Hospitals

ED Transfer Question

  • 1.  ED Transfer Question

    Posted 01-13-2020 09:53 AM
    First time posting on here, but I'm hoping to get some opinions on an ED transfer issue.

    One of my hospital clients posed a question regarding the use of ambulance to transfer and the costs associated with that transfer. In this scenario, the hospital is considered full. The patient is not in a critical state and is considered stable. The patient also has the freedom of choice to go where they please. The ED staff asked if they can transfer the patient, via ambulance, to a different hospital within the system.

    Here's where the problem comes in.

    The receiving hospital would not be the closest based on mileage and therefore would not be covered by Medicare. The ED staff suggested the hospital pay the bill if that is where the patient wants to go.

    Two things:

    1. Is there a risk of inducement

    2. Should the hospital be paying for the cost.

    I understand that any responses are receive are not legal, liable etc... I'm just looking for some thoughts here. I have my own, but this is an issue I don't deal with very often.

    ------------------------------
    Joel Kellner
    Managing Associate
    ------------------------------
    2020 HCCA Compliance Institute


  • 2.  RE: ED Transfer Question

    Posted 01-13-2020 10:12 AM
    Joel, congratulations on your first post!
    We have dealt with this same issue.  Our policy is that we cannot pay for an ambulance transfer to one of our hospitals, that it would be inducing patients to use our hospitals and services.
    Cinda

    ------------------------------
    Cinda
    Compliance/Ethics & Privacy Director
    Ohio
    ------------------------------

    2020 HCCA Compliance Institute


  • 3.  RE: ED Transfer Question

    Posted 01-13-2020 10:44 AM
    Does that policy include transfers within the system?

    ------------------------------
    Joel Kellner
    Managing Associate
    ------------------------------

    2020 HCCA Compliance Institute


  • 4.  RE: ED Transfer Question

    Posted 01-13-2020 11:27 AM
    Joel,
    Yes, we 3 hospitals in our Health System.  It's not a written policy, but rather a practice.  We do not pay for anyone's ambulance ride to any hospital, whether it's within our health system or not.
    Cinda

    ------------------------------
    Cinda
    Compliance/Ethics & Privacy Director
    Ohio
    ------------------------------

    2020 HCCA Compliance Institute


  • 5.  RE: ED Transfer Question

    Posted 01-14-2020 07:57 AM

    On Wednesday, December 7, 2016 the Department of Health and Human Services' Office of Inspector General released Medicare and State Health Care Programs: Fraud and Abuse; Revisions to the Safe Harbors Under the Anti-Kickback Statute and Civil Monetary Penalty Rules Regarding Beneficiary Inducements final rule.  You may wish to review the safe harbor established for "local transportation" and see if your scenario would fit.  There is a proposed rule to expand that safe harbor under review now, with the comment period having closed on December 31, 2019.



    ------------------------------
    Thomas Branch
    Spectrum Health
    Grand Rapids, MI

    The postings on this site are my own views and do not represent Spectrum Health's views, positions, strategies or opinions.
    ------------------------------

    2020 HCCA Compliance Institute


  • 6.  RE: ED Transfer Question

    Posted 01-14-2020 09:01 AM
    Some things to consider:

    1. Have you checked with your local MAC to see if they define "Locality" and if the receiving facility would fall within that definition?
    2. Although not the closest, is the receiving the most appropriate for the patient?
    3. Who owns the ambulance?
    4. Why wouldn't there be a consideration for the ambulance to issue an ABN for any potentially uncovered mileage especially if the receiving facility is by the patient's choice? Medicare should at least pay for the mileage to the closest most appropriate facility if it is not the receiving hospital
    5. I would use caution if considering paying for the ambulance. It could be considered an inducement to the ambulance for referrals especially if they can influence the transport of patients to your facility as well as remuneration to the patient.

    ------------------------------
    Nancy O'Neill, RN, CHC, CHPC
    Sr. Director, Corporate Compliance/Privacy Officer
    Tampa General Hospital
    Tampa, FL
    noneill@tgh.org
    Responses are my own and not the view of my organization.
    ------------------------------

    2020 HCCA Compliance Institute


  • 7.  RE: ED Transfer Question

    Posted 01-14-2020 10:06 AM

    I sincerely appreciate the guidance and feedback on my issue. I wasn't sure what to expect when I posed the question but thank you!

    I'm finding that much of the regulations out there are pretty gray on the matter because it is very circumstantial as some of you have pointed out. The only real reason for transfer is due to the lack of beds and I'm not sure what the medical necessity would be because its on a case to case basis. I was able to determine that there is patient choice in the matter and in this situation, none of chosen to go to the other system hospital as it is nearly an hour away compared to 15 minutes for the closest ED.

    My concern is naturally inducement and I agree that it certainly is a significant risk here. What's odd is regulations are fairly gray on the matter as it pertains to full beds, but as we all know if it doesn't feel right, it probably isn't right. I did explore safe harbors, but ambulances are not included in the safe harbor regulations unless owned or subsidized by the state government. These companies are independent of the system.

    I think I have a path I'm going to take and I appreciate everyone's input.

    Again, nothing said will be taking as legal advice, guidance etc...

    Thanks!



    ------------------------------
    Joel Kellner
    Managing Associate
    ------------------------------

    2020 HCCA Compliance Institute