The Centers for Medicare and Medicaid Services has issued a warning to Greenville Memorial Hospital that, if it does not bring three “conditions of participation” up to standard, the hospital will be terminated as a CMS provider, thus cutting Medicare and Medicaid funding.
According to Scott Sasser, chair of emergency medicine at Greenville Health System, the hospital self-reported to CMS issues it found it “identified as potential areas for improvement” at Greenville Memorial’s emergency department. That prompted an investigation by CMS on March 13 where the agency looked at patient charts and concluded the hospital had fallen behind on three standards, or conditions of participation.
CMS has given the hospital until April 16 to comply. The order only impacts Greenville Memorial Hospital and no other GHS entity.
“I believe we are going to take this report, implement an action plan and, so, I don’t see us losing funding at this institution,” Sasser said.
GHS officials said nearly 21,000 inpatients could be impacted if CMS cut its funding. That represents about 59% of Greenville Memorial Hospital's inpatients, based on FY16 figures. The hospital could lose nearly $495 million — between inpatient and outpatient revenue — if the funding were cut, according to GHS.
The conditions of participation are standards all medical entities have to follow to receive funding from CMS. The three standards addressed by CMS — governing body, patient’s right and nursing services — are broad and Sasser said the hospital could not provide any specific detail on any of them.
According to the CMS website, the governing body, referred to as 42 CFR 482.12, can include the medical staff, chief executive officer, contracted services, emergency services, care of patients and institutional plan and budget. Patient’s rights, or 42 CFR 482.13, includes notice of rights, exercise of rights, privacy and safety, confidentiality of patient records, restraint or seclusion, death reporting requirements and restraint or seclusion: staff training requirements.
The nursing services regulation, or 42 CFR 482.23, includes organization, staffing and delivery of care and preparation and administration of drugs.
“The Centers for Medicare and Medicaid Services has determined that GHS Greenville Memorial Hospital is not in compliance with the conditions of coverage,” the CMS said in a legal notice. “The Medicare program will not make payments to patients who are admitted after April 16, 2017.”
“They (CMS) are saying they want these things addressed and they want them addressed in a certain timeframe,” Sasser said.
He said bringing the hospital into compliance will “enable us to continue to get better at what we do.”
Editor's note: This story was changed to include the hospital's inpatient figures and potential revenue loss. Additionally, due to incorrect information provided, the funding cut would include both Medicare and Medicaid. It was initially reported it was Medicare only.