CMS reconsidering one-hour rule for restraint use

Doctors, hospitals seek to overturn the requirement of a face-to-face physician evaluation of a patient within this restrictive time frame.

By Markian Hawryluk, AMNews staff. Dec. 23/30, 2002.

Washington -- Medicare is once again wrestling with the issue of where to draw the line between patient safety and unnecessary regulation of physicians and hospitals.

The Centers for Medicare & Medicaid Services is considering whether to abolish a rule requiring a face-to-face physician evaluation of patients within one hour of the initiation of restraints or seclusion.

In 1999, the agency issued interim rules on restraints as part of its Medicare and Medicaid Hospital Conditions of Participation. The rules state that the use of restraints and seclusion should be continually assessed, monitored and re-evaluated. Hospitals must conduct ongoing training of direct care staff in the proper and safe use of restraints and to report to CMS on their use of restraints.

But at a CMS town hall meeting in October, hospitals and doctors complained that the one-hour rule adds responsibilities with little or no benefit to the patient.

"Some of the requirements in the interim final rule have unreasonably limited the ability of physicians to order the use of reasonable and necessary patient restraints to protect the safety and welfare of the patients and medical professionals and staff," said Jack Emery, assistant director for federal affairs for the AMA. "This rule is overly prescriptive and interferes with physicians' medical decisions."

The Association said that although the new rules had induced "a positive change in the culture associated with ordering and administering restraints and seclusion," the one-hour rule has diverted limited resources from direct patient care. [...]