Novant NHRMC’s contract with Medicare threatened over numerous deficiencies

WILMINGTON, NC (WWAY) — Allegations made against Novant NHRMC put the hospital’s contract with Medicare in jeopardy, after state regulators identified numerous deficiencies that could potentially affect the healthy and safety of patients.

The Department of Health & Human Services Centers for Medicare & Medicaid Services sent a letter to Novant Health NHRMC CEO Shelbourn Stevens notifying him of the findings of a visit on June 29 that determined ‘immediate jeopardy’ was identified during that visit.

Accredited hospitals must meet all of the Medicare Conditions of Participations for hospitals.

The visit determined NHRMC does not meet the following five Conditions of Participation in the Medicare Program.

• Governing Body: There must be an effective governing body that is legally responsible for the conduct of the hospital, if a hospital does not have an organized governing body, the persons legally responsible for the conduct of the hospital must carry out the functions specified in this part that pertain to the governing body.
• Patient Rights: A hospital must protect and promote each patient’s rights.
• Quality Assessment and Performance Improvement: The hospital must develop, implement, and maintain an effective, ongoing, hospitalwide, data-driven quality assessment and performance improvement program. The hospital’s governing body must ensure that the program reflects the complexity of the hospital’s organization and services; involves all hospital departments and services (including those services furnished under contract or arrangement); and focuses on indicators related to improved health outcomes and the prevention and reduction of medical errors.
• Nursing Services: The hospital must have an organized nursing service that provides 24-hour nursing services. The nursing services must be furnished or supervised by a registered nurse.
• Emergency Services: The hospital must meet the emergency needs of patients in accordance with acceptable standards of practice. Time is critical in the provision of emergency care. The hospital must be able to demonstrate how the hospital’s other departments provide emergency patients the care and services needed within safe and appropriate times.

“When a hospital is found to be out of compliance with one or more Conditions of Participation, and immediate or serious threat to patient health and safety exists, a determination must be made that the facility o longer meets the requirements for participation as a provider of services  in the Medicare program. If the hospital is found to have significant deficiencies and therefore fails to comply with the Conditions of Participation, we are required to keep the hospital under State Agency monitoring until there is full compliance with all of the Medicare Conditions of Participation, ” the letter states in part.

The letter states that the Medicare provider agreement between Novant Health NHRMC and the Department of Health and Human Services is being terminated, effective August 12, 2022.

“The Medicare program will not make payment for inpatient hospital services furnished to patients who are admitted on or after August 12, 2022. For patients admitted prior to August 12, 2022, payment may continue to be made for a maximum of 30 days for inpatient hospital services furnished on or after August 12, 2022,” the letter advised.

The letter tells NHRMC that termination can only be averted by correcting these deficiencies by August 12. The hospital was also given a date of July 25 to notify CMS and the NC State Survey Agency in writing describing in detail the specific corrective measures taken to resolve these problems.

Chief Clinical Officer Dr. West Paul for Novant Health’s Coastal Region says the hospital was aware of these issues before the visit from the state and action plans were already in place to address them.

“A lot of it had to do with how we did operate, our processes, and how we are educating our staff and retraining our staff in the appropriate way to manage our patients,” Paul told WWAY. “A lot of that has to do with resources that aren’t there.”

During a follow up visit on August 11, Chief Nurse Executive Amy Akers says the state told them their corrective actions were sufficient and the hospital is expecting written confirmation in the coming days. According to Shelbourn Stevens, president of Novant Health New Hanover Regional Medical Center and Novant Health’s Coastal region, this is something NHRMC anticipated.

“We knew that we had made the necessary changes to meet the deficiencies that they gave us, so we were very confident,” Stevens said.

Since the sale of the hospital, many employees have complained to WWAY that conditions have worsened. So, WWAY asked Akers if she believed selling the hospital to Novant exacerbated the staffing issues.

“Without the funding, you know as we begin to talk about the need to fill that nursing gap, we need to do so with travel nurses. Right now we are filling that gap with travel nurses. We would not be in the same place we are right now. We would not have the staff that we do had we not become a part of Novant Health,” Akers said.

The nursing shortage is not new nor unique to New Hanover, according to Akers. In the last several weeks, they’ve hired 50 to 100 new nursing staff — a majority of which are travel nurses. Akers says they are working to create incentives to keep more permanent staff.

“We are looking at and continuously looking at retention methods. Whether that be from a compensation perspective or incentive perspective or growth opportunity perspective,” she said.

Dr. Paul says there hasn’t been a lapse in care, but there has been a delay for non-urgent procedures as a result of the staffing shortages. The additional staff has helped reduce these delays, lower ER wait times, and cut the amount of beds closed due to staffing shortages in half.

The hospital is licensed to operate at a full capacity of 800 beds. Of those 800 beds, around 150 were closed at the peak of the shortages.

In addition to the 50 to 100 new hires, the hospital is training 120 new-grad nurses right now and they’re expected to start working in October. According to Akers, this is an unusually large class of new-grads.

Even with the hundreds of new employees, the hospital is still understaffed by about 100 nurses.