On Jan. 10, HHS inspector generals office issued a report regarding the emergency-care policies at physician-owned specialty hospitals (Dueling interpretations, Jan. 14, p. 8). This report was requested in 2006 by Sens. Chuck Grassley (R-Iowa) and Max Baucus (D-Mont.). While Physician Hospitals of America initially endorsed the inspector generals recommendations to the CMS and supported the CMS actions where appropriate, we were not able to address any of the specific facts in the report because a list of hospitals was not immediately available.
We have now obtained that list and contacted the hospitals that were interviewed for the report. The PHA now knows that virtually all of the reports facts and conclusions that relate to hospital compliance with federal staffing requirements and emergency policies are wrong.
The inspector generals office interviewed and obtained documents from 109 hospitals in preparing the report. The inspector generals office suggests that certain policies regarding emergency response and patient transfers might violate Medicares conditions of participation. This suggestion is without merit. All of the hospitals have been surveyed and inspected as part of the process of obtaining Medicare certification. Review of policies is part of the survey process. If these policies were acceptable to the CMS and other independent accrediting bodies, on what basis does the inspector general now challenge their legitimacy?
The inspector generals office further concluded that 37 of these hospitals allegedly use 911 as a substitute for the hospitals ability to stabilize its patients. So far, 29 of these hospitals have challenged this conclusion and provided documentation to PHA that supports this reaction. (One hospital has closed since the inspector general began work on the report and six of the nonresponding hospitals are not PHA members, so we do not have contact with them.)
According to the 29 hospitals, the inspector generals staff did not contact them following the interview and document submission to discuss their concerns and to seek clarification or additional data. The inspector generals office made no effort to allow these facilities to answer these allegations prior to the reports publication. Similarly, the inspector generals office listed eight hospitals that had supposedly violated Medicare conditions of participation due to improper staffing. Again, all eight of the named hospitals have come forward with documentation showing that they were, in fact, properly staffed according to CMS guidelines during the times in question. The inspector generals conclusions were wrong, and the agency erred in forwarding these hospitals to the CMS for further investigative review. Again, these issues could easily have been rectified by a simple follow-up call.
The inspector generals office also reported the number of hospitals with emergency rooms and the size of those ERs. However, the report made no mention of the fact that these issues are controlled by state law. The inspector generals office failed to include a statement that each of these hospitals met their state requirements, thus inferring impropriety where none exists.
Many of the hospitals named are five-star ranked and/or listed by independent quality authorities as the No. 1 hospital in their specialty and state. The inspector generals report does a disservice both to the medical professionals of these hospitals and, more critically, to the patients who are served by them.
In the PHAs opinion, the inspector generals report is either an example of lazy reporting, failure to understand standard hospital policies and procedure, or blatant and purposeful misrepresentation. The PHA and physician-owned specialty hospitals are outraged by the inspector generals willingness to release such an erroneous report and by the failure of many in the media to seek independent confirmation of the reports allegations.
Molly SandvigExecutive director Physician Hospitals of America Sioux Falls, S.D.