hospital loosing medicaid/medicare funding

Nurses General Nursing

Published

Specializes in ICU, ER, EP,.

Has anyone worked at a facility that after a sentinal event and the "visit", funding was pulled? If so, what to expect? All elective surgeries and proceedures held? Shut down what? We just can't admit those with private insurance... so what happens to stay fiscally sound?

What a mess, anyone who's gone through this- we would appreciate some insight. Thanks in advance.

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Specializes in Management, Emergency, Psych, Med Surg.

In my experience this is what happends: if you get a survey secondary to an event, the state can place you on notice and give you a certain amount of time to take corrective action. If you fail to meet their requirements, they can pull your medicare funding. When your funding is pulled you will not get paid from the govt for any medicare/cade pts that come to your facility for care. The state also has the option of closing your facility but I have found that this is usually the last resort and I have actually never seen this occur.

I would wonder what has occured at your facility before that would result in the state pulling the funding. This is a VERY BIG EVENT for any facility. Private insurance companies usually follow what ever medicare does, so you probably won't get private funding any longer either.

You can go to several web sites that will give you a review for your facility. Also, visit the center for medicare services web site. They may have information regarding any actions taken against your facility and why.

Good Luck

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Specializes in ICU, ER, EP,.

thanks for a great response. the legal section of our paper gave public notice for involentary termination of our funding effective shortly. so as anyone can imagine we are very concerned. i'm aware of the issues, but to keep my location private i'd prefer not to be more specific.

anyone else who has been through this, please chime in as well.

thanks

in my experience this is what happends: if you get a survey secondary to an event, the state can place you on notice and give you a certain amount of time to take corrective action. if you fail to meet their requirements, they can pull your medicare funding. when your funding is pulled you will not get paid from the govt for any medicare/cade pts that come to your facility for care. the state also has the option of closing your facility but i have found that this is usually the last resort and i have actually never seen this occur.

i would wonder what has occured at your facility before that would result in the state pulling the funding. this is a very big event for any facility. private insurance companies usually follow what ever medicare does, so you probably won't get private funding any longer either.

you can go to several web sites that will give you a review for your facility. also, visit the center for medicare services web site. they may have information regarding any actions taken against your facility and why.

good luck

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Teaching hospitals are paid by Medicare to train physicians. If they lose this funding, they can't pay the student doctors. The hospitals actually make a profit from Medicare, in addition to getting cheap labor. I think it's a big deal if these hospitals do lose this funding.

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Specializes in med-surg, BICU.

i would probably start sending out resumes and going on interviews if i were you

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Specializes in Critical Care, Education.

I agree - being 'sanctioned' by CMS is a HUGE problem. In this day and age, I doubt whether any hospital can stay afloat under these circumstances unless they are part of a big system - that is willing to provide funding.

If your facility is an independent, or part of a small system - the situation will be dire. Based on my experience --- first they'll cut back on all 'non-essentials' like switchboard services, unit secretaries & cafeteria -- then you'll notice tighter staffing & fewer supplies. As cash gets tighter, they'll be on a cash-only basis with all vendors.

Run while the gettin's good.

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i would probably start sending out resumes and going on interviews if i were you

I agree!!!

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Specializes in ER, ICU, Education.

Actually most hospitals don't make a profit from state or federal funding which accounts on average for 60 - 75% of their patients (depending on demographics).

One of the local hospitals here lost Medicare/Medicaid funding because of a serious problem found by a CMS inspection. What happened was this...

The hospital canceled all unnecessary tests. surgeries etc... The docs started admitting and or transferring their patients to other facilities and staff was laid off. Because once funding was lost from Medicare/Medicaid, the large private commercial insurancers such as BC BS pulled their funding. So the hospital was not bringing in any money to speak of.

The problems were listed, a bunch of people were fired (upper management) and then later replaced - to assist in the fixing of the things that were the problem areas. This hospital also hired an outside consultant to help them.

A couple of months later a follow up inspection was done and believe it or not this little hospital had fixed the problems and funding was restarted. Now this hospital was lucky in that it was in a good place financially when all this occurred.

One of the other posters stated that this is a very big deal and it is. Most don't come out as well as this one did.

If I were you I'd be looking for another job.

I've included a few links to the articles that covered the story.

http://www.citizen-times.com/apps/pbcs.dll/article?AID=/20080225/NEWS01/80224047

http://www.citizen-times.com/apps/pbcs.dll/article?AID=/20080228/NEWS01/80227130/1009/news01

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