The Centers for Medicare & Medicaid Services is expected to decide if a consultant's report that details ongoing problems at Parkland Health and Hospital Sytem will be released to the public. The gap analysis is currently under review by the CMS Freedom of Information Group office in Baltimore.
Parkland Hospital's board of managers, which has been open about providing documents related to the facilitiy's safety problems, originally planned to release the report. But on Monday the board met in executive session with hospital attorneys and decided to withhold the document, citing legal concerns.
"While we have a duty to be as open as possible with the public, we also have a duty to protect the rights of our patients and Parkland as an institution," said board chair Lauren McDonald, MD, in a prepared statement. "The advice we have received from our legal counsel is that the board cannot both release the report and protect those legal rights."
This is the latest episode in a tale that dates back to a July 2011 on-site review of Parkland by CMS. That review identified nine broad categories of deficiencies considered to be so severe that they presented "an immediate and serious threat to patient health and safety."
State health officials requested the review following the death of a patient in Parkland's psychiatric emergency department. The hospital had failed to report the death to federal and state regulators, as required by law.
Multiple subsequent reviews identified further serious problems at Parkland. The hospital remained under immediate jeopardy status and risked the loss of an estimated $417 million in annual Medicare and Medicaid contracts.
In September CMS tossed Parkland a lifeline. Citing the "devastating impact the termination of Parkland Hospital would have on the citizens of Dallas County and the Medicare/Medicaid patients it serves," CMS took the unusual step of entering into a systems improvement agreement with the hospital. The agreement has allowed Parkland to remain open while it attempts to correct its deficiencies.
The gap analysis is the first deliverable document required under the SIA signed in September 2011.
Under the terms of the agreement, Parkland is required to provide a:
- Comprehensive analysis of Parkland's current operations compared to industry-accepted standards of practice that ensure Parkland's compliance with all the Medicare conditions of participation (CAP) for acute-care hospitals and the federal Emergency Treatment and Active Labor Act (EMTALA) related to the provision of patient care and services.
- Analysis of the root cause of process and system failures
- Recommendations for changes and improvement to ensure full compliance with all the Medicare CAPs for acute-care hospitals and EMTALA provisions.
The analysis was prepared by Alvarez & Marsal, a New York-based management consulting firm that specializes in performance improvement. A&M has a multi-million dollar contract with Parkland to guide the beleaguered hospital through the SIA process.
Tom Royer, MD, interim CEO of Parkland Health & Hospital System, told HealthLeaders Media in a telephone interview Wednesday that the gap analysis is humbling.
"It's most troubling because the same issues appear across multiple service lines. It shows that policies and procedures have not been uniformly abided by. There's a lack of accountability and not everyone is held to the same standard of performance," Royer said.
Royer declined to address specifics of the gap analysis. His did say that the report from Alvarez & Marsal looks at 15 services lines as well as quality and safety issues at the hospital. It also addresses some systemic issues such as inconsistencies in nursing practices. He explained that senior management has already begun to implement some of the policies and procedures necessary to address Parkland's problems. "I've been meeting with our consultants as they developed the report so we've been able to develop solutions to many of the issues in real time."
Some of his more public changes have involved senior personnel, including the hiring of a new chief nursing officer and a senior vice president of human resources. Parkland also added an implementation officer to make sure the improvement plan stays on pace.
Royer says the hospital staff and leadership need to take full ownership of the problems. He has little patience, he says, with people who want to blame the aging Parkland facility and its patient load for its poor review performance. "That's the environment in which we work and that's the environment where we must put improvement in place."
Royer joined the hospital in November 2011. He succeeded Ron Anderson, MD, who was the CEO for 29 years before the board removed him from that position in August. Anderson remains under contract with Parkland.
Margaret Dick Tocknell is a reporter/editor with HealthLeaders Media.
