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					                                                                                                                                       PRINTED: 09/12/2012
  DEPARTMENT OF HEALTH AND HUMAN SERVICES                                                                                                FORM APPROVED
  CENTERS FOR MEDICARE & MEDICAID SERVICES                                                                                            OMB NO. 0938-0391
 STATEMENT OF DEFICIENCIES             (X1) PROVIDER/SUPPLIER/CLIA               (X2) MULTIPLE CONSTRUCTION                           (X3) DATE SURVEY
 AND PLAN OF CORRECTION                     IDENTIFICATION NUMBER:                                                                        COMPLETED
                                                                                 A. BUILDING         ______________________
                                                                                                                                                 C
                                                                                 B. WING _____________________________
                                                      240080                                                                                 05/29/2012
 NAME OF PROVIDER OR SUPPLIER                                                           STREET ADDRESS, CITY, STATE, ZIP CODE
                                                                                           2450 RIVERSIDE AVENUE
  UNIVERSITY OF MINNESOTA MEDICAL CENTER, FAIRVIEW
                                                                                           MINNEAPOLIS, MN 55454
   (X4) ID            SUMMARY STATEMENT OF DEFICIENCIES                            ID                  PROVIDER'S PLAN OF CORRECTION                     (X5)
   PREFIX          (EACH DEFICIENCY MUST BE PRECEDED BY FULL                     PREFIX              (EACH CORRECTIVE ACTION SHOULD BE               COMPLETION
                  REGULATORY OR LSC IDENTIFYING INFORMATION)                      TAG               CROSS-REFERENCED TO THE APPROPRIATE                 DATE
    TAG
                                                                                                                DEFICIENCY)



    A 000 INITIAL COMMENTS                                                         A 000

           A survey was conducted to investigate an
          alleged violation of Section 1867 of the Social
          Security Act, with respect to Emergency Medical
          Treatment and Labor Act (EMTALA), and in
          conjunction with complaint #H0080066.The
          following deficiencies are issued:
    A2400 489.20(l) COMPLIANCE WITH 489.24                                        A2400

              [The provider agrees,] in the case of a hospital as
              defined in §489.24(b), to comply with §489.24.

          This STANDARD is not met as evidenced by:
           Based on interview and document review, the
          hospital failed to ensure compliance with
          requirements of 42 CFR 489.24, as evidenced by
          the deficient practice cited at 42 CFR489.24 (d)
          (4-5).
    A2402 489.20(q) POSTING OF SIGNS                                              A2402

              [The provider agrees,] in the case of a hospital as
              defined in §489.24(b), to post conspicuously in
              any emergency department or in a place or
              places likely to be noticed by all individuals
              entering the emergency department, as well as
              those individuals waiting for examination and
              treatment in areas other than traditional
              emergency departments (that is, entrance,
              admitting area, waiting room, treatment area) a
              sign (in a form specified by the Secretary)
              specifying the rights of individuals under section
              1867 of the Act with respect to examination and
              treatment for emergency medical conditions and
              women in labor; and to post conspicuously (in a
              form specified by the Secretary) information
              indicating whether or not the hospital or rural
              primary care hospital (e.g., critical access
              hospital) participates in the Medicaid program
LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE                                          TITLE                               (X6) DATE




Any deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that
other safeguards provide sufficient protection to the patients. (See instructions.) Except for nursing homes, the findings stated above are disclosable 90 days
following the date of survey whether or not a plan of correction is provided. For nursing homes, the above findings and plans of correction are disclosable 14
days following the date these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued
program participation.

