Does this OIG ruling mean that hospitals with inpatient psychiatric units may not transfer psychiatric patients for economic reasons, either unfunded patients to a state psychiatric hospital or managed care patients repatriated to a contracted hospital?
Explore This IssueACEP Now: Vol 36 – No 10 – October 2017
Does this mean any hospital that now only admits voluntary patients for confidential short-term inpatient psychiatric care must also admit involuntary patients or close its inpatient unit? Must they now also admit “forensic” patients from jails or prisons even if law enforcement refuses to provide 24-7 security? What about violent patients? Where does the government draw the line? In essence, CMS and the OIG have usurped a hospital’s ability to define its own scope of services.
The settlement agreement between AnMed Health and the OIG hints but does not specifically delineate that the hospital may have utilized some form of admission financial triage, which justified the monetary penalty.8 However, a hospital representative categorically denied that the hospital had engaged in any financial screening and reported that the involuntary patients had about the same payer mix as the voluntary admissions.9
When Is a Psychiatric Patient Stable for Transfer to a State Psychiatric Hospital?
CMS asserted that each of the 20 boarded IVC patients AnMed Health’s emergency department transferred to the state psychiatric hospital was unstable at the time of transfer. The sole rationale provided for the government’s assertion was that “the patient still required psychiatric evaluation and treatment” or that “the patient required further evaluation and care.”1
EMTALA statutorily defines “stabilized” to mean “with respect to an emergency medical condition … that no material deterioration of the condition is likely, within reasonable medical probability, to result from or occur during the transfer of the individual from a facility [emphasis added].”10
Therefore, whether the patient still needed “further psychiatric evaluation and treatment” is not the correct standard to apply when determining whether the patient is stabilized under the law.
The proper standard to follow is the statutory definition, in which case the government is claiming that transport of a docile suicidal patient in the back of a locked, secure law enforcement vehicle for about six miles, or approximately 11–12 minutes, was likely, within reasonable medical probability, to result in material deterioration of the patient’s emergency condition. Does CMS, its physician reviewer, the OIG, or any experienced emergency physician really believe that to be true? In point of fact, it’s extremely unlikely, and certainly not reasonably probable, that such a transfer will cause any deterioration, let alone material deterioration in a patient’s psychiatric condition, especially after the patient has been in the emergency department for many days waiting for a bed at the state hospital.