OIG’s EMTALA fines continue downward trend
Fines for violations of the Emergency Medical Treatment and Labor Act (EMTALA) were down for the first half of the Office of the Inspector General’s (OIG) fiscal year, with only $314,000 in fines collected from 10 hospitals from Oct. 1, 2002, to March 21, 2003, according to a recent report from Stephen Frew, JD, a longtime specialist in EMTALA compliance.
The OIG only reports closed files, says Frew, a web site publisher (www.medlaw.com) and risk management consultant for Physicians Insurance Co. of Wisconsin in Madison. The amount is much lower than in previous years, when fines exceeded $2 million in a single year, he points out, and is consistent with a declining trend since 2000.
Examples of fines listed and the associated violations include the following:
• $30,000 — Discharge of a head injury patient in New Jersey who was later found unresponsive and taken to another facility, where surgery was performed.
• $35,000 — Failure by a California hospital to provide necessary care for a ruptured appendix based on the patient’s financial status.
• $17,000 — Failure by a South Carolina hospital to provide treatment to a woman in labor, who was transferred to another facility.
• $120,000 — Failure by a Florida facility that had a psychiatric assessment center to provide appropriate assessment and stabilizing care/ appropriate transfer to mental health patients.
Frew points out that OIG civil fines are less of a burden on hospitals than the stress and expense associated with the citation and plan of correction.
HFMA issues status report on billing project
Hospitals and other health care providers can promote patient-friendly billing in a variety of ways, from reviewing their organization’s billing process to signing up to receive an electronic newsletter from the Healthcare Financial Management Association’s (HFMA) Patient-Friendly Billing project.
Those are among the suggestions in a recent report summarizing the project, which was launched in 2001 to promote clear, concise, correct, and patient-friendly billing and financial communications. The report also includes a sample patient letter for use in describing the billing process, a sample hospital patient bill, sample patient glossary terms, and a flowchart showing desirable financial communications from the patient’s perspective.
To date, about 1,000 hospitals and health systems have signed on to the project’s philosophy, according to HFMA. The American Hospital Association is a partner in the project. The report can be found at www.patientfriendlybilling.org.
JCAHO hospital standards reduced to 225 from 508
The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) has slashed the number of standards in the 2004 hospital accreditation program from 508 to 225 as part of the agency’s "Shared Visions, New Pathways" initiative. Agency officials have said the initiative is intended to streamline standards and focus the JCAHO survey on operations and systems that directly affect patient safety and quality. (See "Cancel the triennial stage play’: JCAHO has a new survey process," on the cover of the June issue of Hospital Access Management.)
The requirements for 2004 essentially are the same, officials say, but they note that some "elements of performance" that existed in one accreditation manual may now be applicable across all manuals. In addition, the new format integrates the assessment, care, education, and continuum of care chapters into a single chapter.
Health care personnel may review the new standards, along with a comparison to the current standards, by visiting www.jcaho.org and clicking on "2004 Pre-Publication Standards Now Available."
Survey: Providers ready for October HIPAA deadline
Some 96% of Medicare Part A providers expect to be compliant with the Health Insurance Portability and Accountability Act electronic transactions standards and code sets by the Oct. 16 deadline, according to a recent report from the Department of Health and Human Services Office of Inspector General. The report indicates that 92% of Part A providers are developing an implementation schedule to meet the deadline, and half are developing contingency plans in the event their systems are not fully compliant by the deadline.
A comprehensive national system is needed, however, to prevent payment disruptions in case processing failures occur, says Lawrence Hughes, regulatory counsel and director of member relations for the American Hospital Association.
To see the report, based on the results of a mail survey conducted between Nov. 26, 2002, and March 24, 2003, go to: www.oig.hhs.gov.
Prompt-pay legislation signed by Texas governor
Texas has joined the list of states that have passed legislation designed to ensure hospitals and physicians are paid promptly and appropriately by health plans. Senate Bill 418, signed in late June by Gov. Rick Perry, establishes a payment time frame of 30 days for claims filed electronically and 45 days for paper claims. The legislation defines a clean claim, preauthorization, and verification. It prohibits health plans from denying or reducing payment once a preauthorization or verification has been issued unless the provider materially misrepresented the facts or did not perform the service.
The bill also requires verification to be valid for at least 30 days, and health plans to provide a specific reason for failing to verify eligibility or coverage. It specifies that health plans have personnel available during weekday, weekend, and holiday hours to provide verification and preauthorization, and removes coordination of payment responsibilities from the provider and places them on the payer.
Hospitals doing good job, say majority of Americans
Nearly three-quarters (73%) of American adults think hospitals do a good job of serving consumers, according to the latest annual Harris Poll ranking 15 industries for customer service. The same percentage of Americans said hospitals served consumers well in last year’s poll, while health insurers saw a sharp drop in their standing this year. Only 40% and 30% of Americans said health insurers and managed care companies served their customers well, down from 51% and 33% in 2002, respectively.
Pharmaceutical companies also saw a 10-point slide in their score, from 59% to 49%. The poll surveyed 1,010 adults by telephone between April 10 and April 15. More information is available at www.harrisinteractive.com.
In another recent customer satisfaction poll, by J.D. Power and Associates, hospitals outscored eight other industries. In a survey of 2,350 randomly selected patients recently discharged from general acute care hospitals, three out of four patients who stayed in the hospital at least one night expressed satisfaction with their hospital stay.
Nearly a third (32%) were "delighted" with their overall hospital experience, rating their stay a 10 on a 10-point scale. That’s the largest proportion of highly satisfied customer among nine service industries the company surveys: auto insurance (28%), residential electric utilities (27%), home insurance (25%), hotel (16%), Internet service provider (15%), home mortgage (15%), managed care (14%), and telecommunication (12%).
For more information, go to www.jdpower.com.
OIGs EMTALA fines continue downward trend; HFMA issues status report on billing project; JCAHO hospital standards reduced to 225 from 508; Survey: Providers ready for October HIPAA deadline; Prompt-pay legislation signed by Texas governor; Hospitals doing good job, say majority of Americans
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