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Detroit Medical Center Hospital is at risk of losing Medicare fundings

Detroit Medical Center Hospital is at risk of losing its ability to participate in Medicare due to issues that state regulators discovered during a recent inspection, which continues with a history of safety issues identified within the regional health system.

Loss of eligibility for Medicare, the government health program for seniors, would likely also cause a loss of participation in Medicaid, the government health program for most low-income residents, and would prove financially devastating, said Allan Baumgarten, a Minneapolis-based health analyst who follows the Michigan health care industry. Federal plans account for the vast majority of hospital funding, he said.

The hospital was found not complying with Medicare and Medicaid service center rules on nursing services during an unannounced inspection in May by the Michigan Department of Licensing and Regulatory Affairs, according to a letter and survey. provided to The Detroit News.

The deficiency caused a 52-year-old patient who developed ulcers during his hospital stay in January, injuries documented inconsistently in his medical record and which may have been left without proper treatment, according to the completed inspection survey on May 5th.

“We’ve determined that deficiencies limit the ability of your facility to provide adequate care and ensure the health and safety of your patients,” wrote a Chicago-based CMS official whose name was spelled out. , in a letter Monday to the hospital after the inspection.

The hospital must submit a corrective action plan to CMS by May 26, according to the letter. You will lose your ability to participate in Medicare on August 14 unless you meet and re-apply for CMS to restore eligibility.

DMC will present a plan to address the deficiencies identified during the survey and will await a follow-up survey, DMC spokesman Brian Taylor said.

“Our hospital will continue to be fully involved in the Medicare and Medicaid programs during this process,” it said in a statement. “We will continue to work with LARA and CMS and remain committed to providing excellent care and services to our community.”

The loss of Medicare involvement in the Detroit receiving hospital would put great financial strain on them on the eight-hospital system, Baumgarten said.

If the hospital is not eligible to work with Medicare, it will also likely lose its ability to participate in Medicaid, he said. Medicare cost reports shows that Medicare paid 50.8% of hospitalization days at Detroit Receiving Hospital in 2020, while Medicaid covered 39.4%, Baumgarten said.

Even the threat of losing Medicare involvement could mean Detroit Receiving Hospital and DMC lose business, he said. Private insurance companies and Medicaid plans could take patients away because of continued questions from regulators about the quality of the hospital.

“There’s a whole set of dominoes that could fall apart and not just if the hospital gets the final sanction, which is termination,” Baumgarter said. “This continued public scrutiny of the quality of care, patient safety in these hospitals could affect relationships with patients, it could affect relationships with doctors.”

Seven DMC hospitals have received 247 complaints since January 1, 2020, according to LARA records. The department completed 50 inspections in that time.

Unnamed DMC doctors and nurses also filed a complaint with the Michigan Attorney General’s office in April, alleging that the for-profit hospital system had implemented cost-cutting measures and maintained a staff. low which delayed and worsened attention.

The hospital system is owned by Tenet Healthcare, a for-profit hospital chain. Her Metro Detroit hospitals include Sinai-Grace, Children’s Hospital of Michigan, Harper University Hospital, Hutzel Women’s Hospital, Rehabilitation Institute of Michigan, Huron Valley-Sinai Hospital and Heart Hospital.

Sinai-Grace was notified in April that it was also at risk of losing its ability to participate in Medicare, although the hospital underwent a follow-up inspection on May 6 and is no longer in danger of losing their eligibility.

In 2018, inspections at Sinai-Grace DMC Hospital found “significant” deficiencies in nursing care and building safety, according to government reports. Sinai-Grace temporarily lost her Medicare nursing care and hospital “physical environment,” but eventually regained it.

According to the inspection report, state inspectors in February 2018 found deficiencies in the treatment of wounds in the 402-bed hospital, including a patient who died after a decubitus ulcer who received insufficient treatment. during several hospitalizations and became infected.

In November 2018, CMS revoked Medicare status from Harper University Hospital and Detroit Reception Hospital after October 2018 inspections found “significant” slips in infection control.

Inspection at Harper found flying insects in an intensive care unit, poorly dressed surgical staff and failures in sterile processing of surgical instruments. Inspectors found that the receiving Hospital had discontinued surveillance of most surgical site infections due to staff cuts in 2018, including patients exposed to dirty surgical instruments.

Follow-up inspections eventually found that the two hospitals were once again complying with federal regulations.

Although DMC has so far successfully avoided being permanent removed from Medicare, CMS threats equate to the “nuclear option,” Baumgarten said.

“At some point, CMS has an important responsibility to make sure that the care you are paying for is safe and of good quality,” he said. “If they can’t be convinced by the facts on the ground, by what they observe through inspections …, then they have a duty to take patients out of this hospital and take them to another center where quality and safety standards are met. “.

LARA inspectors visited Detroit Reception Hospital on May 4 and 5 in response to a pre-March inspection, when inspectors determined that the hospital had violated Medicare rules on patient rights. DMC stated that they complied with this standard; LARA inspectors agreed when they visited again in May.

But during the same May survey, LARA inspectors discovered the shortcomings with the nursing services that caused CMS to issue its threat on Monday.

Inspectors found that the hospital did not have 24-hour nursing care supervised or provided by a registered nurse, as evidenced by its lack of skin management and wound care for the 52-year-old patient who developed ulcers.

The patient had been admitted to hospital in late January with chest pain and difficulty breathing, according to the LARA report. His skin was in good condition when he was admitted and he was determined to have a low risk of pressure injuries.

But his skin condition deteriorated and he developed a pressure injury within a few days, according to the DMC records inspection. From there, the patient’s wound and wound care were poorly documented in his medical record, according to the LARA inspection report. He was discharged aa rehabilitation facility on February 2nd.

The hospital also failed to meet standards for planning patient discharge, which is supposed to help guide patient care after they leave the hospital and help prevent readmission. The facility did not guarantee that a social worker would be qualified to supervise discharge planning staff, “resulting in a potentially less than optimal outcome potential for all patients cared for by the facility.”.

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