Early 2010 wasn't the last time the flagship hospital of the prestigious Cleveland Clinic Health System was threatened with the ultimate sanction by CMS-backed state inspectors for not addressing problems initially brought to light by patient complaints. In 2012, inspectors threatened to shut off its nearly $1 billion per year in Medicare payments after hospital officials admitted they hadn't fully investigated a complaint that doctors had implanted a heart stent without first getting the patient's consent.
And last July, Ohio hospital inspectors again threatened to suspend Cleveland Clinic's participation in Medicare after hospital officials told a patient they had no evidence that a surgeon neglected to remove a suture needle after surgery. It was only under questioning by a government inspector that a hospital ombudsman later admitted having an X-ray on file showing the left-in needle, according to inspection reports on file with the CMS.
Cleveland Clinic officials did not make any top-ranking officials available to comment on the issues raised by its responses to these and other patient complaints. “Cleveland Clinic sees more than 5 million outpatient visits per year, has nearly 160,000 admissions and the highest acuity of patients in the country (meaning the sickest of the sick),” hospital spokeswoman Eileen Sheil wrote in an e-mail. “We are committed to providing the best care and safest environment for our patients.” Cleveland Clinic officials also say quirks in the state's inspection system lead to a higher number of CMS deficiencies.
A three-month Modern Healthcare analysis of hundreds of pages of federal inspection reports reveals the 1,268-bed hospital spent 19 months on “termination track” with Medicare between 2010 and 2013 as a result of more than a dozen inspections and follow-up visits triggered by patient complaints.
The Cleveland Clinic is far from alone in facing the only sanction the CMS can apply to hospitals when serious safety problems and violations of informed consent rules are brought to light by patient complaints. An analysis of Medicare inspection data found that between 2011 and 2014 there were at least 230 validated serious incidents—dubbed “immediate jeopardy” complaints—that led the agency to threaten hospitals with losing their ability to serve Medicare patients unless they immediately fixed the problems.
Overall, there were at least 9,505 CMS complaints lodged in that time against 1,638 hospitals, which included low-severity “standard level” violations; midlevel “condition level” violations; and the less common but most serious “immediate jeopardy” complaints. Only the most serious and condition-level complaints can lead to threats of being cut off from government funding.
Only in very rarest of circumstances has the CMS followed through on the threat. The CMS' ultimate goal with hospital inspections “is to ensure compliance with Medicare rules, not close down hospitals that are essential to local communities,” a CMS spokeswoman said.