BRATTLEBORO — After a series of violations, followed by improvements, followed by more regulation dings on the part of the Brattleboro Retreat, the federal health care regulatory and funding agency Centers for Medicare and Medicaid Services (CMS) has told the psychiatric hospital that it's time for a third-party review.
According to Retreat Vice President for Strategy and Development Konstantin von Krusenstiern, Medicaid and Medicare funding will continue for Retreat patients for the foreseeable future.
Based on an exit interview with surveyors from the Vermont Division of Licensing and Protection - that acted on behalf of CMS - the psychiatric hospital remains out of compliance with one or more conditions required to maintain CMS funding, von Krusenstiern said.
To address alleged systemic issues and preserve Medicare and Medicaid, the hospital - with help from the Shumlin administration - and CMS have entered into a Systems Improvement Agreement (SIA).
Under the SIA, the Retreat will work with an undetermined third-party consultant to identify and correct systemwide issues in the areas of quality assurance, patient care, and governance that have led to repeated visits by CMS.
If a hospital cannot meet CMS' conditions of funding then the agency can terminate the hospital's contract. Without a contract, the Retreat cannot receive Medicaid and Medicare reimbursements.
An SIA, however, gives the hospital more time to address problems. CMS continues to provide funding while the agreement is in place.
At the Retreat, Medicare and Medicaid covers about half the patients - those under custody of the state and people who have admitted themselves, von Krusenstiern said.
“It's a significant portion of our revenue,” he added.
That's an estimated $20 million to $30 million of the Retreat's annual budget of $60 million.
But von Krusenstiern stressed that while it's a lot of money, the potential ramifications for patients' ability to receive care at the Retreat “is really what's at stake.”
Between its inpatient programs, outpatient programs, residential programs, and school, von Krusenstiern said that more than 5,000 people use the Retreat each year.
Hospital stays average five to 10 days, he added. Inpatient programs, totaling 112 beds, run at capacity. Approximately 3,000 people access the inpatient programs each year.
The Vermont Division of Licensing and Protection re-surveyed the Retreat on Sept. 29 and Oct. 1.
“The re-survey was a follow-up to surveys conducted at the Retreat in June and August of this year for which a notice of termination of the provider agreement had been issued,” read an Oct. 3 press release from the Retreat.
In June, said von Krusenstiern, CMS surveyors came to the Retreat in response to a patient's attempted suicide in May.
CMS surveyors didn't find fault with the Retreat regarding the patient's suicide attempt and death six weeks later at another hospital, von Krusenstiern said.
While on campus, however, the surveyors found safety issues like a key that had broken in a lock.
In August, surveyors reviewed a fight on the adolescent inpatient unit that resulted in employee injuries.
During the visit, surveyors found that an incident of “inappropriate contact” between adolescents on one of the units had not received enough follow-up to reduce the likelihood of future incidences.
Von Krusenstiern said that the surveyors decided to issue the SIA because although the hospital repeatedly addressed CMS compliance violations, it appeared the hospital had systemic problems that kept triggering the specific CMS issues.
For example, the Retreat lacked controls that could identify risks before they became problems.
Von Krusenstiern remains optimistic, saying that working with a third party under the SIA helps the hospital “find those solutions collaboratively.”
A source inside the Retreat who spoke on condition of anonymity echoed von Krusenstiern's optimism, saying that bringing in a fresh set of eyes could prove best in the long run.