Hospital Visitation Rule in Trouble?

CMS proposed it in response to an April 15, 2010, presidential memorandum that says "every day, all across America, patients are denied the kindnesses and caring of a loved one at their sides."

The American Hospital Association has challenged the Centers for Medicare & Medicaid Services' proposed rule that would require Medicare- and Medicaid-participating hospitals and critical access hospitals (CAHs) to have written policies and procedures spelling out patients' right to receive visitors whom they designate and to withdraw or deny that consent at any time. AHA, which represents more than 5,000 hospitals and health organizations and 40,000 individual members, said in its brief Aug. 27 comments that these changes should be coordinated with state laws and urged CMS to consult with it and other stakeholders before issuing interpretive guidelines or developing instructions for surveyors.

CMS published the proposed rule on June 28, asking for comments by 5 p.m. Aug. 27. Because most CAHs already have policies and procedures regarding visitation rights of patients, the changes would have minimal impact, according to the agency, which estimated 1,314 CAHs would have to spend 15 minutes each to comply.

The proposal stems from an April 15, 2010, presidential memorandum to the secretary of Health and Human Services asking that such requirements be developed. The memorandum says in part, "every day, all across America, patients are denied the kindnesses and caring of a loved one at their sides -- whether in a sudden medical emergency or a prolonged hospital stay. Often, a widow or widower with no children is denied the support and comfort of a good friend. Members of religious orders are sometimes unable to choose someone other than an immediate family member to visit them and make medical decisions on their behalf. Also uniquely affected are gay and lesbian Americans who are often barred from the bedsides of the partners with whom they may have spent decades of their lives -- unable to be there for the person they love, and unable to act as a legal surrogate if their partner is incapacitated. For all of these Americans, the failure to have their wishes respected concerning who may visit them or make medical decisions on their behalf has real consequences. It means that doctors and nurses do not always have the best information about patients' medications and medical histories and that friends and certain family members are unable to serve as intermediaries to help communicate patients' needs. It means that a stressful and at times terrifying experience for patients is senselessly compounded by indignity and unfairness. And it means that all too often, people are made to suffer or even to pass away alone, denied the comfort of companionship in their final moments while a loved one is left worrying and pacing down the hall."

AHA, in comments by Linda E. Fishman, senior VP of public policy analysis and development, said it agrees hospitals and CAHs should have written policies, "including any clinically necessary or reasonable restriction or limitation that the hospital may need to place on such rights and the reasons for the clinical restriction or limitation." Many hospitals restrict the number of visitors who can be present at one time and also refuse to admit anyone with a fever or other indication of a contagious disease, she wrote.

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