Baucus Comment on Medicare Status of West Texas Hospital
MEMORANDUM
TO: Reporters and Editors
FR: Carol Guthrie for Finance Committee Chairman Max Baucus (D-Mont.)
Jill Gerber for Finance Committee Ranking Republican Chuck Grassley (R-Iowa)
RE: update on Medicare/Medicaid status of West Texas Hospital.
Senate Finance Committee Chairman Max Baucus (D-Mont.) and Ranking Republican Chuck
Grassley (R-Iowa) commented today on news that West Texas Hospital, a physician-owned
specialty hospital recently under investigation for a patient death, will suspend healthcare
services effective March 30. The hospital’s action follows news from the Center for Medicare and
Medicaid Services (CMS) that the hospital would no longer be eligible for Medicare payments due
to its failure to meet necessary standards. Baucus and Grassley have questioned the payment
of Medicare dollars to physician-owned specialty hospitals both during and after a two-year
moratorium that was imposed on such payments due to safety concerns.
“At last, CMS’s proper enforcement of Medicare rules for hospitals is working to keep patients
safer in this Texas community. It shouldn’t take a death to kick CMS into gear to protect
Medicare beneficiaries from unsafe facilities,”Baucus said. “The Finance Committee will keep
pushing CMS to do its job where physician-owned specialty hospitals are concerned, and to
ensure that Medicare dollars buy safe and effective health care for all patients.”
“The end of Medicare’s relationship with the West Texas Hospital can’t be the end of work in
Congress on specialty hospitals,” Grassley said. “In fact, the West Texas Hospital’s deficiencies
underscore the problems with physician-owned hospitals. The West Texas Hospital also
exposed failures by the Centers for Medicare and Medicaid Services and the Joint Commission
that is responsible for accrediting hospitals. Why was this hospital given a Medicare provider
number at a time when the law prohibited it? And, how could a hospital that is so out of
compliance with so many Medicare Conditions of Participation be given a ‘seal of approval’ by
The Joint Commission less than two years ago? Overall, this case makes the case for a lot of
attention from Congress to the operations of physician-owned specialty hospitals, the way the
Medicare program interacts with providers including specialty-owned hospitals, the effectiveness of The Joint Commission, accountability in the operation of the Medicare program and the need to legislate limits on the growth of specialty-owned hospitals where care can be driven by doctor profits rather than patient needs.”
Below please find information dated February 8, February 27, and March 6 with more information
on the Senators’ efforts on this issue. Attachments are CMS’s termination letter to West Texas
Hospital, along with briefing information as noted in February 27 memo below.
~United States Congress~
For Immediate Release
March 6, 2007
Contact
Carol Guthrie (Baucus)
Jill Kozeny (Grassley)
Yoni Cohen (Stark)
DEATH IN WEST TEXAS SPECIALTY HOSPITAL RAISES QUESTIONS ABOUT MEDICARE PAYMENTS
Washington, DC –U.S. Senators Max Baucus (D-Mont.) and Chuck Grassley (R-Iowa) and Rep. Pete Stark (D-CA) today reiterated their concerns about physician-owned specialty hospitals. In a letter to Leslie Norwalk, Acting Administrator for the Centers for Medicare and Medicaid Services (CMS), they asked officials to account for any Medicare dollars that may have gone to a physician-owned specialty hospital in West Texas during a congressionally imposed 18-month moratorium on Medicare payments to these hospitals. Baucus is Chairman and Grassley the Ranking Republican on the Senate Finance Committee, which oversees Medicare and Medicaid. Stark is the Chairman of the Ways and Means Health Subcommittee, which oversees Medicare.
The legislators are making their inquiry following the January 23 death of a patient at the
West Texas hospital. The patient suffered respiratory arrest after an elective spinal surgery and, after a 911 call by the specialty hospital, had to be transferred by ambulance to a local community hospital for emergency services.
The government “clearly must take action and ensure that physician-owned facilities that
hold themselves out to the public as ‘hospitals’ have the requisite staff and abilities to
ensure that basic lifesaving measures can be employed,” wrote Grassley, Baucus and
Stark in a letter sent today to CMS.
