HospitalInspections.org

Based on 6 of 7 MR reviewed of patients receiving Medicare benefits (#1, 4, 13, 14, 15 & 16) out of a total of 16 MR reviewed, and 1 of 1 staff interviews (A & B), the hospital failed to ensure that each Medicare beneficiary is informed of his/her right to appeal discharge from the facility which became effective July 13, 2007 per S&C memorandum 07-28.

Findings include:

On 9-5-2012 at 10:50 AM an interview of physician H was completed. Physician H expressed being familiar with pt. #1. Physician H denied refusing to give pt. #1 the Important Message from Medicare form, however physician H would not be the one to do that. Physician H denied telling the patient, " I think you are faking it. " Physician H did explain they could not find anything wrong with pt. #1 and it was a case of malingering.

On 9-5-12 from 7:30 AM to 9:30 AM records for pt.s #1 through #16 were completed.
Pt. #1 ' s record revealed pt. #1 was admitted to the unit, via the ED on 7-5-2012 after an episode of syncope. The discharge summary dated 7-29-2012 shows pt. #1 was admitted to the hospital because of previous episodes of passing out, dizziness and inability to walk. The discharge summary shows extensive lab work, MRI of brain, CT scans, chest x-ray, neurological testing, psychological testing and treatments with physical therapy. A Neurology progress note dated7-29-2012 from physician H states in part, " Informed pt that he will be discharged to home with a diagnosis of malingering of gait complaints. Informed risk management of the decision. Pt. did not challenge the decision and said that " basically I told him he is lying. " Nursing discharge summary dated 7-29-2012 states in part, pt. #1 needs assist of a walker at times for mobility, no restrictions, no home care referrals and pt. #1 should follow up with primary care physician.
The first notice of An Important Message from Medicare, was signed by pt. #1 on 7-4-2012. QMC D explained the second notice may not be scanned in yet, and would find it.

The record for pt. #4 did not have either the first or second notice in the record. Review of pt ' s #13, 14, 15, and 16 revealed they did not have a signed second copy of the notice in their records.
On 9-5-12 at 11:20 AM QMC A and Director of Quality B stated the missing Medicare Discharge notices could not be located and understood this was a problem that the hospital was in the midst of fixing.