• staffing patterns suggesting that the staff could not support 24/7
inpatient care (for example, many fewer staff members on nights and
weekends); and
• how the facility advertises itself to the community, including
advertising as a "specialty," "emergency" or "surgical" hospital, and
whether the name of the facility includes terms like "clinic" or "cen-
ter," as opposed to "hospital."
Numbers don't lie
For Blue Valley, CMS surveyors found that the hospital had never had
an ADC of 2 or above during any 12-month period since opening, and
during the prior 12 months:
• had an ADC of 0.48 and an ALOS of 1.2;
• discharged "nearly every patient" before the weekend;
• performed twice as many outpatient procedures as inpatient pro-
cedures; and
• frequently did not perform any inpatient procedures for several
days, at one point performing no inpatient procedures for a 22-day
stretch.
On Feb. 2, 2018, CMS informed Blue Valley that its Medicare
provider agreement would be terminated, barring significant
changes to address the deficiencies. Blue Valley responded with a
lengthy letter and plan of correction, arguing that the ADC and
ALOS criteria were only 2 factors that a surveyor must consider
when determining whether a facility was a hospital. The facility
highlighted its excellent patient care, recent build-out of inpatient
bed space and community outreach efforts to increase inpatient
admissions. Furthermore, it detailed ongoing hiring and staffing
changes, expansion of inpatient services, targeting of new patient
populations, and marked increases of 3-month ADC and ALOS (to
Legal Update
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