Immediate Jeopardy at Parkland Puts VBP Incentive Pay in Peril

Another part of CMS' final rule says this: "We proposed to interpret this provision to mean that any hospital that is cited by CMS through the Medicare State Survey and Certification process for deficiencies during the performance period (for purposes of the FY 2013 Hospital VBP program,
the performance period is July 1, 2011-March 31, 2012) that pose immediate jeopardy to patients will be excluded from the Hospital VBP program for the fiscal year."

I mentioned earlier that CMS is being more aggressive in looking for hospital immediate jeopardies. David R. Wright, CMS Acting Deputy Administrator for Region 6, which covers Arkansas, Louisiana, New Mexico, Oklahoma, and Texas, told me last week that for the fiscal year that concludes at the end of this month, CMS has issued six of these immediate jeopardies. Three of them, Parkland, Methodist, and Humble Surgical Hospital, in Humble, Texas, occurred after July 1, 2011.

That's an increase from two issued in the prior fiscal year, and when I asked why, Wright explained that CMS this year directed surveyors investigating complaints to not just review patient records when they visit the hospital, but to instead "walk the halls" and focus on "things that are directly observable."

"We've been pushing for surveyors to do more observations, and be out there and observe more – for example the infection control findings (at Parkland) were the result of direct observation, as were the findings regarding (problems with Parkland's) emergency services. It's true that they've always done this, but we're asking them to really focus on this a lot more."

It's plausible, and justifiable, that CMS take a tougher stance on hospitals that distinguish themselves with systemic quality gaps. If the other nine CMS administrative regions in the country are following this policy, perhaps we'll soon see an increasing number of these embarrassing reports nationally.