The process could take up to four months, but Compass Group spokesperson Kate Fenner is hopeful the hospital can get recertified in as little as 60 days.
Cincinnati-based Compass has brought in two nurses, two senior physicians, a pharmacist and a person to help with Emergency Room management to tackle the problem.
This week, the hospital is undergoing a rigorous assessment involving initial observation of areas of improvement. A report will be released Friday, at which point a plan will be implemented in conjunction with physicians, nurses and staff, Fenner said.
“The process for regaining a provider number so HRMC can continue to accept Medicare and Medicaid patients is not easy, (but) you are well positioned to do it in the minimal amount of time,” Fenner assured.
When all deficiencies are addressed in three to four weeks, a preliminary recertification survey will be conducted at the hospital by the Centers for Medicaid and Medicare Services, the federal agency in charge of overseeing compliance. Then, another full-blown survey will be conducted 30 days after that, at which time the hospital has the opportunity to regain its certification.
Fenner said she’s confident in the process being conducted quickly because two main areas the hospital was cited for – documentation and communication — are relatively easy to fix.
“The deviations from standards that caused the issues that now sit before you at HRMC were not frivolous, but they’re primarily focused on documentation and communication and not on patient care safety,” said Fenner.
Additionally, Fenner said the consulting group has worked with hospitals that have problems more serious than HRMC.
“We have worked with organizations with much deeper, broader problems in terms of patient safety than we believe we have before us,” she said. “You’re like none of those hospitals that lost theirs.”
Fenner called her group “seasoned,”, saying they’ve worked with dozens of hospitals before to get them back on track. Clients the group has evaluated include a 450-bed medical center on the West Coast and a hospital in Boston with 31 citations.
One glaring difference, however, is that Compass has never worked with a client that has lost its certification, according to Fenner.
If a consulting group had been called earlier, this might not be the case.
“We unfortunately did not get called or know about you until after it had been pulled,” Fenner said.
Some questioned inspectors’ ability to survey a hospital that lacks patients. Already, Medicare and Medicaid patients are being diverted to Westcare and Mission hospitals, and the hospital has lost two major private insurance carriers — Blue Cross and Blue Shield and Kanawha, a Cherokee tribal insurance program.
“If your population count is down, and the last figures I had yesterday didn’t look too good, what are you going to fix and how are you going to fix it in a position that you don’t have any patients in the hospital?” asked Ben Thompson, a local real estate agent that uses Medicare. “Can you get recertified if there’s only 10 or 20 patients in the hospital?”
“If you’re running with a hospital of 20 patients, you can’t show what you can do,” agreed Michael Rush, a hospital volunteer.
Fenner said inspectors will conduct a survey no matter how few patients are left at HRMC.
“In reality, we need (just one) patient, and if we don’t have one I’m coming to get one of you,” she said jokingly to the audience at Monday’s hospital board meeting.
Mergers and acquisitions
Already, interested parties are making inquiries into purchasing or acquiring the embattled hospital. With HRMC trying to sustain itself on its $20 million in reserves, investors are flocking to tempt the hospital with offers in the chance it is forced to close its doors.
“Several large systems have indicated interest. Compass Group warned a lot of folks would come out of the woodwork with these types of options,” said Dr. Nancy Freeman, chairman of the hospital board.
Fenner said that her group has been contacted by companies wanting Compass to set them up with HRMC. Compass isn’t in that line of work, but many potential investors will persist through any avenue they can, she said.
“There will be a lot of people circling around the pond to try and get you right now,” she said.
Fenner cautioned officials to wait until after the hospital regains certification to proceed with any kind of merger or acquisition.
“If you do it right now without your certification, you’ll get a dime on a dollar for the worth of the hospital. So please don’t do it until you get your certification completed. That doesn’t mean you can’t evaluate options,” she said.
Opinions are mixed in the community about the path the hospital should take. County commissioners could gain back control of the facility, but it would take a lengthy legal process.
“One of the options is reclaiming the hospital. To do that we’d have to go through the court system and that would tie that up for who knows how long,” said Commissioner Skeeter Curtis.
The hospital could also go private, joining a system like Mission or Westcare where it would no longer be accountable to the county. Privatization has downsides, some argue.
“I believe private hospitals ... bring their own problems with them, not the least of which is remote administration,” said Thompson.
Fenner said that remote administration can mean dollars flowing out of Haywood County rather than being put back into the economy.
“Right now the dollars made and earned are spent in your county. If you’re acquired by somebody else, understand that you’re going to do a shift of revenue out of the county. The nurses and physicians continue to work here, but it’s investor-owned,” she said.
Another option is that a university with a medical school could take over HRMC. Thompson said UNC-Chapel Hill has expressed interest in the facility.
Commissioner Kirk Kirkpatrick said he is encouraging the hospital to look at all its options.
Dr. Al Mina, chief of surgery, asked that doctors be included in any talks regarding the hospital changing hands.
“At this time, the role of the medical staff is critical, and opinions and recommendations need to be heard. We respectfully request representation during all discussions regarding any involvement with outside hospitals regarding operations, mergers or acquisitions,” read a statement by chief of staff Dr. Shannon Hunter that Mina shared with the county commissioners.