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Schneider Hemodialysis Unit Gets Scathing Review

Schneider Regional Medical Center’s District Governing Board listened Wednesday to a scathing report of deficiencies on its hemodialysis unit.
The report, released by the Centers for Medicare & Medicaid Services, was issued directly to the board and not made public, but board member Dr. Murli Daswani read from the report for fellow board members and the hospital’s senior leadership team.
Amongst a litany of charges, the report criticized the hospital’s monitoring and safety of the ozone disinfectant system, its failure to evaluate the medical director’s performance or hold staff accountable, and a failure to allocate adequate resources to the unit.
Daswani characterized the tone of the letter as “blistering.”
A response to the CMS must be provided within 21 days. Board members resolved to respond to the letter, highlighting the changes that the hospital has made to the unit, including the contracting of a consultant “to work with staff to begin corrective actions."
The hospital has taken actions to correct the deficiencies on the unit, including the hiring of the dedicated consultant, but board minutes may not have adequately captured all the actions that management and the board have taken, according to Schneider CEO Alice Taylor.
“We have to clearly articulate that in the minutes,” Taylor said following the board meeting.
In addition to the problems noted in the CMS report, last Friday evening the unit’s bicarbonate tank ran dry, causing an interruption and delay in care for the patients receiving treatment at the time.
The hemodialysis unit has been a loss leader at the hospital, losing 40 percent of what it brings in every month, adding up to approximately $1 million per year, according to the board’s financial reports issued in May.
In other actions, the board approved the adjustment of the more than 8,000 billing codes to bring pricing in line with industry standards for service and materials. New pricing will be introduced gradually, and not all prices will increase, according to CFO Eugene Welsh.
The hospital stands to gain over $8 million by making these changes, Welsh said.
Wednesday evening the board also got its first look at a draft audit for FY 2009, issued by the accounting firm of Pershing Yoakley & Associates.
The firm’s Byron D. Bullock detailed one of the major complications with fiscal planning for Schneider Regional.
Bullock noted that estimating Medicare/Medicaid reimbursements has been complicated by Schneider’s required participation in the antiquated Tax Equity and Fiscal Responsibility Act (TEFRA), a medicare reimbursement program.
Most U.S. hospitals are using a prospective pay system based on diagnosis and procedures. The system provides a medical facility with the ability to anticipate how much they can be reimbursed, Bullock said.
“TEFRA is really just an outdated payment system,” Bullock said, noting that the act’s market basket increase of 2 to 3 percent had not kept up with industry costs.
The hospital also learned Wednesday that it has reduced its number of boarder patients to three, and recently met with officials from the V.I. Health Department and V.I. Human Services to discuss the problem of keeping patients in the hospital who do not need the level of medical care that the hospital offers, but may have no family who is able to take care of them.
The hospital is working on the issue with Sea View Nursing Home for a possible solution.

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