The information below comes from the statement of deficiencies compiled by health inspectors and provided to AHCJ by the Centers for Medicare and Medicaid Services. It does not include the steps the hospital plans to take to fix the problem, known as a plan of correction. For that information, you should contact the hospital, your state health department or CMS. Accessing the document may require you to file a Freedom of Information Request. Information on doing so is available here.
|VISTA MEDICAL CENTER EAST||1324 NORTH SHERIDAN ROAD WAUKEGAN, IL 60085||Oct. 13, 2016|
|VIOLATION: DOCUMENTATION OF EVALUATIONS||Tag No: A0811|
|**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY**
Based on document review and interview, it was determined, for 1 of 1 Patient (Pt. #1) whose discharge appeal was voided, the Hospital failed to ensure a Medicare discharge appeal was not voided in error.
1. On 10/13;16 at 11:00 AM, The Center for Medicare and Medicaid (CMS) Hospital Discharge Appeal Regulations were reviewed. The regulations require, " Hospitals are required to deliver the Important Message from Medicare (IM), CMS-R-193 to all Medicare beneficiaries (Original Medicare beneficiaries and Medicare Advantage plan enrollees) who are hospital inpatients. The IM informs hospitalized inpatient beneficiaries of their hospital discharge appeal rights. Beneficiaries who choose to appeal a discharge decision must receive the Detailed Notice of Discharge (DND) from the hospital or their Medicare Advantage plan, if applicable. These requirements were published in a final rule, CMS-4105-F: Notification of Hospital Discharge Appeal Rights, which became effective on July 2, 2007 ... "
2. On 10/12/16 at 11:00 AM, Pt. #1 ' s clinical record was reviewed. Pt. #1 was a [AGE] year old male, admitted on [DATE], with a potential stroke and subdural hematoma [blood in space between outer and middle layer covering of brain]. Pt. #1 was admitted to the Progressive Care Unit for observation.
3. On 9/30/16 (Friday) at 3:38 PM, a physician ' s order (MD #1) was written for discharge " to home with Home Health Care Org " .
4. On 10/13/16 at 9:15 AM, an interview was conducted with the Manager of Case Management (E #4). E #4 stated Pt. #1 ' s daughter requested a Medicare appeal to review the discharge order. Pt. #1's daughter did not want Pt. #1 to return home because she (daughter) was ill with shingles and flu symptoms and could not care for Pt. #1.
E #4 stated that on 9/30/16, E #4 called Pt. #1 ' s Physician (MD #1), informed MD #1 about Pt. #1's daughter's discharge appeal, and asked MD #1 to cancel Pt. #1 ' s discharge order.
On 9/30/16 at 7:33 PM, MD #1 canceled the discharge order.
E #4 stated that E #4 received an " Expedited Appeal Documentation Request " application from KEPRO (the appointed Medicare Quality Improvement Organization) dated 9/30/16. E #4 sent Pt. #1's medical information to KEPRO the next day (10/1/16), at approximately 9:30 AM. E #4 stated that, later on 10/1/16, a KEPRO Representative called and informed E #4 that Pt. #1's discharge appeal was voided because the discharge order was canceled.
5. On 10/2/16 (Sunday) at 3:29 PM, MD #1 rewrote Pt. #1 ' s discharge order, " to home with Home Health Care Org ". Pt. #1 was discharged home on 10/2/16 at approximately 5:30 PM.