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.