Feds say failures at Kansas mental health hospital could delay patient recovery

Federal inspectors have warned a Kansas state mental health hospital that its Medicare payments will be cut off early next year without major improvements to patient care in one of its units.

The Centers for Medicare and Medicaid Services found that the problems at Adair Acute Care – located inside Osawatomie State Hospital — “substantially limit the hospital’s capacity to render adequate care and services,” according to documents obtained by The Kansas City Star and The Wichita Eagle.

CMS has told state officials it will terminate Medicare payments to the 60-bed Adair unit in March 2020 unless Kansas corrects the problems. The Kansas agency that oversees the hospital described the issues found by inspectors as “documentary omissions in patient files.”

The ultimatum is the latest setback to the state’s beleaguered mental health hospital system, which has been beset by worker shortages for years. Osawatomie, located in northeast Kansas, has especially struggled to stay in compliance with federal authorities.

CMS inspectors, who surveyed Adair from Nov. 4 through Nov. 6, focused on eight patients. Among the shortcomings they found:

• Treatment plans lacked specific goals and some didn’t include time frames.
• Treatment notes were missing or lacked enough detail to show each patient’s response to psychiatric treatment.
• Treatment for some patients needed to be more frequent and intense.

In CMS’ survey report, the agency says Adair’s failure to provide treatment intense enough for some patients could lead to delays in patient improvement or end with patients leaving the hospital “without the necessary skills to prevent relapse.”

One patient’s treatment plan named the following as patient strengths: “Able to communicate needs, Medicare.” CMS inspectors said the statements didn’t describe the patient’s personal attributes and couldn’t be used to help in manage psychiatric symptoms. Inspectors documented other similar examples.

Patients at Adair also didn’t receive specific goals. For example, one patient who had attempted suicide was asked to identify three benefits of sobriety and three healthy ways to manage stress, depression and suicidal thoughts. Inspectors found those goals too vague to be helpful.

The CMS report includes an interview with Adair’s medical director, who “agreed that several short-term goals were not measurable.” The medical director also acknowledged some of the goals did not help patients recover.

In a Dec. 2 letter, CMS said an unannounced inspection will be conducted to ensure changes have been made.

The Kansas Department for Aging and Disability Services, which oversees state hospitals, was initially not responsive when asked about the inspection. On Tuesday, a reporter asked a spokeswoman whether CMS had surveyed Osawatomie. The following day, the spokeswoman told the reporter to make an open records request, which often takes weeks or months to fulfill.

CMS provided a copy of the survey report, and the letter it sent to Adair, on Thursday in response to questions. The KDADS spokeswoman, Cara Sloan-Ramos, said the findings “don’t rise to the level of pulling our Medicare provider agreement.” In a follow-up call, she said the agency takes the findings seriously and is confident it can correct the issues so that the agreement isn’t pulled.

Told that CMS sent a letter saying it plans to terminate the Medicare agreement, Sloan-Ramos said, “I think that’s just a standard letter.” She said KDADS has filed an extensive plan to correct the problems, which she said centered on documentary findings.

In a statement, she said that “findings of non-direct care documentation omissions in patient files were cited. KDADS has submitted an extensive plan of corrective action to CMS that we anticipate will bring documentation guidelines in line with CMS requirements making it unnecessary to terminate the hospital’s Medicare provider agreement.”

CMS decertified the entire Osawatomie State Hospital in January 2016 in response to security and safety issues. In December 2017 the agency re-certified the Adair portion of the facility.

The decision meant Osawatomie could again receive Medicare funding for those 60 beds. The facility’s loss of certification at one point was costing the state upwards of $1 million a month in federal funds.

The hospital has limited admissions to less than 170 since 2015, a policy that has placed additional strain on the state system. Officials have told lawmakers they will deliver a plan by January to lift the cap.

This story was originally published December 19, 2019 at 5:47 PM with the headline "Feds say failures at Kansas mental health hospital could delay patient recovery."