Don’t stop restocking of ambulance supplies
Are you confused about whether you can legally restock supplies of paramedics who bring patients to your ED? Many EDs have stopped restocking altogether because they fear violations of the federal antikickback statute, but this is a mistake, argues Robert E. Suter, DO, MHA, FACEP, president of Texas Emergency Physicians, an ED physician practice group based in Dallas.
A recent advisory opinion from the Office of Inspector General (OIG) of the U.S. Department of Health and Human Services should help to clear up this misconception, he adds. The advisory opinion affirms that a hospital may restock ambulance services with medical supplies and pharmaceuticals used to provide emergency prehospital services.
A "safe harbor" for EDs that restock ambulances was established by the Washington, DC-based OIG, which acknowledged that the practice ensures that ambulances are fully stocked with medications, sanitary linens, and other supplies. The safe harbor means that if you meet specific criteria, restocking will not constitute a violation of federal anti-kickback laws. (For more information on the safe harbor ruling, see ED Management, September 2000.)
"[The advisory opinion] agreed that appropriate restocking was in the public interest," says Suter. "Restocking is OK if you stay in a safe harbor, and may be OK under other circumstances." According to Suter, you must meet all criteria in one of two categories to comply with the safe harbor:
1) Ambulance provider pays fair market value for supplies, or
2) Supplies are provided free or at less than fair market if:
- you restock all ambulances equally;
- you are part of a coordinated effort overseen by a non-profit oversight entity;
- the restocking program is outlined in writing;
- the hospital does not bill any federal program for supplies or write-off as bad debt;
- the ambulance service does not bill for supplies;
- the hospital and ambulances keep records of restocked drugs and supplies;
- the hospital and ambulance providers comply with all other laws.
ED managers should not stop restocking, and that is not the intent of the Centers for Medicare and Medicaid Services, stresses Suter. "Hopefully, this opinion will reduce the level of anxiety experienced by EDs involved in appropriate restocking efforts," he says. "The opinion supports a common sense, patient-oriented approach to restocking." However, Suter warns that appropriate documentation is needed. "Do not leave your motives and rationale open for interpretation," he says.
Suter recommends documenting your policy and its relationship to the public interest in the minutes of the regional emergency medical services council, state advisory committees, and the department of health. "When the policy has been validated by the community outside of your institution, it is difficult for the OIG to convincingly assign a criminal purpose to the activity," says Suter.
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