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CMS issues guidance on emergency care

Quality Improvement Monitor, May 4, 2007

One month after The New York Times reported that a specialty hospital had to call 911 because no physician was available to care for a patient who had developed breathing problems, CMS issued guidance this week clarifying the responsibility of hospitals to provide emergency services if they participate in the Medicare program.

The guidance makes it clear that nearly all hospitals  including specialty hospitals and others without emergency departments  must be able to evaluate persons with emergencies, provide initialtreatment, and refer or transfer these individuals when appropriate. The regulation does not apply to critical access hospitals.

In April, The New York Times reported that a 44-year-old man developed breathing problems after spine surgery. No physician was working at the hospital at the time the staff recognized he was in trouble. Staff called 911, and he was taken to a nearby full-service hospital, where he died a short time later. The incident happened at a small hospital that is owned and run by doctors - one of roughly 140 such hospitals around the country, the Times reported.

The CMS guidance was issued in a survey and certification letter. Survey and Certification letters guide state agency surveyors in determining whether hospitals meet all conditions of participation (CoP) required to participate in the Medicare program.

The letter said hospitals must have appropriate policies and procedures in place to address individuals' emergency care needs 24 hours per day,seven days per week.

"Any hospital participating in Medicare, regardless of the type of hospital and apart from whether the hospital has an emergency department must have the capability to provide basic emergency care interventions." Leslie V. Norwalk, acting administrator of CMS said in a press release.

The letter also says that CoPs do not allow a hospital to rely upon 911 services as a substitute for the hospital's own ability to provide these services.

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