HospitalInspections.org

Based on record review and interview, the facility staff failed to issue Medicare recipients with the "Important Message From Medicare" within 2 days of admission and within 2 days prior to discharge per their procedure in 4 of 7 medicare eligible patients (Patient # 1, #2, #6 and #8 ) in a total of 10 medical records reviewed.

Findings include:

Record review of work flow sheet titled "Important Message From Medicare (IM) and the Medicare Outpatient Observation Notification (MOON) Work Flows" dated April 2022 under inpatient arrow revealed "Assure that the IM First notice is signed no later that (sig) 2 days after admission... Final notice... must be completed no more than 2 days and no less than 4 hours before discharge."

Patient #1's medical record was reviewed. Patient #1 was admitted to the hospital on 5/27/2022 and was discharged on 6/07/2022. Patient #1 was issued the first copy of the Important Message from Medicare on 5/27/2022. Patient #1 was declared incompetent on 6/05/2022 and his power of attorney (POA) was activated. There was no documentation of the second copy being issued to the POA [Complainant A].

On 11/21/2022 at 1:05 PM during medical record review and interview with Clinical Informatics Registered Nurse (RN) E, when asked if there was a second IM in Patient #1's medical record, RN E stated s/he did not see one.

On 11/22/2022 at 8:55 AM during interview with Quality Director D, when asked if Patient #1 had a second IM issued, Quality Director D confirmed "that we can't find on him."

Patient #2's medical record was reviewed. Patient #2 was admitted to the hospital on 5/19/2022 and was discharged on 6/10/2022. Patient #2's daughter was issued the important message from medicare information over the telephone and verbal consent of notification was documented on 5/20/2022. Patient #2 was declared incompetent on 6/07/2022 and his POA (daughter) was activated. It was documented that the second IM was verbally issued to Patient #2's daughter 6/03/2022 at 11:02 AM. Patient #2 was discharged 6/10/2022 at 2:45 PM. There was no documentation that an IM was issued after 6/03/2022 (less than 4 hours before discharge).

On 11/21/2022 at 4:10 PM during medical record review and interview with Clinical Informatics RN E, when asked if there was an IM signed before Patient #2 was discharged on 6/10/2022, RN E stated "we didn't see it," only on 6/03/2022. RN E stated they thought s/he was being discharged earlier.

Patient #6's medical record was reviewed. Patient #6, an 88-year-old with dementia, was admitted to the hospital on 9/25/2022 at 7:45 PM and was discharged on 10/07/2022. Patient #6 was declared incompetent 9/28/2022 and the first copy of the IM was issued to the spouse 9/28/2022 at 9:25 AM. There was no documentation of the second copy being issued.

On 11/22/2022 at 8:20 AM during medical record review and interview with Clinical Informatics RN E, when asked if there was a second IM given RN E stated "Let me see if it's in another area" and then stated "no."

Patient #8's medical record was reviewed. Patient #8 was a 71-year-old admitted from a nursing home on 11/18/2022 at 12:24 AM with a temperature of 105 and an altered mental status and remains inpatient. There was no documentation that an IM was issued.

On 11/22/2022 at 9:41 AM during medical record review and interview with Senior Director C, Director C stated we would need to talk with the social worker.

On 11/22/22 at 9:58 AM during interview with Social Worker L, when asked if Patient #8 had been issued the IM, Social Worker L stated "I don't have any part in that." Social Worker L stated s/he has been working with the nursing home to obtain information on his power of attorney and advanced directives and has "not talked with the family" yet.

On 11/22/22 at 10:07 AM during interview with Quality Director D, Director D stated "we are working on it" and confirmed there was no IM on Patient #8.