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Friday, August 23, 2013

Medical Residents Left Out of New CMS Hospital Admission Policy

by Nathaniel Weixel

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CMS recently may have inadvertently made it impossible for medical residents to admit patients to hospitals. In the Medicare inpatient prospective payment system final rule, released Aug. 2, CMS instituted a time-based presumption period for medically necessary inpatient care. Under the rule, Medicare contractors are instructed to define that period as “two midnights.” The policy was made in response to concerns with the overuse of observation status by hospitals.

However, in attempting to solve one issue, CMS may have created another. As pointed out in a letter to the agency from the Association of American Medical Colleges, the final rule requires that the order to admit a patient must be written by a practitioner “who has admitting privileges at the hospital.” Medical residents, who are under the supervision of an attending physician, rarely have that ability, as they are not considered to be members of the hospital’s medical staff, the AAMC said.

The AAMC said CMS told them it not intend to prohibit residents from admitting patients. But the teaching hospital group called on CMS to issue a guidance document making it clear inpatient admissions made by medical residents will not be denied. The group also said after it issues the guidance, CMS should wait six months before enforcing the new rules for inpatient admissions to allow time for hospitals and physicians to fully understand them.
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