2015/05/28 – Merit Health Central Hospital must prove it has made changes in handling emergency care patients, or it could lose Medicare funding, officials have warned the Jackson hospital.

“We have determined that the deficiencies are so serious that they constitute an immediate threat and jeopardy to the health and safety of any individual who comes to your hospital with an emergency medical condition,” Sandra Pace, associate regional administrator for the Centers for Medicare & Medicaid Services, wrote CEO Lisa Dolan.

But administrators at the Merit Health hospital, formerly known as Central Mississippi Medical Center, say corrections were made after these allegations arose two years ago and their current health care meets or exceeds standards.

“First and foremost, Merit Health Central is focused on providing medically necessary emergency care to all patients who come to our emergency room,” said Jana Fuss, director of communications for Merit Health in the Jackson-Vicksburg area.

News of the CMS letter comes on the heels of Merit Health announcing it has become Mississippi’s largest health system, growing to include a dozen hospitals across the state.

In 2014, The Clarion-Ledger reported about the for-profit hospital in south Jackson repeatedly transferring emergency patients it was paid by the state to treat, possibly violating state hospital regulations and federal law. The hospital was then owned by HMA.

Trauma victims were sent away at least 89 times in 2013, often with injuries that CMMC had the capacity to treat, according to records obtained by the newspaper.

Psych patients were redirected at least 73 times in 2013 — despite the fact CMMC has more psychiatric beds, 29, than some of its most common receiving hospitals and a similar occupancy rate to the University of Mississippi Medical Center, according to state records.

On Jan. 23, 2014, a trauma surgeon didn’t arrive at the hospital for 49 minutes after receiving a call to treat a patient with multiple gunshot wounds to the chest — nearly double the maximum time allowed by state regulations. The patient, 26-year-old James McAlister, died before the surgeon arrived.

Federal law prohibits “patient dumping,” in which a hospital transfers patients to another hospital because they can’t pay.

Hospital officials have denied any wrongdoing, saying “several factors” could justify a transfer, such as diversion when the hospital is full. They have pointed out the physicians who make the decisions to transfer patients have no knowledge of their financial situations.

In a May 13 letter, Pace wrote that if “deficiencies” continued, Medicare could terminate Merit Health Central Hospital from the Medicare program as soon as June 5.

CMS concluded the hospital had failed to provide on-call physicians that were available to stabilize treatment, provide adequate medical screening and make appropriate transfers.

Fuss responded that the hospital has put in place several measures “to help ensure that on-call physicians are readily available, healthcare professionals perform thorough medical screenings on patients, emergency patients receive stabilizing treatment, and transfers are appropriate.”

These actions, she said, include new education and documentation requirements, clinical review protocols and updated policies and procedures.

They include:

Updated policies regarding physician on-call services requiring physicians to be available and reachable during the on-call period;

Reviewing trauma surgeon response times;

Increased oversight of documents involving all transferred patients;

Staff additions to ensure Emergency Department screening, treatment and transfer processes are followed.

Fuss pointed to CMS’ Hospital Compare website, which shows “most of our hospital’s emergency department care measures are consistent with or better than the state average and other area hospitals, including the average time patients spend in the ER before being seen by a health care professional, being admitted or being sent home. Given these actions, the hospital is confident that we will be in good standing with Medicare and that funding will continue.”

According to the website, the average time Central patients spent in the emergency department before they were seen by a health care professional was 21 minutes.

A ProPublica report, based on 2014 data, put that time at 23 minutes — better than the average waiting time in the U.S. of 24 minutes and the average waiting time in Mississippi of 27 minutes.

Time before emergency room patients were admitted to the Central hospital? Three hours and 54 minutes.

That beat both the U.S. average of four hours and 34 minutes and Mississippi’s average of three hours and 42 minutes.

According to the CMS website, 62 percent of Central patients said they would recommend the hospital, compared to the 69 percent average for Mississippi hospitals and 71 percent for U.S. hospitals.

Central received a two-star rating from patients — the same as Merit Health Rankin Hospital, formerly known as Crossgates River Oaks Hospital. The rest of Jackson-area hospitals received at least a three-star rating. Mississippi Baptist Medical Center received a four-star rating.

Fuss said Central’s leadership continues to monitor progress on emergency care and look for opportunities to improve medical care.

“In our emergency department and across the hospital, our clinicians and other employees continuously work to provide a safe environment for quality care,” she said. “We believe the changes over the past year demonstrate this commitment to the patients who trust their care to our hospital.”

Source: The Clarion-Ledger 

Jerry Mitchell