Medicare Compliance & Reimbursement

Draft argues for more detailed shared-space planning to protect patients.

Sharing public areas, services, and staff with other healthcare entities is complicated. New guidance from the Centers for Medicare and Medicaid Services (CMS) reminds providers to keep quality, safety, and Medicare Conditions of Participation (CoP) in mind as they establish compliant arrangements.

Definition: “Co-location occurs where two hospitals or a hospital and another healthcare entity are located on the same campus or in the same building and share space, staff, or services,” explain partner attorneys Lawrence W. Vernaglia, Adria Warren, and Judith A. Waltz of national law firm Foley & Lardner LLP, in the Health Care Law Today blog.

Context: Last month, CMS issued draft guidance to State Survey Agency Directors on the arrangements between co-located hospitals and providers. According to the memorandum, Medicare CoPs outline how these different entities can share space. Moreover, the aim of the long-awaited guidelines is to offer “clarity” on how the feds and State surveyors “will evaluate a hospital’s space sharing or contracted staff arrangements with another hospital or health care entity when assessing the hospital’s compliance with the CoPs,” maintains the agency.

“CMS wants to allow flexibility in these partnerships,” but “we want to do so while simultaneously protecting the safety and quality of care for patients,” the memorandum indicates.

Review the Key Takeaways from the Memorandum

Though there are still some “limitations,” CMS eases up in the draft “overturning the more restrictive prior standards,” point out Vernaglia, Warren, and Waltz.

For instance, co-located hospitals may share public spaces — lobbies, waiting rooms, public restrooms, staff lounges, elevators, and entrances — but provisions must be made that ensure clinical areas are “defined and distinct spaces of operation” for the separate healthcare entities, the draft suggests.

Reasoning: Safeguarding patients’ health and security are the primary concerns when “co-mingling” occurs, and arrangements must be both uniform and show accountability, according to the draft. A hospital “may not be able to share certain clinical spaces due to concerns regarding quality and safety, infection control, patient management and confidentiality,” says Florida-based attorney Shannon Britton Hartsfield of Holland & Knight LLP, in the Healthcare Blog.

Hartsfield continues, “If there are shared staff members, there must be ‘clear lines of authority and accountability.’”

Consider these key points in the CMS draft guidance:

• Contracted staff can be shared, but not during a given shift.
• Staff cannot “float” between two co-located hospitals “during the same shift” or “work at one hospital while concurrently being ‘on-call’ at another,” CMS advises.
• All employees must receive the same training whether they’re contracted or direct.
• Credentialed medical staff can float between co-located hospitals; however, this shared status must be approved by a governing board and they must have privileges to practice at both locations.
• “Hospitals may not share the same lab, pharmacy, or nursing director simultaneously,” Hartsfield says.
• Emergency departments within co-located hospitals must follow EMTALA requirements.

Industry input: The American Hospital Association (AHA) weighs in. “We are closely reviewing today’s draft guidance from CMS on co-location policies for how hospitals can share space, services and staff with other providers,” says Nancy Foster, AHA vice president of quality and patient safety policy in a release on the announcement. “The AHA has long urged the agency to prioritize the release of guidance on these issues because confusion and mixed-messages about co-location can result in patients having difficulty accessing needed care.”

CMS asks the public to submit all comments on the draft guidance by July 2.

Note: Read the CMS draft guidance on co-located hospitals and healthcare entities at www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/Downloads/QSO-19-13-Hospital.pdf.