Broughton seeks to win back funding

Reviews are next step to regain ability to bill Medicare, Medicaid

Tuesday, Feb. 26, 2008

By Marcie Young
Charlotte Observer Staff Writer

Officials at Broughton Hospital, one of the state's four mental health facilities, said Monday they are ready for inspectors to return and reinstate federal funding.

Broughton has gone without Medicaid and Medicare funding since August, when the federal government decided to halt payments amid concerns over a patient death and another patient injury.

The state responded to the cuts - about $1 million a month - by sending a team of doctors and administrators to the Morganton facility to identify and fix problems, reorganize clinical staff and retrain every employee, from housekeepers to doctors.

Now, Broughton officials are asking that the federal government review the hospital's progress and allow it to bill Medicare and Medicaid, said Director Art Robarge. About 98 percent of the hospital's annual, third-party insurance revenue comes from such funding.

Since August, a team of state doctors and consultants has been working at Broughton to correct problems and improve care. They've focused, Robarge said, on finding ways to reduce the physical restriction of patients, revamping policies about patient falls and infection control, and reorganizing staff to ensure better clinical supervision.

"We've gone back to the drawing board, read the standards and (drawn) out a plan to make sure it's appropriate for Broughton Hospital," he said. "(We want to make sure) that what folks are doing here is in compliance with those standards."

Broughton has also been recovering from a series of hits since August, including threats that it could lose its accreditation and a shake-up in leadership when Seth Hunt was dismissed as director and Robarge, who led the hospital from 1986 to 1989, took over.

Robarge said he sent a letter Friday to the Centers for Medicare and Medicaid Services, part of the U.S. Department of Health and Human Services, asking that inspectors visit the hospital soon and assess changes the hospital has made.

If everything goes as anticipated, Robarge said, inspectors should make their initial visit to the hospital within two to four weeks. On the first visit, Robarge said, inspectors will evaluate how staff members handle aggressive patients and how they keep those situations from escalating.

The February 2007 death of 27-year-old Anthony Lowery, who died of cardiac arrhythmia after a staff member sat on his torso while trying to restrain him, was one of two incidents that led the federal government to stop Medicaid and Medicare payments.

Situations where staff members have had to physically restrain patients, Robarge said, have dropped 40 percent to 60 percent since last year.

"There has been a tremendous effort to become creative at all levels and use restrictive methods only when absolutely necessary," he said.

If Broughton passes the first inspection, which Robarge said is likely, inspectors will come back to the hospital again within 30 days to make sure it is meeting other standards set by the federal government.

Even if Broughton meets all the federal government's standards during the initial and follow-up inspections, Robarge said it will still take at least an additional 45 to 75 days before Medicaid and Medicare funding is reinstated.

Broughton serves about 4,000 patients each year from the state's 37 westernmost counties and has about 1,200 employees and a $77 million budget.

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