CMS bans residents from admitting patients, teaching hospitals warn


While the final rule issued Aug. 2 by the Centers for Medicare & Medicaid Services clarifies when a patient should be admitted to the hospital, the finalized Hospital Inpatient Prospective Payment System (IPPS) unintentionally prevents medical residents from admitting patients, Bloomberg BNA reported.

As stated, the IPPS final rule requires the order to admit a patient must be written by a practitioner "who has admitting privileges at the hospital"--something few residents have, the Association of American Medical Colleges (AAMC) told CMS last week in a letter.

That's because hospitals don't consider residents working under the supervision of an attending physician members of its medical staff, the AMMC noted.

Moreover, the final rule states, "The practitioner may not delegate the decision (order) to another individual who is not authorized by the State to admit patients, or has not been granted admitting privileges applicable to that patient by the hospital's medical staff."

Although CMS said it did not intend to exclude residents from the hospital admission policy, the AMMC is urging the agency to issue a guidance that clarifies inpatient admissions made by medical residents who are under the supervision of an attending physician should not be denied, according to the letter.

The teaching hospital community also called on CMS to push back the rule's enforcement for at least six months after issuing the guidance, BNA noted. The group said the delay would give teaching hospitals enough to educate physicians and others about the new rules as well as make any changes to electronic health systems to support the revised inpatient admission requirements.

Under the new requirements, Medicare Part A payment is generally inappropriate for hospital stays lasting fewer than two midnights. The policy aims to ease concerns about observation and short inpatient stays, FierceHealthcare previously reported.

For more:
- read the BNA article
- here's the AAMC letter (.pdf)