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Rehabilitation Services: Struggling rural hospitals try to cope with deficiencies

By: Brian Brus The Journal Record 08/20/15


OKLAHOMA CITY - Grady Memorial Hospital's challenge to come up with the money to meet the federal government's facility standards is a too-common occurrence for rural health care, Oklahoma Hospital Association Vice President Andy Fosmire said.

Pushmataha Hospital in Antlers and Craig General Hospital in Vinita faced similar problems with Centers for Medicare and Medicaid Services inspections in 2013, which resulted in temporary closures of certain operations, according to the state Department of Health records.

The partial closure of Grady Memorial this week because of an inadequate air unit serving the operating room is potentially damaging enough to the local economy that Chickasha Mayor Hank Ross immediately called for an emergency public meeting to discuss financial rescue efforts. Early estimates by hospital officials are that it will cost at least $150,000 for the equipment, which doesn't address construction, facility disruptions and the loss of revenue from rescheduled surgeries.

The hospital announced the closure of its surgery center following preliminary results of a review by the state Department of Health on behalf of the CMS. That agency, which operates within the U.S. Department of Health and Human Services, administers the Medicare program and works with state governments to administer Medicaid. The CMS typically doesn't shut down hospitals. However, in extreme situations the agency will issue a notice of termination of federal Medicare funding, a death knell for most centers.

According to CMS records, 20 Oklahoma health care centers received notices of termination since the beginning of 2013, although none required a follow-through of the threat because their deficiencies were remedied, agency spokesman Bob Moos said. Some of those cases are still open.

The hospitals on the CMS list range from Integris Southwest Medical Center in Oklahoma City and Norman Regional Health System in Norman to Mercy Hospital in Healdton and Hillcrest Hospital in Claremore. Fosmire said that although all take the CMS threat seriously, rural communities feel the pain a little more acutely.

"Some of these issues that these facilities are facing are their age and ability to adapt to current industry standards," Fosmire said. "It's a huge challenge, really. They're strapped for funds like any facility. They run on a close margin and it costs a lot of money to retrofit facilities that are 40 or 50 or 60 years old."

The Grady County hospital is 58 years old and needs to be rebuilt, CEO and President Kean Spellman said. For lack of funding, however, the hospital will try to upgrade its infrastructure as much as possible with City Hall's help, Spellman said.

"There are some ways for facilities to access funds, but they're not easy," Fosmire said. "Borrowing money on such a thin margin is difficult to do."

Fosmire said he prefers to avoid placing blame and instead look for opportunities and solutions. He said some centers have found funding through programs such as the U.S. Department of Agriculture Rural Development.

The Health Department shut down Craig General Hospital for problems with its oxygen tanks. The hospital filed for Chapter 9 bankruptcy in March, citing a decline in reimbursements. In its court documents, the hospital reported the Health Department's survey required $700,000 in remodeling expenses to reopen and resulted in the loss of $825,000 in revenue.

The Pushmataha hospital, which was cited for rusting storage units and similar problems with oxygen tanks, recovered under new management at the end of 2013. The center's corrections required the reconstruction of two operating rooms.



OR Remediation Update

08/20/15 5:05 p.m.


We have made significant progress today and finalized steps for our doctors and employees to perform surgical services in Duncan using a leased O.R. from their unused facility. Our employees will be able to work at that site. We are addressing other process-related issues to complete this temporary transition.

We need to thank our LifeCare alliance partner hospitals who have been generous in providing subject matter experts and consultation. Integris has been hugely supportive in arranging for us to receive expert knowledge the past two days. Duncan Regional administration and medical staff have bent over backwards to help by opening up their facility for our use. We are still waiting to hear from administrators at Anadarko about a method to assist us. Southern Plains Medical Center has also offered support and ideas on how we can recover from this business interruption issue.

W. Kean Spellman, CEO
Grady Memorial Hospital



Update for Staff and Stakeholders

08/20/15 12:30 p.m.


As you know, we are temporarily closing our operating rooms to make improvements in the surgical area of our 58-year-old facility, following a finding by a CMS survey.

Our physicians are making arrangements as quickly as possible to accommodate our patients' needs in nearby hospitals with the appropriate O.R. equipment. Duncan Regional Hospital has offered our surgeons and staff one entire O.R. for our use with Grady Memorial Hospital staff. We are finalizing these steps to use their gracious help.

