Detroit Medical Center’s Detroit Receiving Hospital and University Health Center are in danger of losing Medicare and Medicaid reimbursement after regulators determined its nurses did not provide adequate care.

A May inspection by the Michigan Department of Licensing and Regulatory Affairs found that the hospital was not in compliance with Centers for Medicare and Medicaid Services rules around nursing after a 52-year-old patient developed bedsores during an emergency room visit in January.

The Detroit News first reported the situation. Representatives from DMC did not immediately respond to queries on the matter.

CMS will terminate its provider agreement with the hospital on Aug. 14, if DMC does not submit a plan to come into compliance, CMS said in a letter to DMC administrators May 16. DMC has 10 days from receipt of the letter to submit a plan to ensure the violations are not repeated.

Losing Medicare and Medicaid reimbursement would be a death knell for the hospital, which is highly dependent on the federal money.

Medicare and Medicaid reimbursement covered 90.2 percent of inpatient days — days when a patient occupies a bed, regardless of payment source — at Detroit Receiving in 2020, according to data from a Michigan Health Market Review study by independent healthcare consultant Allan Baumgarten released earlier this month.

Medicare and Medicaid, in fact, cover more costs per patient at Detroit Receiving than at any other hospital in Southeast Michigan, according to the study.

Detroit Receiving generated net income of $40.6 million in 2020 on net patient revenue of $260.2 million, but the hospital also received $27 million in COVID-19 relief payments in 2020 from the federal government, according to the study.

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Detroit Receiving accounted for nearly 17 percent of DMC’s total net patient revenue in 2020 of $1.56 billion.

The hospital went afoul of regulators after the patient was admitted at Detroit Receiving on Jan. 18 for shortness of breath and chest pains, according to CMS documents provided to Crain’s from LARA. After three days in the intensive care unit overflow, the patient developed a bedsore and nursing staff failed to properly treat the wound and document wound care in the patient’s chart, according to the report. The resident physician treating the patient told CMS in a May interview that they were unaware the patient even had a bedsore.

The inspection also revealed the patient’s medical social worker was not qualified to oversee discharge planning staff.

“We have determined that the deficiencies limit the capacity of your facility to render adequate care and ensure the health and safety of your patients,” the letter reads. “CMS will not return your deemed status based upon accreditation with the joint commission until your hospital demonstrates compliance with all conditions of participation.”

DMC, a for-profit health system owned by Dallas-based Tenet Healthcare, has had 247 noncompliance complaints from LARA inspections since the start of 2020, The Detroit News reported.

DMC has had compliance problems before.

In 2019, CMS threatened to pull Medicare funding from DMC Harper University Hospital after failing an infection-control inspection. A LARA inspection at Harper found flying insects in an intensive care unit, improperly attired surgical personnel and various incidents of dirty surgical instruments and personnel failing to follow policies.

In 2016 and 2017, DMC was cited for other multiple infection-control infractions by state and federal regulators after media reports of dirty instruments.

DMC submitted corrective plans for all of the issues and was accepted by CMS.

This story first appeared in our sister publication, Crain’s Detroit Business.

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Inspection results endanger DMC’s Medicare, Medicaid eligibility – Modern Healthcare