FORM CMS-2567(02-99) Previous Versions Obsolete               Event ID: F4GY11            Facility ID: 00200                   If continuation sheet Page 1 of 13
                                                                                                                                  PRINTED: 09/12/2012
  DEPARTMENT OF HEALTH AND HUMAN SERVICES                                                                                           FORM APPROVED
  CENTERS FOR MEDICARE & MEDICAID SERVICES                                                                                       OMB NO. 0938-0391
 STATEMENT OF DEFICIENCIES             (X1) PROVIDER/SUPPLIER/CLIA           (X2) MULTIPLE CONSTRUCTION                          (X3) DATE SURVEY
 AND PLAN OF CORRECTION                     IDENTIFICATION NUMBER:                                                                   COMPLETED
                                                                             A. BUILDING         ______________________
                                                                                                                                           C
                                                                             B. WING _____________________________
                                                    240080                                                                             05/29/2012
 NAME OF PROVIDER OR SUPPLIER                                                      STREET ADDRESS, CITY, STATE, ZIP CODE
                                                                                       2450 RIVERSIDE AVENUE
  UNIVERSITY OF MINNESOTA MEDICAL CENTER, FAIRVIEW
                                                                                       MINNEAPOLIS, MN 55454
   (X4) ID            SUMMARY STATEMENT OF DEFICIENCIES                        ID                  PROVIDER'S PLAN OF CORRECTION                   (X5)
   PREFIX          (EACH DEFICIENCY MUST BE PRECEDED BY FULL                 PREFIX              (EACH CORRECTIVE ACTION SHOULD BE             COMPLETION
                  REGULATORY OR LSC IDENTIFYING INFORMATION)                  TAG               CROSS-REFERENCED TO THE APPROPRIATE               DATE
    TAG
                                                                                                            DEFICIENCY)



    A2402 Continued From page 1                                               A2402
          under a State plan approved under Title XIX.

              This STANDARD is not met as evidenced by:
               Based on observation, the hospital failed to post
              EMTALA signs in a location that was easily
              noticeable by persons entering the emergency
              department and persons waiting for examination
              and treatment. Findings include:

          Observations on 05/04/12 at 10:55 a.m. revealed
          that the pediatric portion of the hospital had
          posted the EMTALA signage in a corridor leading
          to the examination and treatment area of the
          childrens' ED, which was at a 90-degree angle
          from the emergency department waiting room
          and approximately fourteen feet from the Security
          check-in point for patients entering the
          emergency department. The corridor where the
          EMTALA signage was posted was in the opposite
          direction from where patients were directed to
          wait for examination and treatment, and was not
          visible from the emergency department waiting
          room. The EMTALA signage was visible only to
          those individuals who walked towards the
          examination and treatment area, which was
          around the corner from the emergency
          department waiting room.
    A2405 489.20(r)(3) EMERGENCY ROOM LOG                                     A2405

              [The provider agrees,] in the case of a hospital as
              defined in §489.24(b) (including both the
              transferring and receiving hospitals), to maintain a
              central log on each individual who comes to the
              emergency department, as defined in §489.24(b),
              seeking assistance and whether he or she
              refused treatment, was refused treatment, or
              whether he or she was transferred, admitted and
              treated, stabilized and transferred, or discharged.

FORM CMS-2567(02-99) Previous Versions Obsolete           Event ID: F4GY11            Facility ID: 00200                  If continuation sheet Page 2 of 13
                                                                                                                                  PRINTED: 09/12/2012
  DEPARTMENT OF HEALTH AND HUMAN SERVICES                                                                                           FORM APPROVED
  CENTERS FOR MEDICARE & MEDICAID SERVICES                                                                                       OMB NO. 0938-0391
 STATEMENT OF DEFICIENCIES             (X1) PROVIDER/SUPPLIER/CLIA           (X2) MULTIPLE CONSTRUCTION                          (X3) DATE SURVEY
 AND PLAN OF CORRECTION                     IDENTIFICATION NUMBER:                                                                   COMPLETED
                                                                             A. BUILDING         ______________________
                                                                                                                                           C
                                                                             B. WING _____________________________
                                                    240080                                                                             05/29/2012
 NAME OF PROVIDER OR SUPPLIER                                                      STREET ADDRESS, CITY, STATE, ZIP CODE
                                                                                       2450 RIVERSIDE AVENUE
  UNIVERSITY OF MINNESOTA MEDICAL CENTER, FAIRVIEW
                                                                                       MINNEAPOLIS, MN 55454
   (X4) ID            SUMMARY STATEMENT OF DEFICIENCIES                        ID                  PROVIDER'S PLAN OF CORRECTION                   (X5)
   PREFIX          (EACH DEFICIENCY MUST BE PRECEDED BY FULL                 PREFIX              (EACH CORRECTIVE ACTION SHOULD BE             COMPLETION
                  REGULATORY OR LSC IDENTIFYING INFORMATION)                  TAG               CROSS-REFERENCED TO THE APPROPRIATE               DATE
    TAG
                                                                                                            DEFICIENCY)



