Dakota to hear these concerns since the rule clarification has been suspended since March.
Currently, according to Kelly, when a patient comes in for a blood transfusion or is admitted for observation status, a physician does not need to physically be present 24 hours per day seven days per week.  Instead, services are ordered by the patient’s treating physician, who is responsible for assessing the patient’s progress and, when necessary, changing the treatment regimen.  The services are furnished in the hospital outpatient department by licensed, skilled professionals under the overall direction of a physician. 
“For most services, a physician does not need to be physically present in order for hospital staff to provide safe and high-quality outpatient care,” adds Kelly. “This is because non-physician hospital staff are professionally competent, licensed health care professionals who provide services that fall within their scope of practice in accordance with state law.”
The provision of care, according to Kelly, is governed by clinical protocols and policies/procedures approved by the hospital’s medical staff.  Non-physician staff can contact a physician by phone, radio or other means if needed for routine consultation.
“The most tragic is that our nursing staff will not be able to begin lifesaving treatment to someone presenting themselves to our emergency room prior to a physician or mid-level provider being physically present at the hospital,” adds Kelly. “The irony is that we do not have physicians physically present for our inpatient admissions which are considered to be sicker than those walking in off the street seeking outpatient services.”
Kelly says North Dakota’s institutions have a good track record of offering low cost, high quality care. And if this rule isn’t fixed, that could go by the wayside. He adds that physicians can be reached at a moment’s notice, since many of them live within a few miles of the hospital.
“This either needs to be amended by Medicare or federal legislation needs to be enacted to prohibit this from going forward,” states Kelly.