The Juan Luis F. Hospital has sent a System Improvement Agreement to the Centers for Medicare and Medicaid – known as CMS – in time to meet its Thursday deadline, and now has until Aug. 20 to make the improvements necessary to allow the hospital to continue participating in the two federal health programs that provide a significant portion of JFL’s operating revenue.
The announcement of the SIA’s completion came shortly after midnight Thursday in a news release from the hospital. The release said the hospital had signed the agreement, but did not indicate who had signed it or whether the hospital’s board had approved it. No public meeting of the hospital board had been scheduled.
Earlier in the evening, Government House spokesman Jean Greaux had said, "The JFL Board and senior leadership with the guidance of their counsel, attorney Deborah Gardner, is completing the SIA and has been in discussion with CMS on the format of the final."
Greaux told the Source that Gov. John deJongh Jr. received the final version of the agreement around 7:30 p.m. and “was satisfied enough with the content to trigger an endorsement letter.”
Part of the CMS systems improvement agreement calls for letters of support from the governor, Senate and JFL board.
“Of course, he will support advance funding to the hospital and follow up with help identifying additional funding sources” in the endorsement letter, Greaux added.
The hospital’s news release did not say whether the agreement has been accepted by CMS, or what time frame that acceptance might take.
“The agreement has been executed to facilitate the hospital’s provision of quality hospital services to the community of St. Croix and to promote the hospital’s compliance with Medicare’s requirements. It will remain in effect until Aug. 20, 2015, at which point CMS will conduct a full re-survey to determine the hospital’s compliance with Medicare rules,” the release stated.
On Sept. 17, JFL received word it would be decertified, effective Oct. 9, from being reimbursed for treating Medicare and Medicaid patients. The hospital is required by V.I. law to treat all patients, regardless of their ability to pay.
In 2012, Jeff Nelson, then chief executive officer, had said CMS reimbursements accounts for as much as 60 percent of the hospital’s revenue, so losing that funding source could force JFL to drastically reduce services or even close its doors.
On Oct. 3, JFL Chief Executive Officer Kendall Griffith and other hospital officials traveled to Baltimore and convinced CMS to reconsider its decision to decertify. JFL was given a deadline of Nov. 20 to develop a systems improvement agreement that meets CMS approval. Then, the hospital has nine months to implement the plan.
In the last six weeks, Griffith and the St. Croix board have talked about what steps they must make to retain CMS participation. Funding is at the top of the list and the V.I. government has been asked for $10.3 million to put in place the correction plan. More than half of the funding would pay bills, purchase supplies, medications and technology upgrades. There would also be funds to renovate the mental health unit and pay for attorney and third-party services to help implement the plan.
The hospital is more than $30 million in debt.
CMS required government support be part of the plan. Greaux acknowledged the governor made suggestions to an earlier version of the agreement.
CMS’s September decertification decision was made following an inspection that offered a scathing indictment of the hospital, citing cases in which patients were harmed and in some cases in which the treatment may have caused or contributed to patient deaths.
In its 112-page report CMS criticized the hospital management for failing to report to the governing or territorial boards incidents where patients were harmed. Patients were given sedative medications without their knowledge and several patients were sent off-island because of injuries sustained at JFL, according to the CMS document.
The report also criticized Griffith for not reporting the incidents to the board or insuring mistakes do not recur. The federal agency also complained about the lack of a quorum on the governing board for more than a year.
“There was no indication that the (board) was apprised of medical errors and quality of care issues, and/or aware that actions, if any, were taken by the hospital to ensure the reduction of medical errors,” the report read.
Since the report, the governor appointed two new board members,Troy DeChabert Schuster and Kimberly Jones, to join Ricketts, Joyce Heyliger and Philip Arcidi. A full board is nine members, so five comprises a quorum. Until then, the board was unable to make decisions and referred the most pressing issues to the territorial board.
Greaux said Wednesday night the governor plans more board appointments.
Other “deficiencies” included lack of quality control improvements, violations of patients rights with chemical and physical restraints, improper disinfection procedures and mislabeled medications in the hospital pharmacy.
The first hurdle to bring back the Juan Luis Hospital into compliance is Thursday’s systems improvement agreement, with its supporting endorsements. That accomplished, effecting change throughout the hospital within nine months will be the final challenge.