    A2405 Continued From page 2                                               A2405

              §489.24 The provisions of this regulation apply to
              all hospitals that participate in Medicare and
              provide emergency services.

              This STANDARD is not met as evidenced by:
               Based on documentation, the hospital failed to
              maintain a central log in the emergency
              department (ED) that accurately tracked the care
              and disposition of each patient in 6 of 39 patients
              reviewed (Patients #6, #7, #8, #9, #11, and #12).
              Findings include:

              The medical record of Patient #6 indicated that
              she presented to the ED on 03/30/11 at 11:11
              a.m. for evaluation of right lower quadrant pain.
              An imaging study at 2:47 p.m. indicated that a CT
              was performed and was negative for appendicitis.
              The ED notes at 4:51 p.m. indicated that Patient
              #6 reported to non-nursing staff that "this is taking
              too long" and then eloped. The nurse found
              Patient #6's gown on the bed, as well as the
              patient's IV, which the patient had removed prior
              to eloping. The ED log for 03/30/11 did not
              include any information about Patient #6 or that
              Patient #6 had ever presented to the ED. Patient
              #6's name was absent from the ED log on
              03/30/11.

              The ED log on 03/29/11 indicated that Patient #7
              arrived at the ED at 5:15 p.m. The ED log did not
              indicate a reason or diagnosis for Patient #7's
              arrival, nor did it indicate Patient #7's disposition.
              Patient #7's medical record face sheet indicated
              that Patient #7's expected time of arrival on
              03/29/11 was 5:15 p.m., at which time he was
              roomed. The face sheet reflected that the patient
              was subsequently discharged at 5:17 p.m., but

FORM CMS-2567(02-99) Previous Versions Obsolete           Event ID: F4GY11            Facility ID: 00200                  If continuation sheet Page 3 of 13
                                                                                                                                  PRINTED: 09/12/2012
  DEPARTMENT OF HEALTH AND HUMAN SERVICES                                                                                           FORM APPROVED
  CENTERS FOR MEDICARE & MEDICAID SERVICES                                                                                       OMB NO. 0938-0391
 STATEMENT OF DEFICIENCIES             (X1) PROVIDER/SUPPLIER/CLIA           (X2) MULTIPLE CONSTRUCTION                          (X3) DATE SURVEY
 AND PLAN OF CORRECTION                     IDENTIFICATION NUMBER:                                                                   COMPLETED
                                                                             A. BUILDING         ______________________
                                                                                                                                           C
                                                                             B. WING _____________________________
                                                    240080                                                                             05/29/2012
 NAME OF PROVIDER OR SUPPLIER                                                      STREET ADDRESS, CITY, STATE, ZIP CODE
                                                                                       2450 RIVERSIDE AVENUE
  UNIVERSITY OF MINNESOTA MEDICAL CENTER, FAIRVIEW
                                                                                       MINNEAPOLIS, MN 55454
   (X4) ID            SUMMARY STATEMENT OF DEFICIENCIES                        ID                  PROVIDER'S PLAN OF CORRECTION                   (X5)
   PREFIX          (EACH DEFICIENCY MUST BE PRECEDED BY FULL                 PREFIX              (EACH CORRECTIVE ACTION SHOULD BE             COMPLETION
                  REGULATORY OR LSC IDENTIFYING INFORMATION)                  TAG               CROSS-REFERENCED TO THE APPROPRIATE               DATE
    TAG
                                                                                                            DEFICIENCY)



    A2405 Continued From page 3                                               A2405
          the discharge disposition section of the face
          sheet indicated that Patient #7 "never arrived."
          Information on the patient's medical record face
          sheet and ED log was contradictory and
          incomplete.

