By Bryan Lowry, August 27, 2016
Kansas officials say conditions at Osawatomie State Hospital have improved dramatically since it lost Medicare certification last year, and the state psychiatric facility is ready for a high-stakes federal inspection.
Osawatomie lost certification in December after federal inspectors raised concerns about safety at the hospital, where a patient allegedly raped a staff member in October. Decertification has cost the state $8 million in federal aid so far. That amount will continue to climb by about $1 million a month until the hospital is recertified. The state also has spent nearly $8 million to address safety and other concerns that led to Medicare’s action.
The state has applied for recertification and set Aug. 30 as the date when the hospital will be ready for a new review by federal inspectors.
"We’re very confident that we’re ready to go," said Tim Keck, acting secretary of the Kansas Department for Aging and Disability Services, the agency that oversees the state’s hospitals.
Staffing continues to be a challenge at the hospital, which provides treatment to adults with psychiatric disorders. More than half of the full-time registered nurse positions were vacant at the start of August, and a moratorium on new patients continues.
"In my opinion, the vacancy rate’s still too high," Keck said. "We need to continue to work to drive that vacancy rate down."
Before decertification, federal inspectors had faulted the hospital for out-of-date facilities and for understaffing, which had contributed to gaps in safety and put staff and patients at risk.
A January 2015 inspection report by the Centers for Medicare and Medicaid Services, sometimes known as CMS, found that the hospital had failed to provide 24-hour nursing service for a patient who died from a bacterial infection that caused a blockage of the intestines.
Federal inspectors wrote that "systemic failure to supervise and evaluate care for each patient” had “resulted in a patient’s death and placed all patients admitted to the hospital at risk."
Keck said the hospital has "changed our approach to care."
To ensure patients receive 24-hour nursing care, the hospital now assigns each registered nurse to a group of no more than 15 patients, according to documents submitted to CMS as part of the recertification application. Previously, nurses could be responsible for up to 30 patients at a time.
The hospital now requires a check on each patient every 15 minutes, has security officers on site at all times and medical doctors on call at all times, according to the documents.
Federal regulations require that psychiatric hospitals "must have adequate numbers of qualified professional and supportive staff" to "provide active treatment measures" for patients. The regulations do not set a specific ratio.
For the last week of June, 37 of the hospital’s 56 registered nurse positions were unfilled, a vacancy rate of 66.1 percent, according to documents obtained through an open records request. At the same time, nearly half (64.5) of the hospital’s 136.5 mental health technician positions were vacant.
Keck blamed the spike in vacancies on competition with a local employer, who increased pay around that time.
The vacancy rate for mental health technicians had fallen to 24.5 percent in the first week of August, but more than half of the positions for registered nurses were unfilled, with a vacancy rate of 58.9 percent.
KDADS has relied on temporary workers and main agency staff, who have nursing or other mental health credentials, to help fill gaps in staffing. If agency staff members who have filled in at the hospital are included, the vacancy rate for registered nurses drops to 16.1 percent, according to KDADS.
The hospital has had a moratorium on new patients since last year because of short staffing. It now houses 145 patients, compared with 249 patients two years ago.
Keck said he hopes to lift the moratorium before the end of the calendar year and gradually begin taking in new patients, which would help alleviate the strain on community mental health centers.
Osawatomie also underwent a number of physical renovations to ensure patient safety, ranging from the installation of new ceilings, a change meant to prevent suicide attempts, to the installation of new showerheads and light fixtures.
Keck said he doesn’t know what date inspectors from CMS will visit the hospital or how long it will take them to determine whether to reinstate the hospital’s Medicare certification.
"Once we declare that we’re ready, it’s out of our hands," he said, explaining it could be months before the federal agency makes a decision.
"If they treat us fairly and are reasonable about things, I’m very confident that we’ll get recertified sooner rather than later," he said, contending that CMS set moving targets in the lead-up to decertification.
Sen. Laura Kelly, D-Topeka, who has been one of the agency’s toughest critics, said she does think there has been significant improvement at the hospital since last year.
"Not only the physical improvements, but I do think the morale of the staff is better because they’ve been getting some attention and there’s been some action," Kelly said.
However, she said, Keck’s suggestion that CMS inspectors might be unfair to the state was likely the agency trying to shift blame to federal officials if Kansas comes up short on the inspection.
"If anything, I think CMS has let Kansas get away with all sorts of things," she said.
Rep. Dan Hawkins, R-Wichita, who chairs the House Health and Human Services Committee, said he toured the hospital while it was still being renovated and is confident the state will pass its inspection. But he called recertification only the first step toward improving the hospital.
"That just stops the bleeding, so to speak. We’ve still got a long, long way to go," he said.
The Brownback administration has previously floated the idea of privatizing the state’s hospitals in Larned and Osawatomie, an idea that sparked some backlash from lawmakers. Keck said the agency continues to look at privatization as an option.
"It’s not something that’s predestined or certain that we’re going to do," Keck said. "It’s just an option. We need to look at what the options out there are."
Keck said the probability of privatization would increase if the state’s application for Medicare recertification is rejected.
"Yeah, it will, honestly," Keck said.
"If they’re not going to be fair to us, then what else can we do?" he said. "We’ve put a lot of resources into this, a lot of effort … and then to me it (privatization) becomes a much more serious conversation."