QA Investigation Results

Pennsylvania Department of Health
FRESENIUS MEDICAL CARE - TOWANDA
Health Inspection Results
FRESENIUS MEDICAL CARE - TOWANDA
Health Inspection Results For:


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Initial Comments:


Based on the findings of an onsite unannounced Medicare recertification survey conducted on June 11, 2018 through June 13, 2018, Fresenius Medical Care-Towanda was found to be in compliance with the requirements of 42 CFR, Part 494.62, Subpart B, Conditions for Coverage of Suppliers of End-Stage Renal Disease (ESRD) Services-Emergency Preparedness.




Plan of Correction:




Initial Comments:

Based on the findings of an onsite unannounced Medicare recertification survey conducted on June11, 2018 through June 13, 2018, Fresenius Medical Care-Towanda was identified to have the following standard level deficiency that was determined to be in substantial compliance with the following requirements of 42 CFR, Part 494, Subparts A, B, C, and D, Conditions for Coverage of Suppliers of End-Stage Renal Disease (ESRD) Services.




Plan of Correction:




494.70(a)(5) STANDARD
PR-PARTICIPATE IN CARE;DISC/REFUSE TX

Name - Component - 00
The patient has the right to-

(5) Be informed about and participate, if desired, in all aspects of his or her care, and be informed of the right to refuse treatment, to discontinue treatment, and to refuse to participate in experimental research;



Observations:

Based on patient interview, review of facility documents and employee (EMP) interviews it was determined the governing body failed to ensure patients' right to choose their own primary nephrologist to direct dialysis care in three of four patients (Pt) interviewed. (Pt #5, #6 & #8)

Finding include:

Review of "FMCNA Patient Rights," conducted 6/11/18 at 1:00 PM, states "You have the Right to: Help Make decisions about your care-Be informed about your care, and have opportunity to participate in all aspect of your care, if you wish...Be informed about dialysis treatment options or schedules not provided by this facility. "

Review of facility documents conducted 6/11/18 at 1:00 PM, revealed each patient at the dialysis center had received a letter from the governing body, authored by the Director of Operations, on 5/23/18 or 5/25/18 during dialysis treatment which states "Effective 5/25/18 Dr...(EMP #9), will no longer be the Medical Director to the Towanda facility and Dr... (EMP #8) will be his replacement as Medical Director. In addition, Dr...(EMP #8), will be assuming all care of patients previously seen under Dr...(EMP #9)."

Review of Patient list conducted 6/11/18 at 1:00 PM for the dialysis center, listed 18 current in center hemodialysis pateints. 12 of the 18 patients listed EMP #9, as their primary nephrologist under the heading "Attending Physician" with a line drawn through it and hand written named EMP #8 (Medical Director) as their "Attending Physician."

Interviews conducted 6/13/18 with patients between 2:00 PM -2:30 PM four patients were asked "Were you offered the opportunity to choose a new nephrologist when you found out your Doctor (EMP #9) would no longer be employed as your nephrology provider?" Patient interviews revealed:

Pt #5, stated "was not asked about choosing a new nephrologist, was provided a letter from Fresenius"

Pt #6, stated "was not asked about choosing a new nephrologist"

Pt #8, stated " was not asked about choosing a new nephrologist, was told who my doctor would be"

Interview with the Clinical Manager (EMP #1), conducted at 3:00 PM , 6/13/18 confirmed the above findings.

Interview with the Director of Operations, conducted 6/13/18 at 6:00 PM, confirmed the letter as described above, was provided to the 18 patients of the dialysis center on May 23 or May 25, 2018.








Plan of Correction:

The Governing Body of the Towanda Dialysis Facility acknowledges its responsibility to ensure that all patients receiving hemodialysis at the facility are informed about and participate, if desired, in all aspects of his or her care, including the right to choose their own primary nephrologist to direct their care.
On 7/2/18, the Medical Director, Director of Operations and the Clinical Manager discussed the Department of Health findings and a specific plan of action for the citation as cited in the Statement of Deficiency, with both immediate and long term resolutions.
For immediate compliance, the Clinical Manager and/or Social Worker will meet with all existing patients to discuss the departure of their previous primary care nephrologist and review all options available to them. Patients will be informed of the option to accept the current available nephrologist at the facility as their primary care nephrologist or request to transfer their care to a primary nephrologist of their choice, with the understanding that this nephrologist may require they receive their dialysis treatments at a dialysis facility other than Fresenius.

Patient meetings/discussions will be documented in the patient's medical record.
For future compliance, a patient communication plan has been added to the facility's monthly QAI agenda. The QAI committee will review all future written correspondence, regardless of the author, prior to distributing to the patients. This will ensure that those whose care may be impacted by the change will receive notification of the change in advance and be given the opportunity to make personal choices regarding all aspects of their care.
The QAI Committee is responsible for reviewing and evaluating the Plan of Correction monthly and for scheduling ad hoc committee meetings when necessary to ensure timely communication to the patient.

For ongoing compliance, the Clinical Manager will report the results of the QAI committee's findings at the quarterly Governing Body meetings. The Governing Body will provide continued oversight for sustained compliance.

Minutes of the QAI and Governing Body meetings will be available for review at the facility.