              The medical record of Patient #11 indicated that
              the patient presented to the ED on 03/28/11 at
              5:28 p.m. for evaluation of shortness of breath
              and cold symptoms. The ED record indicated that
              Patient #11 left without being seen at 8:55 p.m.
              The ED log for Patient #11 was incomplete and
              did not include the date or time of Patient #11's
              arrival to the ED, nor did it include Patient #11's
              disposition or diagnosis on 03/28/11.

              The medical record of Patient #9 indicated that
              she arrived to the ED on 03/31/11 at 4:12 p.m. for
              evaluation of increasing pain with any movement
              to the left lower quadrant and buttock, after
              having fallen three days earlier. The ED record
              indicated that Patient #9 left without being seen at
              6:48 p.m., because she was unwilling to wait any
              longer to be seen by a physician. The ED log for
              Patient #9 was incomplete and did not indicate
              the date or time that Patient #9 presented to the
              ED, nor did it indicate Patient #9's diagnosis on
              03/31/12.

              The medical record of Patient #8 indicated that he
              presented to the ED on 04/16/12 at 5:30 p.m. for
              evaluation of right hip pain. The ED record
              indicated that Patient #8 was roomed at 6:07 p.m.
              and at 8:19 p.m., Patient #8's call light was on
              and he was asking when he would be evaluated
              by a physician. The ED notes indicated that
              Patient #8 was advised that ED patients were
              seen in order of their acuity and that he would be

FORM CMS-2567(02-99) Previous Versions Obsolete           Event ID: F4GY11            Facility ID: 00200                  If continuation sheet Page 4 of 13
                                                                                                                                  PRINTED: 09/12/2012
  DEPARTMENT OF HEALTH AND HUMAN SERVICES                                                                                           FORM APPROVED
  CENTERS FOR MEDICARE & MEDICAID SERVICES                                                                                       OMB NO. 0938-0391
 STATEMENT OF DEFICIENCIES             (X1) PROVIDER/SUPPLIER/CLIA           (X2) MULTIPLE CONSTRUCTION                          (X3) DATE SURVEY
 AND PLAN OF CORRECTION                     IDENTIFICATION NUMBER:                                                                   COMPLETED
                                                                             A. BUILDING         ______________________
                                                                                                                                           C
                                                                             B. WING _____________________________
                                                    240080                                                                             05/29/2012
 NAME OF PROVIDER OR SUPPLIER                                                      STREET ADDRESS, CITY, STATE, ZIP CODE
                                                                                       2450 RIVERSIDE AVENUE
  UNIVERSITY OF MINNESOTA MEDICAL CENTER, FAIRVIEW
                                                                                       MINNEAPOLIS, MN 55454
   (X4) ID            SUMMARY STATEMENT OF DEFICIENCIES                        ID                  PROVIDER'S PLAN OF CORRECTION                   (X5)
   PREFIX          (EACH DEFICIENCY MUST BE PRECEDED BY FULL                 PREFIX              (EACH CORRECTIVE ACTION SHOULD BE             COMPLETION
                  REGULATORY OR LSC IDENTIFYING INFORMATION)                  TAG               CROSS-REFERENCED TO THE APPROPRIATE               DATE
    TAG
                                                                                                            DEFICIENCY)



    A2405 Continued From page 4                                               A2405
          seen by a physician as soon as it was possible.
          The ED notes at 8:26 p.m. indicated that that
          Patient #8 signed out AMA (against medical
          advice) because he wasn't willing to wait any
          longer to be seen by a physician. The ED log for
          Patient #8 was incomplete and did not include a
          diagnosis for Patient #8 on 04/16/12.

