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CMS Compromise Gives Parkland Reprieve

 |  By Margaret@example.com  
   September 12, 2011

Parkland Memorial Hospital has agreed to bring in an outside consultant to “craft a plan of improvement” for the Dallas hospital. The move is among the requirements of the systems improvement agreement that hospital officials will sign by September 15 with the Centers for Medicare & Medicaid Services.

The agreement is the latest effort by Parkland to protect its participation in Medicare and Medicaid. The $417 million funding from both programs represents about 35% of Parkland’s total annual budget. The programs have been at risk since a July review by federal and state officials uncovered immediate jeopardy deficiencies in the hospital’s infection control and emergency department care. The safety net hospital submitted a corrective action plan to address the issues and a follow-up review was conducted late in August.

That review identified continuing deficiencies in emergency care that were deemed to still be at the immediate jeopardy level. However, problems in infection control were downgraded from “serious” to “significant.”

Based on the follow-up review findings, the Dallas office of CMS sent Parkland CEO Ron Anderson a letter on September 9th stating that Parkland “no longer meets the requirements for participation in the Medicare program” and that its Medicare agreement will be terminated on September 30th.

However, late Friday afternoon, CMS released an e-mail statement that acknowledged the “devastating impact the termination of Parkland Hospital would have on the citizens of Dallas County and the Medicare/Medicaid patients it serves.” To ensure that Parkland “promptly and substantively remedies the ongoing quality concerns identified by the recent onsite surveys, CMS has provided Parkland with an opportunity to enter into a systems improvement agreement,” the e-mail said.

According to the CMS e-mail, a systems improvement agreement is a time-limited agreement between CMS and a hospital. The agreement requires the hospital to bring in external, third-party, CMS-approved quality improvement consultants to:

  • Perform a comprehensive hospital-wide analysis of current operations and compare the findings to industry standards to ensure compliance with the conditions of participation for Medicare and Medicaid, as well as the Emergency Medical Treatment and Labor Act(EMTALA) requirements related to the timely provision of care and services
  • Recommend hospital-wide changes and improvements to ensure compliance with all the conditions of participation and EMTALA
  • Assist in implementing and evaluating changes and improvement
  • Implement an effective and ongoing hospital-wide quality assessment and performance improvement program to ensure continued compliance

In a statement released on its website, Parkland Memorial confirmed that it would sign the agreement, which “provides Parkland the opportunity to continue to operate fully and to address the problems identified in the recent CMS survey.” The statement added that “Parkland remains fully accredited and is accepting Medicare and Medicaid. The agreement will abate the notice of termination of Parkland’s participation in the Medicare and Medicaid programs that Parkland received today.”

The primary focus of the second review was to determine whether the problems in infection control and emergency room care had been corrected.

Parkland still faces another follow-up survey to assess the status of other less serious deficiencies, including:

  • Failure to provide 24-hour nursing services
  • Failure to maintain adequate medical records
  • Failure to dispose of expired medications
  • Failure to properly store medical equipment

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Margaret Dick Tocknell is a reporter/editor with HealthLeaders Media.
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