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CMS Gives Hospital Extension after Rejecting Improvement Plan

The Centers for Medicare and Medicaid Services has given Gov. Juan F. Luis Hospital an extension on its deadline for decertification, after rejecting the Plan of Correction presented Friday at a meeting in Baltimore.

At a press conference Tuesday at the hospital, Chief Executive Officer Dr. Kendall Griffith said CMS is looking for action rather than plans.

"We showed CMS that our reform and improvement measures were making a difference and that we had already made great strides in improving the standardization of quality patient care at JFL,” Griffith said.

The press conference did not mention that CMS had rejected the earlier plan. That news came from a statement issued Tuesday night by Government House.

In the news release, Gov. John deJongh Jr. said he was encouraged by CMS’s decision to extend the deadline, then said: "CMS rejected the corrective action plan that had been presented at a meeting in Maryland on Friday last week and instead told the hospital’s leadership that it must get to work on making vast improvements to several aspects of its operations including quality of patient care.”

The governor’s statement continued, “The decertification was held in an abeyance as a result of CMS recognition that an immediate decertification would have devastating ripple effects on the entire territorial healthcare system."

According to information provided at the hospital’s news conference, JFL will have six weeks to revamp procedures and protocols and nine months to make the necessary improvements to avoid decertification.

CMS, the federal agency that certifies medical institutions for taking part in the programs, said on Sept. 17 that the hospital would lose certification on Oct. 9. The 112-page report, based on a tour of the hospital this summer, listed various “deficiencies,” including cases where patient care was compromised and patients were harmed, mandatory surgical checklists were not completed, and medicines in the hospital pharmacy were mislabeled.

According to CMS, at least one patient death this year might have been avoided had proper procedures been followed, and five deaths in 2013. CMS further charged that the cases were not reviewed by the governing board.

In the days after the Sept. 17 announcement, Delegate Donna M. Christensen met with the CMS administrator and other officials and arranged a meeting with representatives from St. Croix. The hospital contracted with the Boston-based law firm of Ropes & Gray to appeal the decertification.

Last Friday, Griffith along with hospital senior management and attorney Deborah Gardner, who helped write the hospital’s Corrective Action Plan, met with CMS officials in Baltimore to plead their case.

“We came out of that meeting with the understanding that what CMS wants from us is not another bundle of policies or plans. What they want to see is the commitment we have as a people – the Virgin Islands community. How we plan to come together to affect change,” JFL Board Chairman Dr. Anthony Ricketts said.

The hospital has six weeks to develop a Systems Improvement Agreement that meets the federal agency’s approval. That plan must be implemented over the next nine months.

Griffith said the Legislature was asked to provide $10 million to bring the hospital up to CMS standards. The Systems Improvement Agreement will include financial information about the use of funds to improve the hospital’s operations. Money will be allocated to buy software to upgrade billing, collections and medical records, Griffith said.

Another $1.6 million will be placed in an escrow account to fund a third-party consultant to monitor the progress of the agreement. Other earmarked funds include $1 million to reopen the behavior health unit and $450,000 to allow remote reading of X-rays.

Christensen said the announcement is a reprieve, but is not open ended.

"There will be no wriggle room next time," the delegate said. "We must all demonstrate that our hospitals are important to all of us and that quality care is a right.”

The governor echoed Christensen’s warning.

“The decision by CMS, while encouraging, is a clarion call for all stakeholders from the hospital management to the administration, the congressional delegate, the Legislature and the oversight district and territorial hospital boards to work together to develop both a short-term and long-term strategic plan to address CMS’s concerns,” deJongh said in the news release.

Also Tuesday, in a letter to CMS, Senate President Shawn-Michael Malone wrote that the Legislature “pledge(s) our best efforts to provide the necessary financial support to correct the deficiencies identified by CMS while ensuring the sustainability of the hospital since it is the only hospital on that island.”

It is not the first time JFL Hospital entered into an agreement with CMS to improve the St. Croix medical institution. In November 2011, the board signed onto an agreement after the hospital had failed 11 of 23 categories in a CMS inspection that summer. The hospital staff, under the direction of then-CEO Jeff Nelson, was working on their improvement plan when Nelson was asked to resign the following year.

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