It is critical we communicate effectively to our community and patients. As a member of our team, we need your help sharing the following messages.

Grady Memorial Hospital is not closing. We are only making improvements to the central sterile area and hallway, and replacing equipment in the surgical area. The ICU, medical beds and emergency room will remain open 24/7. All of our doctors' offices are still serving patients.
The services affected by this temporary closure will include general and orthopedic surgery, labor and delivery and gastrointestinal endoscopy.
Updates include a larger air conditioning unit, improvements to the ceiling in the hallways, and new equipment in the central sterile room and decontamination room.
Once we receive state approval to proceed, it will be at least 45-60 days before renovations are completed.
Administrators are arranging with hospitals in Anadarko, Duncan and Norman to provide surgical services for Grady Memorial Hospital patients.
Should you receive an inquiry from the media, please contact Kelsey Smith at 405-779-2193.

We want you to be informed about our plans and progress every step of the way. Here is a list of frequently asked questions about the improvements we are making to Grady Memorial Hospital.

Why is this happening?
The Centers for Medicare & Medicaid Services (CMS) survey team recently found an unacceptable increase in temperature and humidity in the central sterile room, necessitating replacement of the air conditioning unit that serves the surgical area. We are also taking this opportunity to make additional changes to the facility's ceiling and equipment to enhance the physical environment of the operating rooms.
Administrators are working closely with CMS to ensure necessary improvements are in place and functioning properly prior to re-opening of the operating rooms, upon state approval.
When does the renovation begin?
We expect the renovation will begin in early September, subject to the state's approval of the projected timeline and scope of work.
When will the operating rooms reopen?
Once renovations are completed, we will have to await a second survey from CMS to receive approval to reopen.
Are any other departments at risk of closing?
The hospital is temporarily closing its operating rooms only. No other services will be affected, including the ICU, medical beds and emergency room, which will remain open 24/7.
Where are we sending patients?
We are working with hospitals in Anadarko, Duncan and Norman to provide surgical services for Grady Memorial Hospital patients, most of whom require non-emergency elective surgeries.
Who should we tell patients to call?
We encourage patients to contact their doctor for guidance on rescheduling if care is imminent. This includes surgical patients and obstetrical patients.

For other questions, contact Kelsey Smith at 405-779-2193 or ksmith@gradymem.org or administration at 405-779-2150.




Grady Memorial Hospital Temporarily Closes Operating Rooms


Chickasha, Okla. (August 19, 2015)


Grady Memorial Hospital has temporarily closed its operating rooms following an inspection by the Centers for Medicare & Medicaid Services (CMS). The CMS recommends making operational improvements to the surgical area in the 58-year-old facility. No other services will be affected, including the ICU, medical beds and emergency room, which will remain open 24/7.

A CMS survey team found increased humidity in one of the hospital's large air conditioning units, necessitating replacement of the unit that serves the surgical area. Hospital officials are taking this opportunity to make additional changes to the facility's ceiling and equipment to enhance the physical environment of its operating rooms.

The services affected by this temporary closure will include general and orthopedic surgery, labor and delivery and gastrointestinal endoscopy. "Providing OB/GYN is a critical service. We want to protect the women in our community with the ability to perform emergency surgeries," said Kean Spellman, chief executive officer of Grady Memorial Hospital.

Hospital administrators are arranging with hospitals in Anadarko, Duncan and Norman to provide surgical services for Grady Memorial patients, most of whom require non-emergency elective surgeries.

Administrators are also working closely with CMS to ensure necessary improvements are in place and functioning properly prior to re-opening of the operating rooms upon state approval.

"We are looking at every possible avenue to save the hospital", said Chickasha Mayor Hank Ross. "The hospital is one of the largest economic drivers in the community. We cannot allow the hospital to fail."

Ross has called a special meeting of the Chickasha City Council Economic Development Council soon. Spellman and Ross said they are working with city, county and federal officials and the Oklahoma State Department of Health to make these improvements as quickly as possible.

"Grady Memorial Hospital remains committed to providing the highest quality and safest healthcare," Spellman adds, "We are dedicated to keeping the community informed and updated on our progress."

For questions, contact Administration at 405-779-2150 or cnichols@gradymem.org.