CMS Hospital Discharge Proposal Would Burden FPs

The Academy raised objections recently to a proposed rule involving CMS' hospital discharge policy, saying the rule would place an undue burden on family physicians. As written, the rule fails to address the current discharge process, said the AAFP, and thus stands to be duplicative, creating further drain on an already overtaxed health care system.

"We are concerned that, although aimed at hospitals, this proposed rule may have a significant negative impact on physicians who treat Medicare patients in the hospital," said AAFP Board Chair Mary Frank, M.D., of Mill Valley, Calif., in a June 5 letter to CMS Administrator Mark McClellan, M.D., Ph.D.

As indicated in the proposed rule, "Medicare Program: Notification Procedures for Hospital Charges," published in the April 5 Federal Register, (PDF file: 11 pages / 95 KB. More about PDFs.) CMS would establish a new two-step notification process for hospital discharge.

The first step would require the hospital to deliver a standardized, generic notice of noncoverage to the Medicare beneficiary as soon as the discharge decision was made and approved by the attending physician. The second step would occur only in those instances in which the beneficiary disputes the discharge and would entail delivery of an individualized, detailed notice of noncoverage. The proposed rule calls for the initial notice to be delivered the day before the discharge, and that element has raised the Academy's concern.

"It (the proposal) presumes that hospitals and physicians will always know the date of discharge a day in advance," said Frank, noting that sometimes a patient is admitted and discharged on the same day or that, occasionally, a patient is discharged earlier than expected. "This proposal may routinely extend the length of stay for many Medicare beneficiaries by at least one day regardless of the severity of the cases involved," said Frank.

Frank also questioned the ability of hospital staff to handle the additional paperwork the rule would generate. "This proposed rule presumes that hospitals will have active case management staff to handle all of this paperwork and that either the beneficiary will be competent to sign the standardized notice or that the (patient's) personal representative will be readily available to do so. The reality is that in most small and rural community hospitals, active case management staff does not exist. As such, we anticipate that the burden of this paperwork will often fall to the attending physician(s), which in many cases will be our members."

The Academy asked CMS to rescind the proposed rule and simply revise the current discharge notification document, called "Important Message From Medicare," to include whatever additional information CMS thinks is necessary.