Working together, Baucus, Grassley and Stark have tried to stem the growth of physician-owned specialty hospitals. The legislators have criticized these facilities because, motivated by profit, they focus on only the most remunerative services, without providing the full range of services hospitals are expected to provide. In 2003, Congress approved the legislators’ moratorium on Medicare payments to new physician-owned specialty hospitals as part of the Medicare Prescription Drug, Improvement, and Modernization Act. When this statutory moratorium expired in June 2005, Baucus and Grassley pressed CMS to suspend its enrollment of new facilities. Subsequently, in the Deficit Reduction Act of 2005, Congress prohibited CMS from approving new specialty hospitals until August 2006, when CMS delivered a plan for addressing this issue.
In May 2006, the Senate Finance Committee held a hearing about the dangers posed by
specialty hospitals and heard testimony about the death of a patient at a physician-owned
surgical hospital in Oregon that had also opened during the statutory moratorium. There,
too, the specialty hospital requested 911 emergency services following a surgery. A March 2005 hearing highlighted a report from the Medicare Payment Advisory Commission and prompted Grassley and Baucus to introduce the Hospital Fair Competition Act of 2005. This bill would have prohibited physicians from referring Medicare and Medicaid patients to new specialty hospitals in which they have an ownership interest.
With their request for detailed information from CMS about any Medicare dollars that may have illegally gone to the West Texas hospital, Baucus, Grassley and Stark said that they are trying to set the payment situation right and to further assess CMS’ actions with regard to specialty hospitals.
“I am deeply saddened and also completely outraged to hear of another death of a
patient at a specialty hospital,” Baucus said. “It really seems to me that if you call a
place a hospital, it should have the facilities to handle an emergency, but all this facility could do was call 911. This is a strong reminder that doctors’ financial stakes in a hospital can cloud judgment and blur priorities, and we can’t let that happen. Patient safety is my number one priority and I am going to continue to work to make sure that when patients enter a hospital, they can be certain they will receive the care they need.”
“The fundamental problem with physician-owned specialty hospitals is that decision-making is more likely to be driven by financial interest rather than what is best for the patient,” Grassley said. “You see that in the cherry picking of patients and policies where emergencies are to be dealt with by calling 911 to get to the local community hospital. The Centers for Medicare and Medicaid Services have identified some steps they can take to require the disclosure of physician investment, and that should give the agency the basis to take action against doctors who violate physician referral laws. But the law needs to go further and ensure that patients are
informed when their physician’s ownership interest in a specialty hospital may influence where treatment is provided. Patients deserve to know whether their doctor stands to profit personally from the hospital and whether that hospital is adequately prepared for an emergency if treatment does not go as planned.”
“The tragic death of another ‘specialty hospital’ patient highlights the manner in which physician-owned facilities seem to be eroding the quality of health care in America,” Stark said. “These facilities present themselves as ‘hospitals,’ but perform only the most profitable of operations. In so doing, they suck money out of alreadystrapped community hospitals. When one of their customers demands emergency care, ‘specialty hospitals’ dump the unprofitable patient back onto the very community hospitals they’re helping to bankrupt. If ‘specialty hospitals’ are unable to provide adequate care to Medicare beneficiaries, we should shut them down.”
The text of the letter follows here:
February 8, 2007
Via Electronic Transmission
Leslie V. Norwalk, Esq.
Acting Administrator
Centers for Medicare and Medicaid Services
Department of Health and Human Services
200 Independence Avenue, SW
Washington, DC 20201
Dear Acting Administrator Norwalk:
The Committee on Finance has exclusive jurisdiction over the Medicare program in the Senate, and the Committee on Ways and Means has jurisdiction over the Medicare program in the House of Representatives. Accordingly, we have a responsibility to the more than 40 million Americans who receive health care under the program. We take this responsibility seriously and conduct oversight into the activities of executive branch agencies, including the Centers for Medicare and Medicaid Services (CMS), to ensure that program dollars are spent on the best care available to beneficiaries.
