Respecto a la Sostenibilidad en Base a la Gestión del Conocimiento

Patients are admitted to the CAH only on the recommendation of a licensed practitioner permitted by the State to admit patients to the CAH.

Patients are admitted to the CAH only on the recommendation of a licensed practitioner permitted by the State to admit patients to the CAH.

SR.1 The governing body (or individual who assumes full legal authority and responsibility for operations of the CAH) shall ensure that every patient is under the care of a:

SR.1a doctor of medicine or osteopathy who may delegate such care to other qualified health care professionals to the extent allowed by State law;

SR.1b doctor of dental surgery or dental medicine who is legally authorized to practice dentistry by the State and who is acting within the scope of his/her license;

SR.1c doctor of podiatric medicine, only with respect to functions authorized by State; SR.1d doctor of optometry who is legally authorized to practice optometry by the State;

SR.1e chiropractor who is licensed by the State and legally authorized to perform the services of a chiropractor, but only with respect to treatment by means of manual manipulation of the spine to correct a subluxation demonstrated by x-ray to exist; or

SR.1f clinical psychologist (doctoral degree in psychology), but only with respect to clinical psychologist services as defined in 42 CFR §410.71 and only to the extent permitted by State law.

SR.2. The governing body (or individual who assumes full legal authority and responsibility for operations of the CAH) shall ensure that:

SR.2a A doctor of medicine or osteopathy shall be readily available by radio or telephone for medical emergencies, consultation and referrals. If the CAH maintains a Distinct Part Unit for Rehabilitation and/or Psychiatric patients, the CAH is required to have a doctor of medicine or osteopathy is on duty or on call at all times. 485.631(b)(2)

SR.2b A physician assistant, nurse practitioner and/or clinical nurse specialist shall notify a doctor of medicine or osteopathy on the CAH clinical staff when a patient is admitted as an inpatient, in accordance with State law. 485.631( c)(3)

SR.2c. a doctor of medicine or osteopathy is responsible for the care of each patient with respect to any medical or psychiatric problem that is present on admission or develops during hospitalization and is not within the scope of practice of the licensed practitioners specified in SR 1b-1f (above) as that scope of practice is defined by the medical staff and State law.

Interpretive Guidelines:

The CAH may admit patients only on the recommendation of a licensed practitioner permitted by the State. The governing body is responsible for ensuring that every patient admitted is under the care of licensed practitioner (as defined by SR.1 of this standard (above)).

The governing body (or individual responsible) must ensure that a doctor of medicine or osteopathy shall be readily available by radio or telephone for medical emergencies, consultation and referrals. The governing body must also ensure a doctor of medicine or osteopathy is responsible for the care of each patient with respect to any medical or psychiatric problem that is present on admission or develops during hospitalization and is not within the scope of practice of the licensed practitioners specified and within the scope of practice is defined by the medical staff and State law.

The CAH regulations do permit licensed mid-level practitioners, as allowed by the State, to admit patients to a CAH. However, CMS regulations do require that Medicare and Medicaid patients be under the care of an MD/DO if admitted by a mid-level practitioner and the patient has any medical or psychiatric problem that is present on admission or develops during hospitalization that is outside the scope of practice of the admitting practitioner. Evidence of being under the care of an MD/DO must be in the patient’s medical record. If a CAH allows a mid-level practitioner to admit and care for patients, as allowed by State law, the governing body (or responsible individual) and medical staff would have to establish policies and bylaws to ensure patient safety. As applicable, the patient’s medical record must demonstrate MD/DO responsibility/care.

Surveyor Guidance:

Review the Medical Staff Bylaws, Rules and Regulations to Verify that admitting privileges are limited to practitioners who have been approved by the medical staff and governing body (or individual responsible) and as permitted by State law.

Although the practitioners that are licensed and permitted by State law to admit patients, in some CAHs, the admission of patients must be done under the service of specific practitioners as defined in the medical staff bylaws, rules and regulations – Verify the CAH’s process for addressing these admission requirements to ensure that patients are admitted under the appropriate service.

The medical staff bylaws, rules and regulations will define which practitioners by category (i.e. Active, Associate, Courtesy, Consulting, etc.) staff may admit patients. Verify that admitting privileges are limited to those practitioners holding the appropriate status with the Medical Staff.

Verify the governing body (or individual responsible) has established and monitors the enforcement of policies to ensure an MD or DO is on duty or on call at all times. The medical staff will normally distribute a “on-call” schedule of practitioners by service – verify how such a list is communicated to appropriate departments/units throughout the CAH. If non-MD/DOs admit patients, verify that every patient is being monitored by an MD/DO who is responsible for any medical or psychiatric problem outside the scope of practice of the admitting practitioner.