Hospital in Wilson may lose Medicare funding after inspectors find serious problems

A 300-bed hospital in eastern North Carolina is in danger of losing its Medicare funding in two weeks, a move prompted by serious problems state health officials discovered at the facility earlier this year.

In a letter from the Centers for Medicare and Medicaid Services on June 24, federal regulators warned Wilson Medical Center that Medicare payments to the hospital would be terminated on July 17 without “specific corrective measures,” a rare regulatory threat that carries dire implications for the hospital’s financial future.

Responding to a complaint against the hospital, regulators on-site at the facility in May found serious deficiencies that included an “immediate jeopardy” designation. A finding of immediate jeopardy, according to CMS, means a hospital has “placed the health and safety of recipients in its care at risk for serious injury, serious harm, serious impairment or death.”

The letter, obtained this week by The News & Observer through a public records request, notes Wilson Medical Center violated four federal health regulations required to participate in the Medicare program. Among them, rules governing patient rights, quality assessment and nursing services.

The hospital had until Wednesday to submit evidence that it fixed the problems, the letter said, which would trigger a follow-up survey of the facility by state regulators.

“Please by advised, however, that failure to remove conditions that constituted immediate jeopardy will result in your hospital’s termination under Medicare,” the letter read.

Hospital says issues should be ‘resolved quickly’

So far at least, the hospital has been tight-lipped on the matter.

“The survey identified a few processes that required corrective action, and we have been working collaboratively with the state and CMS over the past few weeks to develop a plan that addresses the issues identified,” Wilson Medical Center spokesperson Melanie Raynor said in an email Friday. “This plan has been submitted already, and we expect the matter to be resolved quickly with our CMS contract to remain intact.”

Raynor did not respond to follow-up questions or a request for an interview with hospital CEO Mark Holyoak.

The hospital is part of Duke LifePoint, a joint venture between LifePoint Health, based in Tennessee, and Duke Health, which “collaborates with health systems and medical centers throughout the country,” Duke spokesperson Sarah Avery said in a statement Friday.

Avery said that while LifePoint manages day-to-day operations, Duke “shares consultative expertise with Wilson Medical Center on best practices for patient safety and quality.”

She did not address the specifics of the CMS letter, and she referred additional inquires to the hospital.

Under the terms of the joint venture’s purchase in 2014, 20% of the hospital is owned by the Healthcare Foundation of Wilson, a community-based nonprofit whose board members include local elected leaders and medical professionals. Board Chair Chris Hill, who also serves on the Wilson County Board of Commissioners, did not respond to a phone call Friday seeking comment.

Neither federal officials at CMS, nor a spokesperson for the N.C. Department of Health and Human Services, which conducted an investigation of the hospital on behalf of CMS, responded to requests for comment Friday.

Details of problems in short supply

Located in a town of about 50,000 people about an hour east of Raleigh, Wilson Medical Center is licensed for 294 beds. It’s the only hospital in Wilson County, and the closest hospitals are about 30 miles away.

The facility has a one-star rating on Medicare’s quality rating site — one of only three one-star hospitals in North Carolina out of the 91 rated by CMS.

The exact details of the problems cited in the CMS letter to the hospital are so far unclear.

The letter referenced an attachment outlining the deficiencies cited during the survey regulators conducted at the facility in May. But officials with N.C. DHHS omitted that list when they provided the letter in response to a records request — and they have not responded to a subsequent request for the document from the N&O.

What the letter does note — a finding of “immediate jeopardy” — is both serious and relatively uncommon.

A 2021 study in the Journal of Patient Safety found that out of more than 30,000 deficiencies CMS identified at facilities across the country from 2007 to 2017, less than 3% were classified as immediate jeopardy.

It’s the most significant type of deficiency and carries the most severe sanctions, CMS guidelines say.

Other North Carolina hospitals have faced immediate jeopardy findings, most recently Cape Fear Valley Medical Center, which according to CMS data corrected a number of patient safety issues following a complaint investigation in late February.