The Medicare and Medicaid programs spend in excess of $120 billion for inpatient healthcare services at thousands of American hospitals annually—including payments made to physician-owned specialty hospitals. For years, we have been outspoken critics of the conflicts created by physician-owned specialty hospitals. Together, we have held hearings, conducted oversight, commissioned studies, and even passed legislation regarding these facilities. We write today to renew our concerns and to inquire about yet another disturbing patient death at a physician-owned specialty hospital.
As you are aware, the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA) imposed an 18-month moratorium on Medicare payments to new physician-owned specialty hospitals. The statutory moratorium expired in June 2005. Through administrative action, CMS began a suspension on enrollment of new facilities from June 2005 through August 2006, when CMS released the final Strategic and Implementing Plan for Specialty Hospitals that was mandated by the Deficit Reduction Act of 2005 (DRA). The difference between the statutory moratorium and the administrative suspension on enrollment took center stage at a Finance Committee hearing held May 17, 2006.
The May 2006 Finance Committee hearing focused on the death of a patient at a physician-owned surgical hospital in Oregon that had opened for business during the MMA moratorium. The tragic death at the Oregon facility was even more egregious because the staff at the physician-owned hospital called 911 for an ambulance to transport the patient from the physician-owned hospital to a community hospital with an emergency room. We remain dismayed that a physician-owned hospital’s standing policy in treating a patient in an emergency situation is to call 911.
We are even more troubled today, after learning of this same scenario playing out again at another physician-owned specialty hospital—this time in Texas. It has been reported that on January 23, 2007, staff at West Texas Hospital—a physician-owned specialty hospital—placed an emergency call to 911 after a patient went into respiratory arrest several hours following an elective spinal surgery. Following the emergency call, the patient was transferred to a community hospital, Abilene Regional Medical Center, where he later passed away.
We are deeply disturbed by these events and want to find out more about what transpired. It is utterly unacceptable to us that we now have witnessed two separate incidents where patients were treated at “hospitals” that maintained a policy of calling 911 for emergency resuscitation of a patient following major elective surgery. CMS clearly must take action and ensure that physician-owned facilities that hold themselves out to the public as “hospitals” have the requisite staff and abilities to ensure that basic lifesaving measures can be employed.
From a review of previous records requests made by the Finance Committee to CMS regarding physician-owned specialty hospitals, it appears that West Texas Hospital was granted its Medicare provider number on May 20, 2005, making it another physician-owned facility granted a Medicare provider number during the MMA moratorium. Further, these records show that West Texas Hospital has been reimbursed $4,193,702 by Medicare since it was granted its Medicare provider number in 2005. While we recognize it is CMS’s position that the granting of a provider number during the moratorium was acceptable, CMS has stated that any Medicare payments made to hospitals during the moratorium are subject to review and possible recovery by CMS.
We are concerned with the fact that West Texas Hospital appears to have opened during
the moratorium and that it appears to have received Medicare funding for procedures
performed during this timeframe.. Accordingly, we request detailed written responses to
the following:
(1) Why did West Texas Hospital receive a Medicare provider number from CMS
during the MMA mandated moratorium on physician-owned specialty hospitals?
a. Did West Texas Hospital file a request for an advisory opinion to determine if it qualified for the “under development” exception to the MMA moratorium? If so, please provide any documentation.
b. Please describe in detail the events surrounding the application for and granting of a Medicare provider number for West Texas Hospital.
(2) Provide a list of all Medicare and Medicaid reimbursements paid to West Texas Hospital or any provider affiliated with West Texas Hospital from 2005 to the present.
a. Were any of the Medicare payments made during the statutorily mandated moratorium on payments?
b. If so, has CMS initiated any action to collect the payments made during this period? If not, why?
(3) Provide a list of all physician owners of West Texas Hospital?
(4) Has CMS conducted any surveys of West Texas Hospital? If so, provide a copy of all such surveys.
(5) Did West Texas Hospital provide responses to CMS’s survey on physician owned specialty hospitals that was sent in an effort to collect information for the Strategic and Implementing Plan for Specialty Hospitals? If so, please provide a copy of West Texas Hospital’s responses.
