Page 9 of Make Time for Patients: How Regulations are Overwhelming Washington Hospitals by Washington State Hospital Association

adding to the confusion are the number of regulators and administrators of the medicare program who interact with providers beneficiaries and health plans for example a hospital may interact with the center for medicare and medicaid services cms claims processing contractors fiscal intermediaries program safeguard contractors peer review organizations and state health insurance programs regulators may be federal state or private agencies some make national policy while others set rules for a region some may provide education on certain aspects of the medicare program while others are charged with enforcement given the size scope and volume of regulations accompanying the medicare program it is easy to understand why it can overwhelm providers what happened to common sense many health-care providers are frustrated by regulations that are well intended but when implemented in the real world simply do not make common sense here are two examples and recommendations for improvement · advanced beneficiary notices and emtala medicare requires providers to notify beneficiaries with an advanced beneficiary notice prior to treatment if medicare does not cover any of the services provided the intent is to allow the beneficiary to be informed of the financial responsibility they might bear for health services this is a well-meaning rule but when put to the test in the real world it is problematic the emergency medical treatment and active labor act emtala requires hospitals to screen and stabilize any patient presenting in the emergency room the emtala rules prohibit any delay of those activities stopping to inform the patient of potential financial responsibilities as required by the advanced beneficiary notice would constitute a delay of care and would violate emtala in addition the rules governing the notice prohibit issuance when a patient is under duress highly likely in an emergency situation statements by the federal department of health and human services office of inspector general that writeoffs or failure to collect co-payments and deductibles can be considered an illegal inducement further complicates the issue the purpose of the office of the inspector general s statement is to ensure hospitals do not bribe medicare patients with free care to get them to the hospital for services that are paid for by medicare this policy makes sense but puts hospitals in a catch-22 if the services required to screen and stabilize a patient as required by emtala are not paid for by medicare the hospital 8

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