          The medical record of Patient #12 indicated that
          she presented to the ED on 07/08/11 at 2:54 p.m.
          for evaluation of depression. The ED record
          indicated that Patient #12 was roomed at 3:04
          p.m. and then transferred to the behavioral
          emergency department at 3:24 p.m. The ED
          record indicated that Patient #12 left without
          being seen at 4:45 p.m. The ED log for Patient
          #12 was incomplete and did not include a
          diagnosis for Patient #12 on 07/08/11
    A2408 489.24(d)(4-5) DELAY IN EXAMINATION OR                              A2408
          TREATMENT

              (4) Delay in treatment.
              (i) A participating hospital may not delay providing
              an appropriate medical screening examination
              required under paragraph (a) of this section or
              further medical examination and treatment
              required under paragraph (d)(1) of this section in
              order to inquire about the individual's method of
              payment or insurance status.

              (ii)A participating hospital may not seek, or direct
              an individual to seek, authorization from the
              individual's insurance company for screening or
              stabilization services to be furnished by a
              hospital, physician, or nonphysician practitioner to
              an individual until after the hospital has provided
              the appropriate medical screening examination
              required under paragraph (a) of this section, and

FORM CMS-2567(02-99) Previous Versions Obsolete           Event ID: F4GY11            Facility ID: 00200                  If continuation sheet Page 5 of 13
                                                                                                                                  PRINTED: 09/12/2012
  DEPARTMENT OF HEALTH AND HUMAN SERVICES                                                                                           FORM APPROVED
  CENTERS FOR MEDICARE & MEDICAID SERVICES                                                                                       OMB NO. 0938-0391
 STATEMENT OF DEFICIENCIES             (X1) PROVIDER/SUPPLIER/CLIA           (X2) MULTIPLE CONSTRUCTION                          (X3) DATE SURVEY
 AND PLAN OF CORRECTION                     IDENTIFICATION NUMBER:                                                                   COMPLETED
                                                                             A. BUILDING         ______________________
                                                                                                                                           C
                                                                             B. WING _____________________________
                                                    240080                                                                             05/29/2012
 NAME OF PROVIDER OR SUPPLIER                                                      STREET ADDRESS, CITY, STATE, ZIP CODE
                                                                                       2450 RIVERSIDE AVENUE
  UNIVERSITY OF MINNESOTA MEDICAL CENTER, FAIRVIEW
                                                                                       MINNEAPOLIS, MN 55454
   (X4) ID            SUMMARY STATEMENT OF DEFICIENCIES                        ID                  PROVIDER'S PLAN OF CORRECTION                   (X5)
   PREFIX          (EACH DEFICIENCY MUST BE PRECEDED BY FULL                 PREFIX              (EACH CORRECTIVE ACTION SHOULD BE             COMPLETION
                  REGULATORY OR LSC IDENTIFYING INFORMATION)                  TAG               CROSS-REFERENCED TO THE APPROPRIATE               DATE
    TAG
                                                                                                            DEFICIENCY)



    A2408 Continued From page 5                                               A2408
          initiated any further medical examination and
          treatment that may be required to stabilize the
          emergency medical condition under paragraph (d)
          (1) of this section.

              (iii) An emergency physician or nonphysician
              practitioner is not precluded from contacting the
              individual's physician at any time to seek advice
              regarding the individual's medical history and
              needs that may be relevant to the medical
              treatment and screening of the patient, as long as
              this consultation does not inappropriately delay
              services required under paragraph (a) or
              paragraphs (d)(1) and (d)(2) of this section.

              Hospitals may follow reasonable registration
              processes for individuals for whom examination
              or treatment is required by this section, including
              asking whether an individual is insured and, if so,
              what that insurance is, as long as that inquiry
              does not delay screening or treatment.
              Reasonable registration processes may not
              unduly discourage individuals from remaining for
              further evaluation.