(6) Does West Texas Hospital provide notification to patients prior to surgery that in the event of an emergency, they may be transferred to another hospital and that the facility may not have a physician on site during the post-operative recovery period?
(7) How many times in the past has West Texas Hospital called 911 to transfer a patient to another hospital in an emergency situation?
We thank you in advance for your cooperation and request that your staff provide a point of contact for this matter no later than February 12, 2007. Additionally, we request that CMS provide a briefing on this matter as soon as all written responses are available, not later than February 21, 2007. In complying with this request for information, please respond to each enumerated question by repeating the questions, followed by CMS’s response.
Should you have any questions regarding this matter please contact David Schwartz or Billy Wynne of Senator Baucus’ staff or Michael Park or Nick Podsiadly of Senator Grassley’s staff at (202) 224-4515 or Debbie Curtis of Representative Stark’s staff at (202) 225-5065.
Sincerely,
Max Baucus, Chairman - Senate Committee on Finance
Charles E. Grassley, Ranking Member - Senate Committee on Finance
Pete Stark, Chairman - Subcommittee on Health, House Committee on Ways and Means
Cc: Dr. David L. Lakey
Commissioner
Texas Department of State Health Services
West Texas Hospital
5602 Health Center Drive
Abilene, Texas 79606
MEMORANDUM (Date: February 27, 2007)
To: Reporters and Editors
Fr: Carol Guthrie for Finance Committee Chairman Max Baucus (D-Mont.)
Jill Gerber for Finance Committee Ranking Member Chuck Grassley (R-Iowa)
Yoni Cohen for House Ways and Means Health Subcommittee Chairman Pete Stark (DCalif.)
Re: CMS response to specialty hospital letter
Attached please find briefing information regarding West Texas Hospital, a physician-owned
specialty hospital in Abilene, Texas, where a patient death occurred in January of this year.
Finance Chairman Max Baucus (D-Mont.), Ranking Republican Chuck Grassley (R-Iowa), and
House Ways and Means Subcommittee Chairman Pete Stark (D-Calif.) wrote the Centers for
Medicare and Medicaid Services (CMS) on February 8, requesting information on Medicare
dollars paid to West Texas Hospital. A recent moratorium on Medicare payments to physician owned hospitals, sparked by safety concerns, did not stop all Federal payments to such facilities. The attached information is CMS’s response to that letter, the text of which is also provided below. Baucus, Grassley, and Stark commented on the new information from CMS today.
“The contractor CMS paid to keep seniors safe ignored instructions. They didn’t stop signing up
specialty hospitals for Medicare payments. Medicare dollars were going to a hospital that had to
call 911 more than a dozen times when patients were in trouble. If that’s not a total breakdown of oversight by CMS, I don’t know what is,” said Baucus. “CMS is proposing some welcome changes, like a separate designation for specialty hospitals and requirements for more disclosure about physicians’ financial stake in facilities. But CMS can’t just shuffle papers when patients may be in danger. Medicare policies and Medicare dollars need to ensure that beneficiaries get safe, quality care.”
“This information reveals serious problems with how Medicare and other responsible parties are
handling these hospitals. The West Texas hospital was not eligible for Medicare payments at the
time it applied, but a government contractor issued a Medicare provider number anyway and
received payment for its work from Medicare as if no mistake was ever made, and even after it
was determined that the hospital was being paid illegally. On top of that, the Joint Commission
responsible for accrediting hospitals didn’t do anything at all until the patient’s death was made
public. Congress clearly needs to act to make sure a trusting public isn’t victimized by what is, at
least, bureaucratic bungling by the Centers for Medicare and Medicaid Services. This specialty
hospital in particular holds itself out as a full-service acute care hospital even while it lacks the
ability to provide emergency medical care to its patients. As a practical matter, that seems like
false advertising. At a minimum, these facilities should be required to disclose such material
facts to patients so that they can make informed decisions. I intend to keep up vigorous oversight of the specialty hospitals that are already operating and to seek meaningful curbs on the proliferation of these hospitals, which weaken the community hospital system that we all rely on, while also condoning conflicted medical care by physicians,” Grassley said.
