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Photo: Phil Skinner
Photo: Phil Skinner

Threat of sanction on Atlanta home health agency lifted

Thousands of Georgia patients struggling with debilitating medical problems depend on Visiting Nurse Health System to provide care for them in their own homes. But the nonprofit organization had been threatened this month with a cutoff in federal funding after inspections found issues said to potentially jeopardize some patients’ health and safety.

In sampling cases of six of Visiting Nurse’s 6,000 patients, inspectors found that required care was apparently not provided in four cases. In one of those, involving a patient with a pressure ulcer, a nurse was to provide wound care twice a week but records didn’t show the care was provided one week in a two-month period.

Other issues involved incomplete records. And in one case, inspectors found a record was wrong: A physical therapist’s note described the patient as a woman who was paralyzed and needed a lift for transfers. The patient was a man who was not paralyzed.

On Tuesday, though, inspectors lifted all potential sanctions, said Dabney Hollis, the organization’s vice president for communications. She also said that the deficiencies inspectors had noted were largely related to the nonprofit’s switch to a new electronic medical record system, not to quality issues.

“The state came the week we implemented the new system, with a big learning curve for staff,” Hollis said.

“The bottom line was sloppy documentation — no one was put in harm’s way,” she said.

Nurses and other care providers were not entering information correctly in the new system, she said. That was the situation with the patient wrongly described as a paralyzed woman. “That person got appropriate care,” Hollis said.

In the case of the patient needing wound care, she said, if the care actually wasn’t provided, a nurse may have failed to note why. Sometimes, Hollis said, a patient isn’t home for an appointment or has another complication. “Our nurses walk into a different situation every single day,” she said.

The new system, Hollis said, will now quickly catch quality of care issues and flag patterns that may point to concerns. “Everybody is held accountable. Everybody has to document in a timely manner,” she said.

The new system also will enable Visiting Nurse, the state’s largest nonprofit provider of home health care and hospice services, to collect proper reimbursement because it requires a much more detailed level of documentation. That could boost funding for the nonprofit, which reported net losses in 2015 and 2016, according to tax returns.

Health care reimbursement is based on detailed records of services provided, and with the older system, records were not always complete, she said.

“We have had to write off millions because of the documentation,” Hollis said.

She also noted that as a nonprofit, Visiting Nurse provides uncompensated charitable care and care to others regardless of their ability to pay.

Inspectors first reviewed services and interviewed agency staff in January, then did a follow-up visit in early March, finding a repeat of some violations, according to records obtained by The Atlanta Journal-Constitution. “The cumulative effect of these systemic problems resulted in the agency’s inability to ensure the provision of quality health care,” the inspection report said.

In late March, the federal Centers for Medicare and Medicaid Services posted a notice of involuntary termination. It said that Medicare and Medicaid funding would be cut off April 11, unless another inspection showed the agency met federal health and safety standards.

The deadline for re-inspection was changed when CMS could not schedule the visit before the 11th, Hollis said.

“Throughout this time we were always licensed by the state of Georgia, certified by Medicare, and accredited by JACHO (the Joint Commission),” Norene Mostkoff, CEO of Visiting Nurse, said in a written statement.

All technology and documentation issues have been resolved, she said.

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