               A hospital meets the requirements of paragraph
              (d)(1)(ii) of this section with respect to an
              individual if the hospital offers to transfer the
              individual to another medical facility in
              accordance with paragraph (e) of this section and
              informs the individual (or a person acting on his or
              her behalf) of the risks and benefits to the
              individual of the transfer, but the individual (or a
              person acting on the individual's behalf) does not
              consent to the transfer. The hospital must take
              all reasonable steps to secure the individual's
              written informed refusal (or that of a person acting
              on his or her behalf). The written document must

FORM CMS-2567(02-99) Previous Versions Obsolete           Event ID: F4GY11            Facility ID: 00200                  If continuation sheet Page 6 of 13
                                                                                                                                  PRINTED: 09/12/2012
  DEPARTMENT OF HEALTH AND HUMAN SERVICES                                                                                           FORM APPROVED
  CENTERS FOR MEDICARE & MEDICAID SERVICES                                                                                       OMB NO. 0938-0391
 STATEMENT OF DEFICIENCIES             (X1) PROVIDER/SUPPLIER/CLIA           (X2) MULTIPLE CONSTRUCTION                          (X3) DATE SURVEY
 AND PLAN OF CORRECTION                     IDENTIFICATION NUMBER:                                                                   COMPLETED
                                                                             A. BUILDING         ______________________
                                                                                                                                           C
                                                                             B. WING _____________________________
                                                    240080                                                                             05/29/2012
 NAME OF PROVIDER OR SUPPLIER                                                      STREET ADDRESS, CITY, STATE, ZIP CODE
                                                                                       2450 RIVERSIDE AVENUE
  UNIVERSITY OF MINNESOTA MEDICAL CENTER, FAIRVIEW
                                                                                       MINNEAPOLIS, MN 55454
   (X4) ID            SUMMARY STATEMENT OF DEFICIENCIES                        ID                  PROVIDER'S PLAN OF CORRECTION                   (X5)
   PREFIX          (EACH DEFICIENCY MUST BE PRECEDED BY FULL                 PREFIX              (EACH CORRECTIVE ACTION SHOULD BE             COMPLETION
                  REGULATORY OR LSC IDENTIFYING INFORMATION)                  TAG               CROSS-REFERENCED TO THE APPROPRIATE               DATE
    TAG
                                                                                                            DEFICIENCY)



    A2408 Continued From page 6                                               A2408
          indicate the person has been informed of the
          risks and benefits of the transfer and state the
          reasons for the individual's refusal. The medical
          record must contain a description of the proposed
          transfer that was refused by or on behalf of the
          individual.

              This STANDARD is not met as evidenced by:
               Based on interview and document review, for two
              of three patients reviewed who presented to the
              hospital with an emergency medical condition
              (EMC) and who had not yet completed a medical
              screening examination (MSE) and stabilizing
              treatment (Patients #32 and #28), the hospital
              failed to utilize a reasonable registration process
              that does not unduly discourage individuals from
              remaining for further evaluation. In addition, for
              one of one patient (#1) who presented to the
              hospital for an evaluation of an EMC, the hospital
              failed to utilize a reasonable registration process
              when they requested the co-pay before the MSE
              had been completed. Findings include:

              During ten of ten interviews of hospital
              registration staff conducted between 05/02
              through 05/05/12, it was determined that the
              hospital's registration practice and policy was to
              request patient payment of either the current
              hospital charges or past hospital debts, after the
              MSE was initiated, but before the MSE was
              completed and, as applicable for patients with an
              EMC, before the patient's stabilizing treatment
              was completed. Registration staff were trained to
              ask for co-payments, co-insurance, and past due
              amounts when patients were still receiving
              examination and treatment required under
              EMTALA.


