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CMS Compromise Gives Parkland Reprieve

Margaret Dick Tocknell, for HealthLeaders Media, September 12, 2011

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.

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2 comments on "CMS Compromise Gives Parkland Reprieve"


Hannibal (9/13/2011 at 3:34 AM)
I think the authors of this article should make it clear that Parkland was indeed terminated from participating in Medicare programs as of Sept. 30 of this month. So, Parkland is the largest hospital in the history of the US to be terminated from Medicare, surpassing the previous title holder, King/Drew in LA. CMS only allowed a compromise for "probationary" terms for Parkland to continue to operate by forcing the hospital into a "service improvement agreement." That compromise occurred because Parkland is the only public hospital serving the Dallas area. If the hospital closed, then there were no other safety net hospitals to pick up the slack. The point is that Parkland was deemed such a bad hospital that it would have closed down, if it wouldn't have caused a catastophic collapse of public health services in Dallas.

Doug Keiller (9/12/2011 at 3:03 PM)
Public hospitals serving large Latino populations (Dallas, Houston, LA, Chicago, Phoenix, etc.) are a critical public resources, but face huge operating challenges. One cost-effective strategy the CMS-approved consultants should explore is improving ER and OB operating efficiency by training and sourcing more fully bilingual staff. Currently, a large portion of patient conversations require interpretation, which slows service delivery by up to 50%. Bilingual staff (RNs, etc.) have been shown to triage ER patients faster, for example, reducing wait times, and improving initial assessment accuracy. In OB, speeding patient communication with bilingual staff can free up time to focus on infection control and other safety procedures.