Durham Regional Hospital is at risk of losing $67 million of Medicare funds following a patient�s leap from a fifth-floor window Aug. 11.
Durham Regional Hospital is at risk of losing $67 million of Medicare funds following a patient’s leap from a fifth-floor window Aug. 11.
After Durham Regional, which is a part of Duke University Health System, reported the incident, the federal Center for Medicare and Medicaid Services placed the hospital in “immediate jeopardy” of losing all reimbursement from Medicaid patients—which amounts to about 40 percent of the hospital’s total revenue.
The patient, whose name and patient care information has been withheld due to federal privacy guidelines, smashed the window with a bedside tray and jumped, landing two floors below on a gravel-covered roof. He was then transferred to Duke University Hospital in critical condition.
Two CMS inspectors visited Durham Regional Aug. 13, and late Friday it received the designation of “immediate jeopardy.” If satisfactory action is not taken by Sept. 5, the hospital will lose Medicare funding until is passes a review.
“What it would mean is until such time that they lift the sanction, any patient that comes through with Medicare or Medicaid will be treated but the hospital will not receive any reimbursement,” said John Burness, senior vice president for public affairs and government relations.
The hospital was most recently put on probation by Medicare officials in 2002, over an incident regarding management of a contract of an inpatient dialysis unit. Administrators quickly addressed the issues and was not penalized.
The hospital has already put in place an “action plan” designed to remedy the problems noted by CMS, said Katie Galbraith, director of marketing and corporate communications at Durham Regional. Hospital officials expect CMS to check the hospital and remove the designation by the Sept. 5 deadline.
“It is important that people know that we take the concerns raised by CMS very seriously and welcome the feedback from them,” Galbraith said. “We are committed to take all the necessary steps to always serve our patients.”
The action plan involves a small change in Durham Regional’s patient observation policy. When a patient comes in needing individual observation, the hospital assigns a sitter to keep vigil, to help with other patient care activities as needed and to report to the appropriate nurses. Under the old system, a patient might be alone between the recommendation and the arrival of the sitter. Now the hospital will provide an interim sitter to prevent any problems.
A second change involves Durham Regional’s alcohol screening policy. A nurse will now screen for intoxication upon admission. The test will be followed-up by physicians as appropriate.
Burness said that all the problems at Durham Regional were fixed, adding that the sanctions were understandable but might have been excessive.
“I think that one of the problems is that the nature of the sanctions that are available to [CMS] are either doing nothing or something very extreme,” Burness said. “They are using the sanction they have available.”
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