The Brattleboro Retreat psychiatric hospital signed a two-year quality improvement agreement with the federal government last week, which will allow its continued participation in federal health care programs.
The deal with the Centers for Medicare and Medicaid Services (CMS) requires the Retreat to do “root cause” analysis to determine the source of persistent patient safety issues, and come up with a plan to address them.
The Retreat must also evaluate the “entire programmatic philosophy” or “gestalt” of operations on its Tyler 3 inpatient adolescent unit.
There were at least two suicide attempts on Tyler 3 since May, as well as a near drowning, a sexual assault and a brawl that injured patients and staff.
The hospital must come up with a governance structure to track and monitor short- and long-term changes it’s making to ensure patient safety.
The Retreat will be resurveyed within 120 days of when the agreement was signed on Oct. 31 by state investigators acting on behalf of CMS.
If, during that survey, the Retreat is found to be out of compliance with the CMS conditions for participation in Medicare, as it was during the most recent survey Oct. 1, the hospital’s contract with CMS can be terminated.
“CMS reserves the right to immediate termination if it finds risk of harm or actual harm to patients,” when that survey is conducted.
By entering the agreement with CMS, the Retreat has waived its right to contest a termination, either by judicial or administrative means, according to the agreement document.
The agreement notes that the Retreat may hire an outside consultant to help it make systemic changes that will ensure patient safety and get it back in the good graces of CMS, but that does not appear to be mandatory.
Retreat spokesman Jeff Kelliher said the Retreat will hire a consultant, but it’s too early in the process to say what that might cost or how long it might last. He was unsure what other overhead costs the CMS agreement could generate.
“I think it’s really dependent on how the process goes, our working relationship, and how quickly we’re able to come up with solutions,” Kelliher said. “It’ll be included in our budget for next year, and we will make accommodations for it to ensure we get the best consulting we can.”
The Retreat has annual revenue of $56.8 million and annual expenses of $54.5 million, leaving it with a $2.3 million operating margin, according to its latest publicly available tax filing from 2012.
Regardless of the cost, the Retreat is committed to the agreement, which is an investment in the hospital’s long-term viability, Kelliher said.
The Retreat will also have support from the Department of Mental Health, which sends patients in state custody to the Retreat. DMH Commissioner Paul Dupre has said his quality assurance team will work closely with CMS and Retreat officials to ensure people in state custody receive quality care.
State officials have stressed the Retreat’s importance to the region as the only psychiatric facility in the state that takes children and adolescents, as well as being a major provider of mental health and substance abuse services.
“It would limit access not only to state of Vermont-involved psychiatric patients, but also people who are voluntarily seeking help for child services and drug addiction, many of whom are not Vermonters,” said Jeb Spaulding, secretary of administration, after the negotiations between CMS and the Retreat were announced last month.
If the Retreat lost its certification it would cost Vermont millions, because the state would not be able to use Medicaid money to support its $8 million contract with the hospital to house patients in state custody.
