Emergency room complaint source of Bristol hospital's Medicare notice

UPDATE:

An investigation stemming from complaints about the handling of a belligerent emergency room patient by a Bristol Regional Medical Center employee is behind a recent public notice by the agency responsible for Medicare that the hospital’s Medicare payments will stop after Aug. 27.

The announcement by the Centers for Medicare and Medicaid Services has many area residents who depend on Medicare for their health coverage worried and hospital officials scrambling to let people know they have things under control.

“We do not expect to be excluded from the Medicare program,” Wellmont Health System Chief Medical Officer Dale Sargent said Monday during a hastily scheduled news conference.

Wellmont owns and operates BRMC, along with nine other hospitals in the area. Currently, 60 percent of BRMC’s patients are covered by Medicare, hospital officials said.

In the legal notice, which was published in Saturday’s Bristol Herald Courier, the U.S. Centers for Medicare and Medicaid Services announced it has determined that the hospital violated an agreement it had to follow to receive Medicare payments. Because of this non-compliance, the federal agency will not make payments for inpatient services administered at the hospital after Aug. 27, the ad states.

Medicare beneficiaries currently receiving care at the hospital would see their coverage run out on Sept. 26.

“It shocked me a great deal,” Marty Kitchens, of Bristol, Tenn., said Monday of her reaction to the notice.

Kitchens said she was worried that she and the other thousands of Medicare beneficiaries who live in the area could end up going to the medical center for treatment only to learn that care wasn’t covered.

Wellmont officials said Monday they are working to address the agency’s concerns and are confident a solution can be reached before the Medicare reimbursements are stopped.

During the news conference, Sargent said that it is “absolutely our intent” to bring the hospital back into compliance with its agreement.

Any health care provider covered by Medicare must follow a Conditions of Participation agreement, which dictates rules that must be followed so quality health care is provided in a safe environment, Centers for Medicare and Medicaid Services spokeswoman Lee Millman said.

The agency makes sure the terms are followed when a Medicare or Medicaid recipient files a formal complaint about the quality of care they receive from a provider, Millman said.

“Our major concern is always the health and safety of the patient,” Millman said during a Monday interview from her Atlanta office.

If the investigation finds that the health care provider isn’t following the terms of its agreement, Millman said, the Centers for Medicare and Medicaid Services gives it a certain amount of time to solve the problem or risk losing its Medicare payments.

This window of time depends on the severity of the violation, she said. The agency is required to publish a legal notice a certain number of days before that window expires and the Medicare payments stop.

Millman said she couldn’t comment further on the specifics of BRMC’s violation due to medical privacy rules. She also said a copy of the complaint and the investigation’s results would only be available after the matter has been settled.

Citing the same privacy concerns, Wellmont’s executives were vague about the complaint and the investigation.

Sargent said the Centers for Medicare and Medicaid Services had been keeping a close eye on the hospital’s operations because BRMC was in the middle of a corrective action plan it worked out with the agency to address a complaint made last year.

Then, another complaint surfaced against the hospital earlier this year following an incident involving an impaired or intoxicated patient who was belligerent while in the emergency room and threatened a staff member, Sargent said.

That staff member did not follow the procedures for handing this type of problem that are spelled out in the company’s organizational policy manual or its employee handbook, said Pat Kane, Wellmont’s vice president for communications and marketing.

Normally, it would have been considered a simple personnel issue, Kane said, except the Centers for Medicare investigation found that only 88 percent of the hospital’s 1,500 employees have read the entire policy manual.

“We got dinged for that,” Kane said after Monday’s news conference. “They just hadn’t gone all the way through [the policy manual] and they should have.”

During its investigation, the agency also found some expired medical supplies on the hospital’s shelves and identified a personnel policy that treated the hospital’s medical staff differently than the rest of its employees, Sargent said.

BRMC’s staff has been working to correct the problems identified in the investigation. The agency is slated to do a surprise inspection of the hospital to make sure it’s in compliance with its participation agreement next week, he said.

Sargent also said the hospital’s Medicare recipients routinely file complaints about the care they receive and many are unfounded.

The investigation and compliance process that follows a legitimate complaint is part of the “normal back-and-forth” between health care providers and the federal agency, Sargent said.

But he admitted that as far as he knows it is the first time the Centers for Medicare has announced that it would suspend Medicare reimbursements to one of Wellmont’s hospitals.

Millman said the agency “very rarely” has to suspend Medicare payments because the problem is usually solved before the deadline.

gmclean@bristolnews.com | (276) 645-2518

Wellmont Health System officials said today they are confident they can address concerns that the federal agency in charge of Medicare has raised about Bristol Regional Medical Center before more than half that hospital’s patients are affected.

The U.S. Centers for Medicare and Medicaid Services published a legal notice in Saturday’s Bristol Herald Courier announcing that Medicare would no longer pay for inpatient services administered at the medical center after Aug. 27 because the hospital “is not in compliance with its Conditions of Participation.”

During a news conference this afternoon, Wellmont officials said they have been working to address that agency’s concerns and are confident they can resolve it before the hospital’s Medicare payments are suspended.

Read Tuesday’s Herald Courier to learn more about what led to this notice and what Wellmont officials plan to do about it.