Dallas-based Parkland Health & Hospital system will have to be on alert for federal safety officials longer than planned.
The troubled hospital is nearing the end of a two-year corrective action plan for myriad quality and patient safety concerns that the Centers for Medicare & Medicaid Services found in 2011. The federal agency was due to inspect the hospital for improvements by April 30, but on Wednesday the hospital announced that CMS would conduct its Medicare certification survey after that date.
In 2011, CMS placed Parkland under a systems improvement agreement (SIA), which means a hospital may continue to receive Medicare reimbursements as long as a third party is onsite to monitor and facilitate changes that need to be made.
The consulting firm Alvarez & Marsal has been working with Parkland to implement some 499 action items CMS deemed critical to the hospital keeping its Medicare certification, thus reimbursements. At Parkland's last board meeting on February 26, the hospital reported it had completed 484, or 97% of those recommendations.
Parkland still has to get that number up to 100% by April 30, but now that CMS has extended the time it will take to survey the hospital's changes, there's what CMS calls an "element of surprise" to the federal surveyors' arrival.
In a statement, Debbie Branson, chair of the Parkland Board of Managers, said the adjustment changes nothing.
"As of April 30, Parkland should be ready for that level of scrutiny on any day at any hour."
April Foran, director of communications for the hospital, says Parkland did not ask for the change.
The hospital has been preparing for the federal survey since December when it announced there would be two mock surveys conducted, also by surprise, as a sort of practice for when CMS showed up.
Parkland says it has already completed one mock survey; its results are confidential. An outside group of 11 "clinical experts" reviewed Parkland's progress in every area for five days. The surveyors also inspected its outpatient clinics and community health centers.
To bring the hospital up to par with the CMS requirements for Medicare certification, Parkland has beefed up its emergency department by adding triage rooms, seating, and more staff on weeknights. It has also started using something the hospital calls a sustainability schedule to document best practices in triage, staffing, and other processes.
The ED changes are supposed to effect patient flow, which was an issue CMS pointed out in 2011. To that end, Parkland also recently named Marilyn Callies, RN, BSN, MBA, as vice president of care coordination. Her focus will solely be on case management and improving patient flow as well as discharge planning. Callies was previously the director of care coordination at Baylor University Medical Center.
One position that is part of the recommended improvements is the role of newly-created Chief Patient Rights and Safety Officer, which Parkland has had trouble filling. The position is supposed to help the hospital show how seriously it considers patient rights and safety.
In December, Alvarez & Marsal acknowledged the delay in hiring a CPRSO, but said it was intentional, to "get the role right." Now, according to Foran, the responsibilities of a CPRSO will be split between an Associate Chief Medical Officer for Quality, who hasn't been hired, and the Senior Vice President for Quality and Performance, Jackie Sullivan, PhD.
Areas that Parkland continues to focus on as the April 30 deadline approaches are care coordination and transitions in behavioral health, as well as continuing to audit departments across the system to determine if the new processes and practices are sustainable.
Jacqueline Fellows is a contributing writer at HealthLeaders Media.