“I commend CMS for their swift response to the patient death at West Texas Hospital, a
physician-owned facility. But there is no good explanation for the death of yet another patient at a ‘specialty hospital.’ It is tragic that it took a second death to highlight the grossly inadequate
process that is in place to monitor whether these facilities are really hospitals and can safely
provide the care they sell. It is clear to me that Congress needs to intervene and I look forward
to working with colleagues on both sides of the aisle and in both bodies of Congress to achieve
that change,” said Rep. Pete Stark, Chairman of the Health Subcommittee of the Committee on
Ways and Means.
~United States Congress~
For Immediate Release
March 6, 2007
Contact
Carol Guthrie (Baucus)
Jill Kozeny (Grassley)
Yoni Cohen (Stark)
BAUCUS, GRASSLEY, STARK HOLD OFFICIALS ACCOUNTABLE FOR IMPROPER APPROVAL OF SPECIALTY HOSPITAL IN WEST TEXAS
WASHINGTON — U.S. Senators Max Baucus (D-Mont.) and Chuck Grassley (R-Iowa) and
Rep. Pete Stark (D-CA) are asking more questions about how a specialty hospital in West Texas
was allowed to participate in the Medicare program despite an enrollment suspension on specialty hospital participation. They also want to know about this hospital, which Medicare now says doesn’t meet necessary standards for hospital care, receiving accreditation from the Joint
Commission, the entity the government relies on to determine hospital fitness.
In a letter sent today to the Acting Administrator of the Medicare program, these members of
Congress pressed for information about the actions of a Medicare contractor in making West
Texas Hospital eligible for Medicare dollars and the response of Medicare officials to the
contractor’s failure to comply with the ban. The Centers for Medicare and Medicaid Services
uses contractors to enroll Medicare providers and to process and pay over $300 billion in claims
annually. “Given the significant responsibilities delegated to these contractors and the enormous
amount of federal money they manage, it is reasonable to expect that CMS would take steps to
ensure that their instructions are followed and that there is accountability among the contractors
when these instructions are not followed,” Baucus, Stark and Grassley wrote.
The lawmakers also wrote to the President of The Joint Commission for information about its
oversight of the West Texas Hospital. An independent, not-for-profit organization, The Joint
Commission is the nation’s predominant standards-setting and accrediting body in health care.
According to the Social Security Act, the Medicare program deems hospitals that are accredited
by the Joint Commission to be compliant with Medicare Conditions of Participation.
“CMS has a serious responsibility to keep Medicare beneficiaries safe, and in this situation
it is clear that they failed,” Baucus said. “Congress passed a moratorium on physicianowned
specialty hospitals because of serious concerns that these facilities don’t meet the safety standards and expectations hospitals should. CMS imposed the ban on all new facilities because it agreed with our concerns. It is unacceptable to me that the contractor hired by CMS failed to uphold their ban, and approved the West Texas hospital, but it is even more outrageous that CMS has not sanctioned this contractor. I also wonder why West Texas Hospital failed to comply with four Medicare participation standards less than two years after it was accredited by the Joint Commission. I am going to keep very close watch to ensure that the Joint Commission, CMS and the contractors it hires are holding physician-owned specialty hospitals up to the high safety standards patients expect and deserve.”
“Medicare officials are responsible for making sure their contractors execute their instructions. When the contractors don’t meet their responsibilities, the ramifications are enormous given what’s at stake, both for patients and taxpayers. So it’s very necessary for Medicare officials to aggressively oversee the contractors and hold them accountable when they drop the ball,” Grassley said.
“The regulatory process Congress was told was in place to prevent specialty hospitals from
entering Medicare didn’t work,” said Stark. “Perhaps it should come as no surprise that the
Joint Commission – which accredited California’s Redding Medical Center despite years of
deadly heart surgeries – is partly responsible for this breakdown and for the death of a patient at a physician-owned facility in West Texas. I expect more from CMS and its fiscal intermediaries.”
Baucus is Chairman and Grassley is Ranking Republican of the Senate Finance Committee,
which oversees Medicare and Medicaid. Stark is the Chairman of the Ways and Means Health
Subcommittee.
