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By Mark Tosczak
UPDATE 2: CMS jeopardy rescinded, as of April 11. Story here.
UPDATE: Wake Forest University Baptist Medical Center announced Friday that its Medicare contract, which had been scheduled for termination on Sunday, has been extended 12 days, to April 6, Wake Forest Baptist Health President Kevin High said in a statement.
The delay gives government inspectors more time “to complete the required follow-up visit to validate our corrective action plan,” the statement said.
ORIGINAL STORY: The federal agency that administers the Medicare program announced that Wake Forest Baptist Medical Center will no longer be able to bill the program for patients admitted starting Sunday, unless the agency approves a plan to fix problems related to pathology testing before then.
“Last fall, Wake Forest Baptist Medical Center became aware of deficiencies in its pathology quality monitoring process, which led to a change in diagnosis requiring a change in management for 10 of our patients,” the hospital said in a statement. “We promptly notified all patients affected, as well as the physicians who cared for them. We have completed a review of hundreds of similar cases to satisfy ourselves that there are no other patients who have been affected.”
The decision potentially puts at risk tens, if not hundreds of millions of dollars in annual revenue to the Winston-Salem medical center.
Two trade publications, Modern Healthcare and Becker’s Hospital Review, have reported that the pathology problems led to problems with cancer diagnoses for four patients, with one patient’s treatment being delayed as a result. Three other patients were falsely diagnosed with cancer and started treatment programs before the error was caught, the publications reported.
Cancer treatment can include radiation therapy, surgery and chemotherapy, which can themselves negatively affect a patient’s health.[sponsor]
The hospital “determined that most, if not all, of the misdiagnoses centered on a single individual who is no longer with Wake Forest Baptist,” the hospital’s statement says. Wake Forest Baptist said it’s also made changes to its lab processes, equipment and training to address the issue.
The errors were reported by hospital employees through the medical center’s Safety Starts Here program and subsequently reported to regulators. Medicare is the government-funded health insurance program for the elderly and is the largest health care payer in the country.
Wake Forest Baptist Medical Center has submitted a corrective plan to the Centers for Medicare and Medicaid Services, the agency that oversees the Medicare program. For its last full fiscal year, which ended June 30, 2017, 27 percent, or about $680.4 million, of the medical center’s $2.52 billion in patient revenue came from Medicare.
North Carolina Health News inquiries to CMS weren’t immediately returned.