“The lawsuits contend that several provisions included in the [CMS] final inpatient prospective payment rule for 2014 burden hospitals with unlawful arbitrary standards and documentation requirements, and deprive hospitals of proper Medicare reimbursement for caring for patients,” according to an AHA press release.
The hospitals involved with the suit have stated that it is a “wholly arbitrary requirement” to have a physician certify during admission whether a Medicare patient is expected to need inpatient care spanning two midnights.
“New Jersey Hospital Association is participating in the lawsuit because of deep concerns over both the substantive changes made in the rule and the procedural method that CMS used to circumvent public comment and debate,” said Kerry McKean Kelly, vice president of communications and member services for NJHA.
“For our emergency physician partners, when a patient presents in the emergency department, it should be a clinical judgment how a patient should be treated or whether the patient should be observed for the time being,” said Kelly. “By setting this black-line rule, the clinical decisions are being taken out of the physician’s hands.”
Vanessa Caceres is a medical writer in Bradenton, Florida.