Very Interesting Article- CMS In Action

I wish I was at liberty to freely discuss my most recent
experience with CMS inspectors. Unfortunately I am not.

These are a state agency personnel under contract to enforce CMS policies and compliance. I’ve had 25 years experience dealing with all sorts of regulatory bodies, many of which are quite stringent. But I’ve never seen anything like this, nor has anyone one else in our hospital administration.

The inspectors are ignorant. Almost all have no background in acute care hospital settings, as their prior work experiences are primarily from home health, physician offices, and nursing homes. They know their regulations but that is about it.

They have immense authority. They can literally rescind our hospital’s participation in Medicare effectively shutting it down simply on their word with no notice. And they have threatened to do just that.

They have run roughshod over all manner of employees to the point that we now consider any communication from them as hostile and insist on the presence of a knowledgeable attorney and witnesses whenever they talk to any employee about anything, no matter how inconsequential, trivial or mundane it may appear.

In one exchange between the inspectors and our administrators they posed a hypothetical situation with an armed and violent patient in our emergency department and asked how we would handle the situation. Each suggestion by our staff was rejected by the inspectors. They insisted that it was against regulations to use force against a patient. After a while the administrators became exasperated and asked the inspectors how they would then suggest we handle this situation while protecting the safety of our staff and patients. Their response was that they didn’t know, they didn’t care and it wasn’t their responsibility. They only had to assure that our interaction with the “patient” met CMS regulations.

We have come to the conclusion that our only practical course of action is to try and get by for another 18 months when the current head of this agency and the governor’s terms end and they will be replaced, hopefully by someone with a bit of common sense and less of a gestapo mind set.

But it has been a frightening experience to witness what can happen with all powerful bureaucrats. I thought this type of stuff didn’t happen in the US, that there were still some checks and balances. It has reinforced my distrust of government power and the need to keep it in check.

It is one of the reasons I’m so wary of the proposal in the Senate bill for the MedPAC on steroids committee. I don’t think giving small groups of appointees that kind of power over so much is wise regardless of the good intentions.

Now, everyone knows what we have to look forward to.

What is the citation for this article? Is it an article published in a journal, a letter to the editor, or a blog by someone whose facility provided substandard care? Medicare termination only happens if there is an “immediate jeopardy” situation which puts patients health and safety at substantial risk and there is evidence that this is occurring. This doesn’t happen based on the word of a surveyor. It requires an investigation and consultation with the survey team and the State Agency as well as with the CMS Regional Office.

Here are some examples of the kinds of care in dialysis that have led to termination of Medicare payment:

New York City,2933,423882,00.html


Decision by the Administrative Law Judge when the provider appealed

I’m sure DialysisEthics has additional examples of dialysis providers that have been cited for providing poor care.

From other posts, I gather you’re opposed to most regulation. However, after reading concerns patients have posted on the Home Dialysis Central and other message boards about the care provided in their dialysis clinics, I can’t understand why you would post an article/blog written by a provider whining about surveyors who interpreted the hospital regulations (I don’t see that the provider was a dialysis facility) too strictly. It seems like most patients who complain about their dialysis care would say that surveyors don’t survey often enough or have high enough expectations for dialysis providers.

Yes we do:

This is just a small example of some of what underfunded state inspection teams have found, I shudder to think what no oversight would bring about. For too many of these clinics there isn’t much financial incentive to do better - so it is up to the states to provide the incentive to do better.

Know there was an advocacy assoc. that that has since closed its doors which purchased and posted an extensive number of state surveys from clinics all across the country. Are you aware of any other location on the net where state surveys are posted in their entirety? How do financial incentives encourage clinics to do a better job? In what ways can states provide incentives? Do you mean incentives towards better care or incentives towards complying with current regulations?

Hi Jane,

I’m afraid I don’t know of anyone posting an extensive list of state surveys. What I have on our site is what I inherited - maybe someday I can collect some more.

I could have been a little more clear, when I mentioned incentives the states provide I was talking about the incentive to comply with regulations. It does look to me the dialysis companies have a huge financial incentive not to comply, and without some oversight I don’t see what is going to counter their tendencies to cut corners on care.

I do also have a fact sheet we presented to the Colorado State Legislators, and was verified by the state - they checked accuracy and sources. It was quite an eyeopener for me, just when I was hoping to be proved a crazy man, they couldn’t do it:

Looks to me to be more reasons for oversight.