Reviewers note State Hospital positives

— A team of 11 federal surveyors finished a highstakes, week-long final review of the State Hospital on Friday, checking compliance with hundreds of standards to determine whether the facility can maintain its ability to receive federal reimbursements for patient care.

The team’s f indings stand to determine the future of the public psychiatric hospital and the reimbursements that make up millions of dollars of its annual budget.

The hospital will continue to receive the funds under a conditional agreement until the federal Centers for Medicare and Medicaid Services reviews its findings, said Amy Webb, spokesman for the Arkansas Department of Human Services, which operates the facility.

“We know we still have work left to do at the hospital,” she said. “But the surveyors did offer us some positive comments as well.”

The federal agency will take about a month to determine whether the hospital has successfully remedied problems with patient treatment and conditions identified through patient complaints and previous visits by site reviewers, Webb said.

If reviewers are satisfied, the State Hospital will maintain its status as a Medicare and Medicaid provider. If they are not, it will quit receiving the reimbursements.

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.

“We hope that we met their expectations and the conditions of treatment,” Webb said.

Hospital and Human Services Department administrators who attended a verbal exit conference with federal site reviewers Friday would not comment until they read a final, written report, Webb said.

State leaders and patient advocates have carefully monitored the progress of the hospital, which has more than 200 beds and is the state’s treatment center for people who have been arrested on criminal charges and later found incompetent to stand trial or to be sentenced.

“It’s a different place than it was when CMS first came in,” said Dee Blakley, a patient advocate for the federally funded Disability Rights Center of Arkansas, which monitors treatment at the State Hospital. “However, I still think that we have areas of concern.”

Before the federal agency and the hospital signed the conditional “Systems Improvement Agreement,” the Centers for Medicare and Medicaid Services had repeatedly threatened to pull the hospital’s funding if administrators couldn’t remedy problems by a deadline.

Those threats came after reviewers identified multiple “immediate jeopardy” findings over situations that threatened the health and safety of patients dating 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.

In each instance, the federal agency provided extensions, offering the hospital more time.

In July 2011, the two parties etched out an 11th-hour agreement to maintain the federal funding with the condition that the hospital successfully complete an improvement plan created by consultants paid to do a top-to-bottom review of the hospital and its treatment standards.

That agreement expired Tuesday. The hospital will operate under its terms until the Centers for Medicare and Medicaid Services makes its final determination.

Bob Moos, a spokesman with the Centers for Medicare and Medicaid Services’ regional office in Dallas, confirmed that site reviewers visited the State Hospital this week. The agency does not comment on cases, only providing survey documents once they are finalized.

This week’s review included hundreds of conditions of participation, ranging from broader patient treatment issues to small facilities standards, such as the size and placement of laundry bins, Webb said.

Reviewers in the Friday exit conference complimented the hospital’s staff for a “positive culture” and a noticeable change in attitude since previous visits, Webb said.

The hospital has completed training sessions, changed its nursing model and increased patient supervision as part of its improvement plans.

Reviewers this week also noted a continuing need to update patient treatment plans and align treatment with each individual’s needs, Webb said.

“We went into this knowing there were issues we still needed to work on,” she said.

Treatment plans were an initial concern when the Centers for Medicare and Medicaid Services began citing the hospital in 2010.

A December 2010 survey noted that patient-treatment plans “documented generic treatment interventions with little relationship to the patient’s reason for admission.”

On that visit, surveyors found State Hospital patients who were secluded without a doctor’s order and without documented justification or given psychotropic drugs, known as “chemical restraints,” without proper documentation, the review said.

Since that survey, the hospital has replaced leadership and implemented a computerized patient treatment plan system.

Administrators also adopted a new process for reviewing patient complaints and videos of incidents, Webb said.

Site reviewers this week looked at how the hospital handled 11 random patient complaints and found no problems, Webb said.

Blakley, the patient advocate, said her organization remained concerned about how the hospital responds to patient complaints and the use of handcuffs by internal police officers to restrain patients.

But hospital leadership has grown more willing to hear complaints and more ready to fix problems there, she said.

“We are cautiously optimistic that things will continue to improve,” Blakley said. “But we still intend to call them on the carpet if they mess up.”

Front Section, Pages 1 on 09/22/2012

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