Medicare surveys call for corrections at Palomar Medical Center
What started with an examination of the nearly
She said Palomar is committed to satisfying all government concerns.
"It's important for us to wake up and take notice," Hansen said. "It doesn't matter how small the finding. The reality is, in those things we needed to do a better job and those are the things that we're trying to shore up for our patients."
That shoring up has included firing one doctor and one nurse found to have been stealing prescription medications and installation of a better medication-tracking system.
Hansen said she also "elevated" Palomar's chief quality officer, insisting that the position be filled by a physician and that he or she report directly to her rather than to a subordinate executive.
The survey results also played into a reorganization effort in January that resulted in the layoff of 42 executives, most of whom worked in Palomar's
"We're also bringing on additional resources over the course of the next several weeks in order to really make sure that the next time CDPH (
Palomar also recently announced the pending resignation of
The exact details of the events that led to Palomar's current efforts around staff training and accountability remain a bit foggy. The ongoing surveys, and an overview of the subjects they covered, were the subject of a recent memo Hansen sent to all staff in mid-April.
While Palomar executives did answer some questions about the government surveys, which appear not to involve
Hospital executives did say that the state conducted an initial focused inspection at Palomar in April of last year after
The fire, according to Palomar, was immediately extinguished, but the report brought investigators to the hospital to look into deeper causes of the incident. Details were not immediately available from Palomar or state inspectors on what happened with the botched surgery, though these kinds of incidents tend to draw large fines from the
No such fine has yet been leveled against Palomar but the CDPH said in an email Friday afternoon that the wrong-site surgery occurred in late 2016 but was not investigated until
The state agency also confirmed the follow-up surveys in August and October, but added all three are not yet available because "components of each investigation remain open or otherwise unresolved."
Hospitals found to be out of compliance with Medicare participation requirements can lose their ability to bill the nation's largest health insurance program for their services. That's a huge threat because Medicare made up nearly 52 percent of Palomar's total revenue in the health system's most recent quarterly financial filing with the state
"At many hospitals, Medicare makes up a huge percentage of their revenue, so having to go without Medicare for very long at all would mean they would have to close their doors," she said.
On Friday, for example, the termination page shows that Medicare access ended for
In situations where there may not be another hospital nearby or where closing a hospital would significantly erode access to life-saving health care, the federal government provides plenty of chances, Pusey said, for hospitals to get their operations up to snuff. It's common, she said, for hospitals to enter into special "improvement agreements" to avoid loss of Medicare access. Such agreements often have hospitals working with a group of outside consultants for one year or more to improve their survey results.
What should the public make of the fact that investigators found problems at
Pusey said that many hospitals aren't able to fully satisfy CMS on the first go-around.
"I'd guess that maybe 50 percent to 75 percent of the time they come back and find that they still have concerns after the first focused survey," she said.
Why don't more hospitals improve their performance on the first try?
Pusey said she doesn't think they're ignoring problems.
"I can't say anyone would make an action plan and then just put it on the shelf and let it collect dust, because then you're really putting yourself at risk," she said. "But I do think that, sometimes, you get paralyzed when you're trying to look objectively at your own organization."
Palomar's leaders insist they've been willing and able to make big changes.
Brown said the organization has moved recently to bolster its nurse training program, moving away from electronic continuing education systems to direct teaching, with nurses coaching their colleagues on the wards where they work.
"We're having them go side-by-side working with the nurses," Brown said.
Hansen said that she could not say exactly why
She noted that she did not become interim CEO until November, one month after the follow-up survey was conducted. In her previous position as Palomar's chief financial officer, Hansen did not have direct responsibility for patient care.
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