A federal judge ruled against a Michigan critical-access hospital complaining that the states limits on the use of swing beds contradict Medicare rules that restrict involuntary transfers of nursing-home patients.
Schoolcraft Memorial Hospital, a 25-bed county-owned hospital in rural Manistique, sued the Michigan Community Health Department in U.S. District Court in Grand Rapids, Mich., after getting slapped with a $500,000 fine for failing to move patients out of its swing beds within five days after a nursing-home bed became available.
Judge Robert Jonker ruled that there is no conflict between the states rule and Medicares requirement that hospitals operate swing beds in substantial compliance with rules governing nursing homes.
Schoolcraft, Jonker wrote, sought to contrive an irreconcilable conflict so that it can continue to enjoy the considerable revenue stream that it has received from using swing beds in violation of the five-day rule and then use that revenue stream to finance a new hospital construction project.
The management of swing beds is a problem rural hospitals are facing across the country (June 23, p. 42).
The Michigan Health & Hospital Association supported Schoolcrafts position in a friend-of-the-court brief. Jonker, however, noted that other hospitals told the court they have no trouble complying with both rules. The judge also suggested Schoolcraft could have obtained written consent from patients to transfer them to available beds in a county-owned nursing facility that is attached to the hospital literally down the hallwhere they could have received the same care for $337 a day rather than $2,182.
Lawyer Carey Kalmowitz, a partner in the firm of Wachler & Associates who is representing Schoolcraft, said the figures cited by the judge misrepresent the costs of care.
Jonkers interpretation of substantial compliance and the suggestion of obtaining patients advance consent for transfers, Kalmowitz added, contradicts guidance received from the CMS, which the judge declined to consider because it was in the form of letters rather than sworn testimony.
Kalmowitz said that the hospitals board will decide in August whether to appeal the decision.