September 21, 2019
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CMMC president says hospital will remedy problems that feds flagged

Courtesy of Central Maine Health
Courtesy of Central Maine Health
Central Maine Medical Center in Lewiston

The president of Central Maine Medical Center said the hospital fully expects to meet the June 30 deadline it was given to correct problems identified by a federal agency.

The Lewiston-based hospital, which is part of Central Maine HealthCare, received letters from the Centers for Medicare and Medicaid Services this February and April warning the hospital to comply with standard procedures and protocols for patient care or face the possibility of losing federal reimbursements.

“We fully anticipate that we will comply by or before the deadline,” said Dr. David Tupponce, president of Central Maine Medical Center and executive vice president of parent Central Maine HealthCare.

The hospital gets what Tupponce described as a substantial amount of revenue from Medicare.

“For our patients on Medicare or Medicaid, we are not limiting access in any way. We are open to them,” he said.

The federal agency found problems in the hospital’s emergency department. The agency had received patient complaints and conducted surprise inspections.

About 43,000 patients use Central Maine Medical Center’s emergency department each year.

In correspondence with the hospital, the federal agency detailed problems with how one patient with a spinal fracture was handled. That patient lost motor function after being propped up in bed due to poor staff communications between a doctor and nurse. Another patient left after the severity of a heart problem was not identified quickly.

The Sun Journal first reported Thursday evening that federal inspectors found procedural deficiencies and other problems at the hospital during several inspections starting this January.

The federal agency warned the hospital that it could lose Medicare and Medicaid payments if it doesn’t correct the issues by June 30 and show it can sustain the improvements.

The agency sent letters to Tupponce along with detailed descriptions of the problems.

Tupponce said the agency focuses on whether the hospital followed policies and protocols, and with how it can comply and improve its processes.

He said that such warnings are not unusual for hospitals, and that the hospital and agency work together to form a plan of correction.

“They give us feedback if the plan is appropriate and revisit the hospital to check,” he said.

Tupponce said the correction plan was submitted in January to the agency, and that the most recent inspection and warning letter are part of the process to refine the plan.

“We’re working on a process of improvement around when patients come into the emergency department, how to assess the patient correctly and determine the severity of their problem, and then how to transfer them [for care] to nurses and physicians,” he said.

“We are working to improve what happens when we get a surge of patients, so how to build in robustness and redundancy,” he said. “The other area [of focus] concerns specific issues around chest pain or spinal injury precautions, that we make sure the processes that are in place can withstand minor breakdowns in communication.”

He said it takes time to implement new protocols and procedures. They must be easily understood by staff and reflect the most up-to-date practices. And everyone involved in patient care must know those practices.

The hospital has ongoing training programs, he said, so the cost for the new training is part of the business of running a hospital.

“Training is not an aberration from what we normally do,” he said. “We are in a constant process of improvement.”

While the education will not add cost to the hospital, Tupponce is concerned about reputational harm.

“That really is the concern we have,” he said. “This process isn’t unusual. But I am concerned that if a patient avoids or doesn’t get needed care, there could be an unfortunate outcome.”

He said that the reports by the federal agency can be sensationalized, but the agency focuses on improvements in safety and quality in hospitals.

He said the hospital has gone through a number of changes in the past two years to improve quality, and that doctors and other staff have supported the organization.

The hospital’s parent, Central Maine HealthCare, had been losing money before its new president, Jeff Brickman, took over two-and-a-half years ago. Brickman streamlined operations and brought in an electronic health care system, but staff who did not like the changes left en masse.

The original deadline for the corrections was May 4, but the federal agency extended that until June 30.

“[This] acknowledges we made good progress, and with more time we’ll show full compliance,” he said.

 



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