Medicare to cut off clinic: American Dialysis Center to appeal decision

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April 23, 2009

Medicare to cut off clinic: American Dialysis Center to appeal decision

By Connor Murphy
Pacific Daily News

American Dialysis Center is scheduled to be terminated from participating in Medicare tomorrow for what federal investigators allege are conditions of "immediate jeopardy" to patients.

However, the center's management said investigators' concerns stem from a now-resolved personnel dispute, and the termination is a harsh move that will hurt patients.

Beginning tomorrow, Medicare no longer will make payments for end-stage renal disease services at the year-old facility, according to a U.S. Department of Health and Human Services notice.

"The decision to terminate was made following a recent survey by our inspectors," said Jack Cheevers, HHS Centers for Medicare and Medicaid Services regional office spokesman. "The inspection found conditions of 'immediate jeopardy' to patients, which means a systemic problem that imperils the health and safety of multiple patients."

Surprise walkout

However, the alleged problems the inspectors found were due to a surprise walkout that about three-quarters of the facility's staff staged one day, said Dr. Hoa Van Nguyen, chairman of the American Dialysis board of directors.

"The personnel walked out on strike with no notice," Nguyen said. "That raised concerns regarding the impact on patient care."

Caught up in the dispute are patients such as Julia De Mesa of Harmon, who has been receiving dialysis three times a week at the center since December.

She said she has never had any problems with her care at American Dialysis. The center's staff and level of care have helped her move toward accepting her condition, she said, and finding the same environment at another center that accepts her Medicare won't be easy.

"I found a home here. To go somewhere else? I don't look forward to it," De Mesa said. "Emotionally, I'll have to start all over. I'm disappointed it had to come to this, and they had to go to such drastic measures."

About half of the dialysis center's approximately 70 patients are on Medicare, Nguyen said. He added that patients who aren't part of the Medicare program wouldn't be affected.

Plans to reapply

Cheevers said federal regulations prohibit him from detailing the problems inspectors allegedly found, but he said they were "egregious."

"An immediate jeopardy citation is very serious; it means that the health and safety of Medicare patients is at immediate and severe risk," he said.

Two inspectors completed a three-day visit March 27. During their inspection, they interviewed the administrator, medical director, staff and patients, in some cases more than once, Cheevers said.

Inspectors also observed how the center's staff interacted with patients, checked infection controls, observed staff as they hooked up patients to dialysis machines, checked the staff's competency with the machines, looked at medical logs and checked to see if water being used to dialyze patients was free of contaminants, he added.

Nguyen said patients who investigators talked to had no problems with the facility. He said he believed investigators may have been misled by the disgruntled staffers.

"They only got one side of the argument," Nguyen said. "We don't feel like they have all the evidence and they made the appropriate decision."

The termination will be permanent, Cheevers said. However, American Dialysis management can appeal the decision, or apply for new Medicare approval after 90 days, according to a letter sent to the facility.

Nguyen said the facility plans to reapply if nothing else, but hopes to convince federal officials that termination from the program would be too severe.

One of the items management plans to present the Medicare administrators is a memorandum of understanding signed with the Guam Memorial Hospital, which allows off-duty hospital staff to fill in at the dialysis center when staff is short, Nguyen said.

The staff involved in the walkout were terminated, he said.

Additionally, the center is pursuing criminal charges against those employees, he said, for allegedly endangering patient safety, as well as allegedly violating federal laws such as the Health Insurance Portability and Accountability Act, or HIPAA.

'Rare event'

Cheevers said Medicare staff couldn't remember another dialysis facility in Guam being terminated from the program in at least 10 years.

"Terminating Medicare funds to any medical facility is a relatively rare event," he said.

Nguyen said that the center is planning to transfer Medicare patients to one of the other three dialysis centers on island, run by the same management company.

This would allow the facility's Dr. Sherif Philips to remain the patients' primary nephrologist at the other centers run by Innovative Dialysis Systems Inc., Nguyen said.

Antonia Cruz was at the facility yesterday waiting while her husband, Antonio, was in his four-hour dialysis session. She said she and her husband are happy with the care. The couple has been driving up from Merizo for treatment sessions since November.

"The patients don't really know what went on, but this will be real hard on us," she said. Medicare pays a big chunk of the expenses for her husband's dialysis, Antonia Cruz said.

Antonio Cruz said he had never had problems at the facility, adding that he has built relationships with the staff.

"If this center loses Medicare privileges, then I'm going to be troubled," he said from his dialysis chair. "I'm going to have to go somewhere else, and I don't know where I'm going to go."

http://www.guampdn.com/article/20090423/NEWS01/904230303/1002