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State Releases Plan To Keep Medicare Reimbursements At Osawatomie Hospital

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State officials have a three-pronged plan to ensure Osawatomie State Hospital maintains its Medicare reimbursements after a federal agency announced last week they are in jeopardy.

Meanwhile, mental health advocates say the situation at that hospital underscores the need for legislators who hold the state's purse strings to allow the executive branch to follow through on reforms that are still in their early stages.

The corrective plan for the Osawatomie hospital includes regular "fire watch" room checks when the facility is over its Legislature-approved capacity, or census, according to Angela de Rocha, a spokesperson for the Kansas Department for Aging and Disability Services. It also includes nursing reforms and better pharmacy coordination.

The Centers for Medicare and Medicaid Services gave state officials until Dec. 8 to address deficiencies identified by Kansas Department of Health and Environment surveyors in a visit to the hospital last month. The public notice from CMS warned that the facility would suffer termination of its Medicare benefits, which make up about 23 percent of the hospital's total budget, if the shortfalls weren't corrected.

De Rocha said it was a routine letter.

"The hospital is working closely with CMS to implement a plan of correction that increases the quality of care delivered at the hospital," de Rocha said.

De Rocha said that following an inspection, the fire watch was initiated to address concerns from KDHE and the state fire marshal.

The watch entails two staff members checking each hospital room once an hour when the facility is above its 206-patient census. When the public notice from CMS was sent, the hospital was at 221 patients. De Rocha said Friday the facility was at 210 with eight discharges scheduled. The day before, she said, the facility was below the census threshold.

De Rocha said the surveyors also identified "immediate jeopardy" issues related to nursing and pharmacy during their visit.

"Immediate steps were taken to remedy these deficiencies and the hospital was afforded the opportunity to construct a plan of correction," de Rocha said.

That plan includes a nursing assessment upon admission to determine if new patients are at risk for edema, rashes, pressure ulcers or other conditions. Additionally, the pharmacy staff is to work more closely with others at the facility to improve "clarity and accuracy in medication orders and follow up."

Osawatomie State Hospital is the largest of the state’s two inpatient facilities for adults with severe and persistent mental illnesses. Prior to admission, most of the hospital’s patients have been declared a danger to themselves or others.

Mental health advocates say they hope legislators will follow throughwith the funding for Gov. Sam Brownback's wider plan to improve delivery of mental health care.

Kyle Kessler, executive director of the Association of Community Mental Health Centers of Kansas, said federal incentives that discourage the institutionalization of people with mental illnesses had contributed to a lack of beds within community facilities and put more pressure on state hospitals.

"The reduction in community beds has really caught up with us, and I think the state is working to reduce the census in a safe and appropriate manner," Kessler said.

Kessler said that effort includes changing Rainbow Mental Health Center to a short-term "sobering" and crisis stabilization facility, which allows doctors to triage patients and reserve Osawatomie for those who are "really sick."

Amy Campbell, lobbyist for the Kansas Mental Health Coalition, also praised the effort at Rainbow. Legislators are looking for places to cut the state budget, but Campbell warned that if they do anything to impede the Brownback administration reform effort, it will lead to further problems at state hospitals like Osawatomie.

"That’s why this is important," Campbell said. "We have been so encouraged by what this administration is doing to address these very specific problems, but we’re only in the beginning of those efforts."

Andy Marso is a reporter for KCUR 89.3 and the Kansas News Service based in Topeka.
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