The text of those letters, along with the text of the inquiry sent last month by Stark, Grassley and Baucus regarding this hospital receiving Medicare payments while it was ineligible for Medicare payments, follows here. On January 23, a patient of the West Texas hospital died after suffering respiratory arrest after spinal surgery and being transferred by ambulance to a local community hospital when emergency services weren’t available at the specialty hospital.
March 6, 2007
Leslie V. Norwalk, Esq.
Acting Administrator
Centers for Medicare and Medicaid Services
Department of Health and Human Services
200 Independence Avenue, SW
Washington, DC 20201
Dear Acting Administrator Norwalk:
The Committee on Finance has exclusive jurisdiction over the Medicare and Medicaid programs
in the Senate, and the Committee on Ways and Means has jurisdiction over the Medicare program in the House of Representatives. Accordingly, we have a responsibility to the more than 40 million Americans who receive health care under the program. We take this responsibility
seriously and conduct oversight into the activities of executive branch agencies, including the
Centers for Medicare and Medicaid Services (CMS), to ensure that program dollars are spent on
the best care available to beneficiaries.
We write today to express our concern about the apparent lack of oversight and accountability of
the contractors that CMS entrusts to operate the Medicare program. On February 26, your staff
provided a briefing to our staff regarding events surrounding the death that occurred at West
Texas Hospital, a specialty hospital, in Abilene, Texas. During the briefing, it was revealed that a
Medicare contractor known as a fiscal intermediary, TrailBlazer Health Enterprises, LLC
(Trailblazers), approved West Texas Hospital's Medicare enrollment application despite CMS
instructions to temporarily suspend the processing of applications from hospitals that met the
federal definition of a physician-owned specialty hospital. As a result, this physician-owned
specialty hospital was issued a provider agreement despite the suspension on enrollment and
received Medicare payments during a period of time it should not have. It is unclear from the
briefing whether TrailBlazers was or will be sanctioned for their failure to comply with CMS'
express instructions.
We find these events deeply troubling because of CMS' heavy reliance upon contractors like
TrailBlazers not only for services such as enrolling providers, but also for processing and paying
over $300 billion in claims annually. Given the significant responsibilities delegated to these
contractors and the enormous amount of federal money they manage, it is reasonable to expect
that CMS would take steps to ensure that their instructions are followed and that there is
accountability among the contractors when these instructions are not followed. Accordingly, we
request detailed written responses to the following:
(1) Describe in detail all actions CMS has taken or will take in response to TrailBlazer's
processing of West Texas Hospital's Medicare enrollment application.
(2) In addition to serving as a fiscal intermediary for the state of Texas, identify all other
CMS contracts TrailBlazers currently holds and provide a copy of those contracts. In addition,
provide responses to the following questions:
a. Describe in detail any other incidents since 2003 in which TrailBlazers failed to follow
CMS instructions, how the noncompliance was discovered and what actions CMS took in
response to these incidents.
b. Describe in detail any actions taken by CMS to recoup monies paid to TrailBlazers for
failed and/or poor performance within the last four years. In complying with this request state the
reason for the recoupment and the amount recovered.
(3) Describe in detail all CMS policies and procedures for ensuring contractor compliance
with CMS instructions for the last four years and provide copies of all documentation of these
policies and procedures.
(4) Describe in detail all CMS policies and procedures for addressing contractor
noncompliance with CMS instructions/contracts for the last four years and provide copies of all
documentation of these policies and procedures.
(5) Describe in detail all CMS policies and procedures for evaluating contractor performance
and provide copies of all documentation of these policies and procedures.
(6) Describe in detail all CMS policies and procedures for addressing poor contractor performance and provide copies of all documentation of these policies and procedures.
(7) Describe in detail all CMS policies and procedures in place for recovering any payments
made by CMS that result in incomplete and/or substandard performance by CMS contractors and
provide copies of all documentation of these policies and procedures.
We thank you in advance for your cooperation and request that your staff provide a point of
contact for this matter no later than March 20, 2007. In complying with this request for information, please respond to each enumerated question by repeating the questions, followed by CMS's response.
