Federal regulators taking a closer look at hospitals' admitting practices

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Federal regulators taking a closer look at hospitals' admitting practices
Federal regulators taking a closer look at hospitals' admitting practices

The Centers for Medicare and Medicaid Services has notified hospitals that they are being closely watched over concerns about how they have decided whether to admit certain individuals or refer them elsewhere.

“Hospitals have been put on notice that we will be monitoring the appropriateness of hospital admissions,” said Sheila Lambowitz, CMS's director, division of institutional post-acute care, during the agency's monthly Open Door Forum conference call Tuesday. “We are working within a number of areas in CMS to get a better handle on what is going on with hospitals' use of observation days, rather than using inpatient days.”

Hospitals are a top referral source of nursing home admissions. How individuals are characterized during a hospital stay influences payment methods and modes.

“We need to admit based on medical needs, rather than their social needs,” Lambowitz said. “Admissions up to this point may have been made because a person had nowhere else to go, a hospital did not know how to arrange some sort of transfer arrangement for these folks and patients were admitted. This is a very complicated situation.”

She did not set a timeline for the monitoring but said the agency was seeking “clarity” to better understand what's happening at “the hospital level and know the kind of patient discharges that really, truly are hospital discharges, and not (being) held at the hospital on an observational basis.”

Another CMS official noted during the call that the planned Oct. 1, 2010 rollout of the MDS 3.0 is on schedule, and that the chapters of the RAI manual that have not yet been published – 2, 4, 5, 6 and Appendix C – should be available sometime this month. CMS next week is planning to hold the first of three satellite broadcasts on MDS 3.0.


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