27 March 2018

North Carolina Hospital Risks Medicare Payments After Multiple Cancer Diagnoses

After a spate of recent cancer misdiagnoses, a North Carolina hospital is at risk of losing Medicare reimbursements, according to an announcement from the Centers for Medicare and Medicaid Services (CMS).

Wake Forest Baptist Faces Strict Penalties Over Cancer Misdiagnosis

Winston-Salem’s Wake Forest Baptist Health will lose its ability to receive Medicare payments on March 25, 2018, unless the hospital can hammer out a “corrective action plan” with federal regulators. Officials for CMS say doctors at Wake Forest Baptist, a teaching hospital affiliated with Wake Forest University, incorrectly diagnosed three patients with cancer and inaccurately assured a fourth patient that they did not have cancer.

Microscope In Pathology Lab

“The errors resulted in unnecessary treatment for three patients and a delay in diagnosis for a fourth patient,” Modern Healthcare writes. The problem, regulators say, can be found inside Wake Forest Baptist’s pathology lab. As agency officials wrote in a notice to the public, “the complaint investigation resulted in identification of an immediate jeopardy to the health and safety of patients as evidenced by the staff’s failure to provide oversight and ensure laboratory specimens were appropriately processed with accurate results for medical interventions.”

Hospital President Blames Former Lab Employee

Wake Forest Baptist Hospital’s pathology lab processes around 25,000 pathological samples every year. Dr. Kevin High, the hospital’s president, is now working with the Centers for Medicare and Medicaid Services to find a path forward. Speaking with Modern Healthcare, Dr. High blamed most, “if not all,” of the previous cancer misdiagnoses on a single employee who isn’t working at the hospital anymore.

High says the hospital first became aware of an issue in the fall of 2017, when “deficiencies” were identified in the pathology department’s quality control system. Wake Forest Baptist immediately notified the affected patients, High continued, then went on to review hundreds of other pathological findings, but found no mistakes.

North Carolina Hospital Risks Losing $60M+ In Medicare Payments

A spokesperson for the Centers of Medicare and Medicaid Services confirmed to Modern Healthcare that Wake Forest Baptist has already submitted a plan to correct its laboratory’s problems. The proposal is now under review.

Like all hospitals, Wake Forest Baptist relies to a large extent on payments from Medicare. In fiscal year 2017, the medical facility received an estimated $63 million in Medicare payments. Losing all of that money would be a major blow, especially in light of similar penalties that have already been assessed against Wake Forest Baptist.

The Hospital-Acquired Condition Reduction Program

In December 2017, CMS announced that Wake Forest Baptist, along with 20 other hospitals in North Carolina, would see their Medicare payments drop by 1% as a penalty for allowing patients to suffer “potentially avoidable complications, including various types of infections, blood clots, bed sores and falls,” according to Kaiser Health News.

Under a new program, started in 2015, the Centers for Medicare and Medicaid Services is obligated to reduce Medicare payments to hospitals that rank in the worst-performing 25% of medical facilities. The Hospital-Acquired Condition Reduction Program doesn’t apply to highly-specialized hospitals, like mental facilities, or so-called “critical access” hospitals, which serve as the only care provider in a given area.

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