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What can RI Hospital expect from the CMS survey?

November 15, 2010

Everyone at RI Hospital is freaking out about an impending visit from the Centers for  Medicare and Medicaid Services (CMS).

Why?  Because CMS can come at any time, ask to see any record, and look into any room as it examines whether the hospital is following the so called “Conditions of Participation” and “Conditions For Coverage.”  These are the minimum standards for continuing to receive reimbursements through Medicare and Medicaid.

If the CMS investigators find too many violations at RI Hospital, the non-profit could lose its medicare and medicaid funding- which make up a huge chunk of its income.  So, the folks over there are taking this very seriously.  I’m hearing that the hospital has even asked employees to act as “practice investigators” who walk through the hospital pretending they’re from the CMS to get everyone ready.

CMS decided to visit RI Hospital following the incident where surgeons left a tiny piece of a drill bit inside of a patient.  The problem wasn’t that the doctors made a mistake, it was the fact that they didn’t follow their own protocols- which required using a x-ray to find the drill piece before they closed the surgery.  That miss step got CMS’s attention.

So, what can RI Hospital expect?  We can get some idea by looking at the CMS survey of Massachusetts General Hospital earlier this year.  The actual report is pretty long and technical, but the hospital also posted a summary of the violations uncovered by CMS.

Some of the problems are just about paper work- the file for a rehired security guard didn’t include a copy of his criminal background check, even though the check had been conducted.

Others were more serious- a patient died when the crisis alarm on his/her heart monitor was turned off.

And some were just bad manners- CMS found Mass General didn’t do a good job of responding to patient complaints.

Despite a long list of all different types of violations, Mass General successfully responded to the concerns of CMS in its “plans for correction” and maintained its medicare and medicaid funding as well as the CMS stamp of approval.

The survey at RI Hospital could happen any day.  We’ll see what happens this time around…




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