LITTLE ROCK — The federal Centers for Medicare and Medicaid Services found the State Hospital in “substantial compliance” with its provider standards and free of most of the problems that once jeopardized its eligibility to receive millions of dollars in federal funds, the agency said Friday.
Document set
Arkansas State Hospital's CMS Report
The psychiatric hospital will regain its “deemed status” as a provider for Medicare and Medicaid patients after it files a plan to correct remaining concerns identified by site surveyors in September, Centers for Medicare and Medicaid Services Enforcement Branch Manager Ginger Odle wrote in a letter to the Arkansas Department of Human Services, which operates the facility.
Those concerns - identified in an 85-page review - include ineffective patient-treatment plans and problems with parts of the facility, such as waste bins and door latches.
“This isn’t the end,” hospital Chief Operating Officer Steve Henson said. “We’re really looking at this as we’re on the right path now, and we’re going to continue improving going forward.”
Friday’s letter brings a new measure of certainty to the future of the hospital, which treats patients with acute mental illnesses and people court-ordered for treatment after they’ve been arrested on criminal charges and found mentally unsuitable for trial or sentencing.
It’s the resolution of an eleventh-hour agreement between the hospital and the federal agency, drafted after site surveyors identified multiple cases of “immediate jeopardy” that threatened the health and well-being of patients there dating back to 2010. Those situations included a suicidal adolescent who was taken to the emergency room after he bloodied his nose by beating his head on the door of a seclusion room.
After each instance, the Centers for Medicare and Medicaid Services threatened to pull the hospital’s eligibility to receive the federal funding if it couldn’t remedy problems within set time frames.
The agency provided several deadline extensions, ultimately signing an all-or-nothing agreement last year that allowed the hospital to continue treating Medicare and Medicaid patients if it hired consultants to do a top-to-bottom review of its treatment, staffing and facilities and to help it make an improvement plan.
If federal site surveyors who visited in September - when that agreement expired - hadn’t found the hospital in “substantial compliance” with treatment standards, it would have lost its eligibility to treat Medicare and Medicaid patients.
Administrators project the current fiscal year’s $44.2 million budget will include about $8.16 million in Medicaid funding and $3.8 million in Medicare reimbursements.
To maintain that funding, the hospital hired new administrators, created a new nursing treatment plan, remodeled its pharmacy and retrained staff members to create a “culture change.”
“The staff are well down the road to understanding we can do a better and more efficient job of taking care of our patients,” Henson said. “They’re not satisfied anymore with what was the status quo.”
Many of the hospital’s problems were originally identified by patient advocates, who called into question its use of restraints, vague and generic patient-treatment plans, certain psychotic drugs and seclusion rooms.
Dee Blakley, a patient advocate for the federally funded Disability Rights Center of Arkansas, said her organization expected the hospital to regain its deemed status.
Blakley, who had not read the site review Friday, said she agreed with site reviewers’ assessment that the hospital needed to create patient-treatment plans with specific, measurable goals and appropriate treatments to address patient needs.
“That shortens hospital stays,” she said, noting that the State Hospital’s average treatment duration exceeds that of some private psychiatric hospitals. “It gets somebody healthy again in the most expeditious manner.”
Hospital Medical Director Dr. Steve Doman said staff members are adjusting to a new model for creating patient-treatment plans, and a nurse/social worker has been hired to review the documents to make sure they are in compliance with standards.
“We’ve had problems with treatment plans on every survey since this process started,” he said. “Those problems have changed over time.”
Issues in Friday’s survey report related to staff certification and documentation are already fixed, the hospital’s leaders said.
Surveyors also found two patients who were sent to other hospitals for preventable conditions - an infection and low sodium levels, the survey said.
Doman said those patients had refused to have their blood drawn, making it difficult to monitor their conditions. The hospital is creating a policy to determine when it should restrain patients to collect blood samples, he said.
Some concerns in the site survey are “systemic” and may require additional money or input from other state agencies before they can be addressed, Doman said.
Those include housing court-ordered patients without acute mental-health problems and a rehabilitation program for male youthful sex offenders that has been housed there since 1995.
There are ongoing discussions within the Human Services Department about other facilities that could house certain patients, agency spokesman Amy Webb said.
The agency’s leaders were pleased to learn the hospital had been found in compliance.
“We felt that we have made significant progress over the last year, and meeting the conditions of participation clearly validates that,” said Human Services Deputy Director Janie Huddleston, who helped oversee the changes at the facility.
“We still have improvements to make, but we now have a leadership team and staff that are committed to moving the hospital forward.”
Front Section, Pages 1 on 10/13/2012