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Public Statements

Letter To Mr. Robert A. Ortenzio, Chief Executive Officer, Select Medical Corporation And The Honorable Gene L. Dodaro, Acting Comptroller General Of The United States, Government Accountability Office

Letter

By:
Date:
Location: Washington, DC

Senators Chuck Grassley and Max Baucus are asking for information about patient safety and quality of care in long-term care hospitals, in response to allegations reported last month by The New York Times.

Baucus is Chairman and Grassley is Ranking Member of the Senate Committee on Finance, which is responsible for Medicare legislation and oversight.

"Medicare beneficiaries and taxpayers deserve more information when questions are raised about safety and quality. If allegations are proven true, then there ought to be accountability," Grassley said.

"These reports of practices at Select Medical hospitals are alarming. Medicare patients deserve the safest and highest quality care in all facilities. Patient care should be determined by what's best for the patient, not what's best for a hospital's bottom line," said Baucus.

The senators sent letters to the Government Accountability Office, which is the independent investigative arm of Congress, and Select Medical Corporation. The text of those letters from Baucus and Grassley is below, along with the February 10 news story that prompted the inquiry.

March 8, 2010

The Honorable Gene L. Dodaro
Acting Comptroller General of the United States
Government Accountability Office
441 G Street, NW
Washington, DC 20548

Dear Mr. Dodaro:

We are writing regarding the February 10, 2010, New York Times article entitled "Long-Term Care Hospitals Face Little Scrutiny" in which Select Medical Corporation (Select Medical) is discussed. A copy of the article is enclosed. This article describes a number of disturbing incidents reported to have occurred in Select Medical long-term care hospitals (LTCHs) that allegedly resulted in patient deaths and contains a host of other allegations about Select Medical including, but not limited to:

*Unusually high rates of violations of Medicare requirements;
*Poor health care quality;
*Inadequate staffing in terms of the type and number of practitioners;
*High staff turnover rates; and
*Inadequate patient monitoring.

We find these allegations to be of great concern, especially if they are systemic in facilities operated by Select Medical or in the LTCH industry as a whole, as the article suggests. If these allegations are true, then Medicare beneficiaries who receive services at LTCHs are being exposed to an unreasonable risk of harm.

We therefore request that the General Accountability Office (GAO) review various issues related to oversight of LTCHs. Specifically, we would appreciate GAO's examination of the level and type of oversight that is conducted related to patient care provided at LTCHs relative to other facilities and long-term care settings, including hospitals and skilled nursing facilities. As part of this, we would request information on what types of quality and patient safety information the Centers for Medicare & Medicaid Services (CMS) collect regarding LTCHs.

Finally, we request an examination of the coordination between CMS, state survey and certification agencies, and private accrediting entities to ensure that LTCHs are providing quality care to Medicare beneficiaries.

Thank you in advance for your attention to this important matter.

Sincerely,

Max Baucus
United States Senator
Chairman of the Committee on Finance

Chuck Grassley
United States Senator
Ranking Member of the Committee on Finance

***

March 8, 2010

Robert A. Ortenzio
Chief Executive Officer
Select Medical Corporation
4718 Old Gettysburg Road
P.O. Box 2034
Mechanicsburg, PA 17055

Dear Mr. Ortenzio:

The United States Senate Committee on Finance (Committee) has exclusive jurisdiction over the Medicare program in the Senate. Accordingly, as the Chairman and Ranking Member of the Committee, we have a responsibility to the more than 45 million Americans who receive health care under the program to ensure that program dollars are spent appropriately and to monitor whether safe and appropriate care is provided to beneficiaries. This responsibility includes conducting oversight of services and care provided by institutions that participate in the Medicare program, including long term care hospitals (LTCHs).

We are writing regarding the February 10, 2010, New York Times article entitled "Long-Term Care Hospitals Face Little Scrutiny" in which Select Medical Corporation (Select Medical) is discussed. A copy of the article is enclosed. This article describes a number of disturbing incidents reported to have occurred in Select Medical LTCHs that allegedly resulted in patient deaths and contains a host of other allegations about Select Medical including, but not limited to:

*Unusually high rates of violations of Medicare requirements;
*Poor health care quality;
*Inadequate staffing in terms of the type and number of practitioners;
*High staff turnover rates; and
*Inadequate patient monitoring.

The article also suggests that Select Medical has a corporate culture of putting profits before patients.

We find these allegations to be of great concern, especially if they are systemic in facilities operated by Select Medical or in the LTCH industry as a whole, as the article suggests. If these allegations are true, then Medicare beneficiaries who receive services at LTCHs are being exposed to an unreasonable risk of harm.

Accordingly, in an effort to obtain more information about the issues presented in the New York Times article, we ask that you respond to the following questions and requests for documents by no later than March 22, 2010. In responding, please repeat the question followed by the appropriate response.

1.How many LTCHs does Select Medical own or operate? Please provide a list of the names and locations (city and state) of these LTCHs. Of these LTCHs:

a.Which LTCHs are freestanding?

b.Which LTCHs are located in another facility?

