A new report from HHS inspector generals office on physician-owned specialty hospitals is being cited by both sides in the debate on whether such facilities should be allowed.
The report, released last week and immediately seized by specialty-hospital opponents, criticized the facilities preparedness for medical emergencies. But physician-owned hospital advocates noted that the report did not reveal problems with the care and treatment provided at these institutions.
The report was requested by Sens. Chuck Grassley (R–Iowa) and Max Baucus (D–Mont.) in March 2006 after the July 2005 death of a patient at a physician-owned hospital in Portland, Ore. That death followed complications from elective surgery (Feb. 20, 2006, p. 7). The senators also called for an inquiry into a similar occurrence at a 14-bed physician-owned hospital in Abilene, Texas, in January 2007 (March 26, 2007, p. 14), and these incidents are briefly noted in the inspector generals report.
Two recent deaths of specialty hospital patients have raised concerns about the ability of physician-owned specialty hospitals to manage medical emergencies, the report stated. 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.
After reviewing hospital emergency-management policies and eight days of staffing records at 109 physician-owned hospitals identified by the CMS, the inspector general found that 55% of physician-owned specialty hospitals have an emergency department, but most of these departments have only one bed. Only 28% of these facilities have a physician on-site at all times; only 45% of hospitals with emergency departments have physicians on-site at all times. And, for 66% of the hospitals, dialing 911 is part of the facilitys medical-emergency response procedure.
The inspector generals office recommended that the CMS take action to ensure that hospitals have the capability to provide for the assessment and initial treatment of emergencies.
The CMS issued a response agreeing with the recommendation and noted that it had already issued a memorandum on April 26, 2007, stating that every hospital that participates in Medicare, regardless of whether it operates an emergency department, must have basic capacities to address medical emergencies that arise within the hospital.
Both Grassley and Baucus issued statements noting how the report highlighted the shortcomings of physician-owned specialty hospitals, and both questioned if these facilities should even be able to call themselves hospitals in the first place.
This new report documents the significant and potentially life-threatening shortcomings of physician-owned specialty hospitals when it comes to emergency services, Grassley wrote. Patients and consumers deserve to know what theyre getting into with specialty hospitals. Most people assume that if its called a hospital, it can handle emergencies, but this data shows thats not the case.
Grassley also stated that Congress needs to take action to protect patients as well as to strengthen the community hospital system.
In his statement, Baucus noted that the report found that many physician-owned specialty hospitals were not meeting the requirements for Medicare participation.
Its unbelievable that a facility that calls itself a hospital would, at times, not even have a doctor on call or nurse on duty, Baucus said. Medicare dollars for hospitalizations should not be spent on facilities that most people wouldnt even call a hospital.
Both the American Hospital Association and the Federation of American Hospitals responded to the report by saying that it provides evidence of how important it is for Congress to take action against the proliferation of physician-owned hospitals and to address the issue of doctors referring patients to facilities where they have a financial interest.
Physician Hospitals of America Executive Director Molly Sandvig and Randy Fenninger, a lobbyist with that organization, noted how the report found that 93% of the hospitals studied met requirements for having nurses on-site and physicians on call. But Fenninger agreed with the reports recommendation that calling 911 was not an appropriate emergency-management strategy.
Thats something we think should definitely be corrected, he said. It shouldnt be a substitute for having the right kind of staff available or on call.
Sandvig also noted that, in some cases, physician-owned hospitals are located across the street from community hospitals, so having a fully equipped emergency department would be a waste of resources.
Frankly, the number of emergencies that occur in our hospitals are few and far between, she said.
Fenninger added that, beyond the reference to the patient deaths in Abilene and Portland, the report failed to find examples of patients being harmed.
Theres nothing in the report to suggest that, in any of the hospitals they examined, that there was an actual patient-care problem, he said.