CMS has the authority to terminate a hospital's Medicare contract if it is out of compliance with requirements. Deficiencies are often revealed in routine state surveys or in surveys prompted by negative news reports. In most cases, hospitals are able to correct any issues and avoid termination.
Becker's has tracked six hospitals in 2018 that have been issued contract termination notices. Here is what the surveys found and the steps the hospitals have taken to reverse, or attempt to reverse, Medicare contract termination:
1. Baylor St. Luke's Medical Center (Houston). CMS notified Baylor St. Luke's Medical Center on June 22 its heart transplant program could lose Medicare funding Aug. 17. The agency felt not enough was done to ensure patient safety after news reports found high patient volume in the heart transplant program led to deaths and unusual complications. St. Luke's said it plans to work with CMS to strike a systems improvement agreement, among other corrective actions.
Contract status: In jeopardy
2. Brookwood Baptist Medical Center (Birmingham, Ala.). Brookwood Baptist Medical Center faced a potential loss of Medicare billing privileges in May after a CMS survey found psychiatric unit staff were using inappropriate patient restraint methods, which led to a patient death. CMS lifted the termination notice in June after the hospital submitted a plan of correction and a follow-up survey showed it had taken steps to address the issues.
Contract status: No longer at risk
3. Wake Forest Baptist Medical Center (Winston-Salem, N.C.). After a CMS survey revealed four patients received erroneous cancer diagnoses at Wake Forest Baptist Medical Center, the agency threatened to revoke the hospital's Medicare contract March 25. An amended report later found deficiencies in the laboratory affected at least 25 patients. Two patients underwent unneeded cancer treatment and three patients were wrongly told they did not have cancer, potentially delaying treatment. The hospital submitted a corrective action plan for its pathology laboratory and was cleared June 15.
Contract status: No longer at risk
4. UnityPoint Health-Meriter (Madison, Wis.). UnityPoint Health-Meriter was at risk of losing Medicare billing privileges in June after a third CMS inspection showed deficiencies. After patients in the newborn intensive care unit suffered unexplained injuries, the hospital's Medicare contract was set to be terminated in March. Despite finding more than 30 new deficiencies in March, the deadline for termination was extended as the hospital made progress toward compliance. The hospital was officially cleared by CMS on June 12 as being in compliance with all Medicare conditions.
Contract status: No longer at risk
5. Blue Valley Hospital (Overland Park, Kan.). CMS terminated Blue Valley Hospital's Medicare contract April 11 because it fell short of Medicare's new minimum inpatient requirement of at least two inpatients per day with an average length of stay of two nights. The hospital sued HHS and CMS over the decision, saying the rules are arbitrary and unrelated to quality of care. Instead, Blue Valley said its patients were able to leave the hospital sooner than expected because of the high-quality care provided. Blue Valley was able to retain Medicare billing privileges until early June, when a federal judge ruled she did not have jurisdiction to hear the hospital's case.
Contract status: Terminated
6. Hill Hospital of Sumter County (York, Ala.). Hill Hospital of Sumter County's Medicare contract was at risk Feb. 17 when an investigation by the Alabama State Survey Agency found the hospital was not in compliance with Conditions of Participation for hospitals. Specifically, the hospital did not have a physician to staff the emergency department for lengths of time ranging from 12 hours to 84 consecutive hours. This deficiency was linked to two patient deaths. CMS retracted its termination notice on Feb. 17.
Contract status: No longer at risk
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