2.Does Select Medical have physicians on staff at its LTCHs? If so, please respond to the following:

a.What is the average number of physicians on staff in a Select Medical LTCH as well as the range?

b.What percentage of the average number of total staff in a Select Medical LTCH does the average number of physicians represent, and what is the range?

c.What specialties are represented among physicians on staff?

d.What percentage of physicians on staff are Select Medical employees and what percentage of physicians are on staff by contractual arrangement?

e.What is the average number of hours that physicians on staff spend at Select Medical LTCHs, and what is the range?

f.Do any of your responses to question 2a-2d differ by type of LTCH (freestanding or hospital-within-hospital) or other facility characteristic?

3.Does Select Medical have physicians on staff in its LTCHs on a 24 hour, seven days per week basis?

If so, please respond to the following:

a.What percentage of Select Medical LTCHs have physicians on staff on LTCH premises on a 24/7 basis?

b.Does this percentage differ between freestanding or hospital-within-hospital LTCHs?

If not, please respond to the following:

c.What is done to ensure physician coverage on a 24/7 basis? Please provide copies of all corporate policies and protocols concerning 24/7 physician coverage and identify all changes made to these policies and protocols since 2004.

4.The New York Times identified 22 reports from Medicare inspectors citing "condition level" violations at Select Medical LTCHs. Please provide all documents and communications regarding "condition level" violations identified by Medicare at Select Medical LTCHs from 2007 to the present.

5.Provide copies of corporate policies, protocols, and directives regarding the discharge of patients and patient length of stay at Select Medical LTCHs from 2004 to the present. Please also include information on average length of stay and range for patients in Select Medical LTCHs.

6.Are physicians on staff involved in the administration and/or management of Select Medical and/or its individual LTCHs? If so, please respond to the following:

a.Describe the extent of physician involvement in hospital-level committees that have responsibility for:

1)Oversight/governance;

2)Quality assurance;

3)Quality improvement;

4)Compliance;

5)Patient safety; and

6)Practice standards.

b.Describe the extent to which physicians are medical directors in Select Medical LTCHs. Please include the following:

1)The percentage of medical directors that are employees of Select Medical and the percentage that serve as medical directors on a contractual basis;

2)The average number of hours that medical directors spend at Select Medical LTCHs as well as the range.

c.Describe the extent to which physicians hold corporate executive/leadership positions at Select Medical, and identify the positions.

d.Describe the extent to which physicians hold corporate-level positions such as "chief medical officer" or corporate-level positions concerning quality assurance, quality improvement, compliance, patient safety or practice standards.

e.Describe the extent of physician involvement in corporate-level committees that have responsibility for:

1)Oversight/governance;

2)Quality assurance;

3)Quality improvement;

4)Compliance;

5)Patient safety; and

6)Practice standards.

7.Does Select Medical have corporate-wide policies and protocols to address emergency situations in LTCHs? If so, please respond to the following:

a.Provide copies of all policies and protocols to address emergency situations in Select Medical LTCHs and also provide previous versions since 2004.

b.Identify what capabilities that Select Medical LTCHs are required to have to address emergency situations including:

1)Equipment;

2)Staffing;

3)Staff training and certifications.

c.Please indicate how long the requirements identified in question 5b have been in effect and identify any changes made since 2004.

d.Please indicate if your responses to questions 5a, 5b or 5c differ by type of LTCH (freestanding or hospital-within-hospital) or other facility characteristic.

8.Does Select Medical have corporate-wide policies and protocols on or related to patient monitoring? If so, please respond to the following:

a.Provide copies of all policies and protocols on patient monitoring in Select Medical LTCHs and also provide previous versions since 2004.

b.Identify what capabilities that Select Medical LTCHs are required to have to monitor patients including:

1)Equipment;

2)Staffing;

3)Staff training and certifications.

c.Please indicate how long the requirements identified in question 6b have been in effect and identify any changes made since 2004.

d.Please indicate if your responses to questions 6a, 6b or 6c differ by type of LTCH (freestanding or hospital-within-hospital) or other facility characteristic.

9.Does Select Medical have corporate-wide staffing requirements for LTCHs? If so, please respond to the following:

a.What types of direct care providers are required to staff Select Medical LTCHs?

b.What is the average number of direct care providers, by category and in total, in Select Medical LTCHs and what are the ranges, by category and in total?

c.What is the average staff-to-patient ratio in Select Medical LTCHs, by direct care provider category and in total, as well as the range by category and in total? Please also provide a staffing ratio broken down over a 24-hour period.

d.What is the average staff turnover ratio in Select Medical LTCHs, by direct care provider category and in total, as well as the range by category and in total?

e.Please identify any changes made to Select Medical's corporate-wide staffing requirements for LTCHs since 2004.

10. Please identify each federal and state agency or private accrediting body that has inspected/surveyed Select Medical LTCHs during each year since 2004. For each agency or private accrediting body, please indicate:

a.The number of inspections/surveys each year;

b.The outcome of each inspection/survey and the identity of the LTCH inspected/surveyed;

c.If any deficiencies were discovered, what was the disposition of such findings; and

d.If any citations/penalties were issued, when, and what follow-up, if any, ensued.

In cooperating with the Committee's review, no documents, records, data or information related to these matters shall be destroyed, modified, removed or otherwise made inaccessible to the Committee.

Thank you for your attention to this important matter.

Sincerely,

Max Baucus
United States Senator
Chairman of the Committee on Finance

Chuck Grassley
United States Senator
Ranking Member of the Committee on Finance


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