From staff reports
The Centers for Medicare and Medicaid Services on Friday notified Freeman Health Systems that it has rescinded its termination notice following a state evaluation of recent changes made in the hospital's emergency department.
The federal agency would have ended Freeman's participation with Medicare on June 30 had the changes not been made. That would have meant that the Medicare program would not have made payment for services furnished by Freeman to patients who were admitted after June 30.
Julie Brookhart, a spokeswoman for the federal agency, said in a written release that Freeman had made the necessary corrections to be in compliance with the Emergency Medical Treatment and Active Labor Act.
In a telephone interview on Friday, Gary Duncan, president of the hospital, said a state evaluator had spent an entire day in the emergency department of the hospital and then made a report to the federal agency.
"The folks at CMMS were very straightforward," said Duncan. "They felt that we had taken the concern seriously."
A notice of the agency's intentions to terminate the hospital's participation with Medicare was published in the legal section of The Joplin Globe on June 7. The notice was triggered by two complaints about the hospital within the same year. The notice was the first in the history of Freeman.
The hospital's first infraction, according to documents released by CMMS, concerned a Nov. 18 incident involving a child with a fractured leg who was transferred from Freeman Neosho Hospital to Freeman Hospital West.
An emergency-room physician at Freeman West contacted the on-call orthopedic surgeon, who declined to treat the child because of the child's age. The federal agency said the violation could have been avoided if Freeman Neosho had immediately notified the chief medical officer at Freeman West that an on-call physician had failed to comply by not accepting an appropriate transfer.
In response, Freeman established a new policy for emergency transfers from other hospitals. Now, all emergency transfers will be accepted by emergency-room physicians. The physicians must report to the hospital's chief medical officer all physicians who refuse to accept or try in any way to avoid their on-call duties.
The second violation, which happened within the past 90 days, involved the failure to provide an adequate medical screening by emergency department staff. Information about the investigation into the incident and the corrective plan Freeman filed with the agency was not available to the public.
Duncan praised the hospital's emergency-room staff on Friday.
"It's certainly no fun to be the focus," said Duncan, of the emergency department.
He said on the day of the evaluation, the state worker went through the department as a patient. During the exit interview, the evaluator found no deficiencies.
In addition to the corrective actions, Duncan said Freeman has also added an around-the-clock, master's-prepared behavioral health professional to the emergency department. Duncan said the worker would assist in cases requiring a mental or behavioral focus and help meet the needs of those patients.
"We did a study of our own during a weekend," said Duncan. "What we found was there were 39 times when behavioral problems were involved."
He said the compliance episode with CMMS thereby helped Freeman improve its services in more than one way.
"When you get in the cauldron," Duncan said, "you go in and fix the problem and look for other ways you can improve."
St. John's complaint
One complaint filed against St. John's Regional Health Center is being investigated. A report on the incident and the hospital's plan to correct the problem are to be released in July. It is the only complaint St. John's has had within the past 12 months. The hospital is not at risk of losing its Medicare status.
