Early Discharge Of Mental Health Patient Jeopardizes Emporia Hospital’s Medicare Payments
Federal officials may halt Medicare funding to an Emporia hospital because a mental health patient was discharged too soon — an incident that hospital officials say resulted in part from a lack of mental health beds in Kansas.
The Centers for Medicare and Medicaid Services conducted a follow-up visit March 10 at Newman Regional Health to determine if it had corrected the lapse in procedure that led to a patient being improperly discharged in September. CMS has not made results of the follow-up visit public.
If the hospital has corrected the violation, it will continue to receive Medicare payments. Otherwise, it could lose those payments. Newman also could lose its Medicaid funding, as CMS requires the Kansas Department of Health and Environment to halt those payments when a facility is decertified.
An inspection report from CMS cited the case of a person, identified only as patient #1, who sought treatment Sept. 24, 2015, at Newman’s emergency department for chest pain and thoughts of suicide.
A staff member from the Mental Health Center of East Central Kansas determined the patient qualified for inpatient mental health treatment, and a physician at Newman contacted three unidentified hospitals that provide inpatient psychiatric treatment to try to find a place for the patient, according to CMS. The three hospitals declined to take the patient because of a lack of space and because the chest pain could have indicated a cardiac condition.
Newman hospital staff conducted suicide checks on the patient until the next afternoon, when the patient was discharged with the understanding that a staff member from the Mental Health Center of East Central Kansas would take the patient to one of the hospitals the Newman physician had contacted earlier. Staff told CMS the arrangement was unusual, because they didn’t fill out the typical paperwork for a transfer in this instance.
According to the report, a staff member from the Mental Health Center of East Central Kansas told CMS the hospital where the patient was taken hadn’t been notified and didn’t have a bed available in its psychiatric unit. The report didn’t specify what happened to the patient after the botched transfer.
Federal law prohibits hospitals from discharging a patient with an unstable emergency medical condition, which would include signs of cardiac trouble or severe psychiatric problems. They can transfer an unstable patient to a facility capable of treating the patient if the benefits of treatment at a different facility outweigh the risks of the transfer.
A statement from Newman CEO Robert Wright said the hospital is taking steps to comply with CMS and will continue to treat Medicare patients. Decertification means that federal authorities won’t pay for care to Medicare patients but doesn’t forbid a hospital from providing care to those patients.
“We have fully cooperated with CMS and developed a plan of action,” Wright said in the statement, which was issued March 17.
In the statement, Wright noted a shortage of mental health beds and other mental health services, particularly in rural Kansas. He also cited an admissions moratorium at Osawatomie State Hospital during renovations under way due to CMS concerns about patient safety.
“As a result of a waiting list for inpatient psychiatric beds, which has persisted since at least June of last year in Kansas, many rural hospitals like ours are in the position of trying to care for mental health patients in emergency rooms and other inpatient and outpatient settings not intended for that purpose while waiting for the next available psychiatric bed,” Wright said in the statement.
Osawatomie, which is about 70 miles east of Emporia, is one of two state-run inpatient facilities for Kansans with severe or persistent mental illness. The other is in Larned.
Wright said the hospital has hired a consultant to assess its policies and clarified which psychiatric symptoms constitute an emergency medical condition that would prevent a person from being discharged. It also clarified how the mental health center and hospital should communicate and trained employees on discharge requirements.
The hospital declined to comment on its corrections beyond the statement.
Cindy Samuelson, a spokeswoman for the Kansas Hospital Association, said several hospitals have been affected by capacity problems in the state’s mental health system. She said officials at several member hospitals have reported that mental health patients are having to wait in their emergency departments — some for days — for an inpatient psychiatric bed to open.
She said she hadn’t heard of CMS investigating other hospitals for housing mental health patients in emergency departments, but that small hospitals with fewer resources have had more difficulty serving those patients.
Megan Hart is a reporter for KHI News Service in Topeka, a partner in the Heartland Health Monitor team. You can reach her on Twitter @meganhartMC