Sincerely,
Max Baucus, Chairman - Senate Committee on Finance
Charles E. Grassley, Ranking Member - Senate Committee on Finance
Pete Stark, Chairman - Subcommittee on Health, House Committee on Ways and Means
March 6, 2007
Dennis S. O'Leary, M.D.
President
The Joint Commission
One Renaissance Blvd.
Oakbrook Terrace, IL 60181
Dear Dr. O'Leary:
The Committee on Finance has exclusive jurisdiction over the Medicare program in the Senate,
and the Committee on Ways and Means has jurisdiction over the Medicare program in the House
of Representatives. Accordingly, we have a responsibility to the more than 40 million Americans
who receive health care under the program. We take this responsibility seriously and conduct
oversight into the activities of executive branch agencies, including the Centers for Medicare and
Medicaid Services (CMS), to ensure that program dollars are spent on the best care available to
beneficiaries.
We have been outspoken critics of the conflicts created by physician-owned specialty hospitals.
Together, we have held hearings, conducted oversight, commissioned studies, and even passed
legislation regarding these facilities. One of the overriding concerns that spurred our involvement
in this issue is the risk of harm these facilities pose to patients.
A recent example of this risk is the death of a patient at West Texas Hospital in Abilene, Texas.
It was reported that on January 23, 2007, staff at this physician-owned specialty hospital placed
an emergency call to 911 after a patient went into respiratory arrest several hours following spinal surgery. Following the emergency call, the patient was transferred to a community hospital, Abilene Regional Medical Center, where he later passed away.
It is alarming that this physician-owned facility holds itself out as a "hospital" yet called 911 to
transfer a surgical patient to another hospital in an emergency situation. This practice appears to
be the hospital's standing policy in light of CMS' finding that there were 15 instances from May
2005 to February 2007 in which West Texas Hospital called 911 to transfer patients to other
hospitals in emergency situations.
West Texas Hospital has since been notified of its termination from the Medicare program
"because of deficiencies that represent an immediate and serious threat to patient health and
safety." The facility was out of compliance with Medicare Conditions of Participation including
"Governing Body," "Patient Rights," "Nursing Services," and "Emergency Services."
West Texas Hospital received accreditation from the Joint Commission in May 2005. According
to the Social Security Act, the Medicare program deems hospitals that are accredited by the Joint
Commission to be compliant with Medicare Conditions of Participation and thus eligible to treat
Medicare patients and be reimbursed by Medicare for doing so. CMS therefore relies on the Joint
Commission's judgment that a hospital it accredits is in compliance with Medicare's Conditions of
Participation, which aim to ensure that Medicare beneficiaries receive hospital care without risks
to their health and safety.
We find it disturbing that a Joint Commission accredited hospital has been found to be out of
compliance with Medicare Conditions of Participation less than two years after receiving your
accreditation. As part of our investigation, we accordingly request detailed written responses to
the following:
(1) Describe in detail the events surrounding the application for and granting of Joint
Commission accreditation for West Texas Hospital.
(2) Describe in detail all activities the Joint Commission conducted with regard to West Texas Hospital after accrediting the facility. In complying with this request, describe the number
and nature of reviews the Joint Commission made of West Texas Hospital during its tenure and
the results of each review.
(3) Describe in detail how the Joint Commission learned of the January 23, 2007 patient
death and any actions the Joint Commission took in response to this notice.
(4) What is the current status of West Texas Hospital's Joint Commission accreditation?
(5) Provide copies of all the Joint Commission issued reviews or reports of West Texas
Hospital for the last three years.
We thank you in advance for your cooperation and request that your staff provide a point
of contact for this matter no later than March 20, 2007. In complying with this request for
information, please respond to each enumerated question by repeating the questions, followed by the Joint Commission's response.
Sincerely,
Max Baucus, Chairman - Senate Committee on Finance
Charles E. Grassley, Ranking Member - Senate Committee on Finance
Pete Stark, Chairman - Subcommittee on Health, House Committee on Ways and Means
Cc: Dr. David L. Lakey
Commissioner
Texas Department of State Health Services
West Texas Hospital
5602 Health Center Drive
Abilene, Texas 79606
###
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