South Dakota hospital to lose Medicare contract: 4 things to know

CMS notified Pine Ridge (S.D.) Indian Health Service Hospital Nov. 3 that it had placed the hospital on "immediate jeopardy" status and will terminate the hospital's provider agreement Nov. 18.

Here are four things to know about CMS' findings.

1. CMS recently surveyed Pine Ridge IHS Hospital and found the hospital inaccurately determined the severity of a patient's condition on Oct. 16. Although the patient was transferred to another hospital several hours after being admitted to Pine Ridge, the inaccurate assessment allegedly led to delays in appropriate emergency care and the patient's death on Oct. 17.

2. In a letter to CMS sent Monday, Michael Toedt, MD, CMO of IHS, said it is impossible to know if the patient's death was due to care he received at Pine Ridge. "Many factors could contribute to the patient's outcome, including comorbidities and care in another facility, and it is not possible to draw a direct conclusion from the care received at Pine Ridge Hospital to the patient's ultimate outcome," he said. 

3. CMS said Friday that Pine Ridge's participation in the federal Medicare program will end Nov. 18. Termination means the hospital can no longer bill Medicare for services, which would impact Medicaid funding as well. CMS also placed the hospital on "immediate jeopardy" status, which is the term used when a hospital's actions have caused or are likely to cause serious injury or death to a patient.

4. Pine Ridge Hospital was also placed on "immediate jeopardy" status last year, but the status was lifted in January.

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