FORM CMS-2567(02-99) Previous Versions Obsolete           Event ID: F4GY11            Facility ID: 00200                  If continuation sheet Page 7 of 13
                                                                                                                                  PRINTED: 09/12/2012
  DEPARTMENT OF HEALTH AND HUMAN SERVICES                                                                                           FORM APPROVED
  CENTERS FOR MEDICARE & MEDICAID SERVICES                                                                                       OMB NO. 0938-0391
 STATEMENT OF DEFICIENCIES             (X1) PROVIDER/SUPPLIER/CLIA           (X2) MULTIPLE CONSTRUCTION                          (X3) DATE SURVEY
 AND PLAN OF CORRECTION                     IDENTIFICATION NUMBER:                                                                   COMPLETED
                                                                             A. BUILDING         ______________________
                                                                                                                                           C
                                                                             B. WING _____________________________
                                                    240080                                                                             05/29/2012
 NAME OF PROVIDER OR SUPPLIER                                                      STREET ADDRESS, CITY, STATE, ZIP CODE
                                                                                       2450 RIVERSIDE AVENUE
  UNIVERSITY OF MINNESOTA MEDICAL CENTER, FAIRVIEW
                                                                                       MINNEAPOLIS, MN 55454
   (X4) ID            SUMMARY STATEMENT OF DEFICIENCIES                        ID                  PROVIDER'S PLAN OF CORRECTION                   (X5)
   PREFIX          (EACH DEFICIENCY MUST BE PRECEDED BY FULL                 PREFIX              (EACH CORRECTIVE ACTION SHOULD BE             COMPLETION
                  REGULATORY OR LSC IDENTIFYING INFORMATION)                  TAG               CROSS-REFERENCED TO THE APPROPRIATE               DATE
    TAG
                                                                                                            DEFICIENCY)



    A2408 Continued From page 7                                               A2408
          The observed practice in the ED, during the
          investigation from 05/02 - 05/05/12, established
          that registration staff had discontinued asking
          patients for co-insurance amounts and past due
          hospital bills, but registration staff continued to
          ask patients for insurance copayments.

              Registration staff interviewed, between 05/02 -
              05/05/12, all confirmed that they had been
              trained by the hospital to collect payments from
              patients, through a "scripting" process that did
              not allow the patient to opt out of immediate
              payment. (Registration staff were employed by
              the hospital but required to take direction from a
              hospital contractor (Accretive) in the manner in
              which they accomplished their work). Not only
              were registration staff required to ask patients for
              co-payments, co-insurances, and outstanding
              balances, but registration staff were also required
              to aggressively pursue setting up a payment plan
              for the patient, if the patient was unable to pay the
              full amount at the point of service. Registration
              staff were required to tell the patient that the
              hospital accepted cash, checks, and a variety of
              credit cards. All of the registration staff stated
              they were uncomfortable with the "scripting," but
              were required by Accretive staff to implement it.
              The registration staff were given weekly quotas
              regarding how much money they were each
              required to collect from patients.

              Director of Patient Access & Finance/(H) was
              interviewed on 05/02/12 at 12:55 p.m. She stated
              that approximately two years ago, management
              contracted with a company to increase the
              hospital's revenue at the patient's point of service.
              (Registration staff were employed by the hospital
              but required to take direction from a hospital

FORM CMS-2567(02-99) Previous Versions Obsolete           Event ID: F4GY11            Facility ID: 00200                  If continuation sheet Page 8 of 13
                                                                                                                                  PRINTED: 09/12/2012
  DEPARTMENT OF HEALTH AND HUMAN SERVICES                                                                                           FORM APPROVED
  CENTERS FOR MEDICARE & MEDICAID SERVICES                                                                                       OMB NO. 0938-0391
 STATEMENT OF DEFICIENCIES             (X1) PROVIDER/SUPPLIER/CLIA           (X2) MULTIPLE CONSTRUCTION                          (X3) DATE SURVEY
 AND PLAN OF CORRECTION                     IDENTIFICATION NUMBER:                                                                   COMPLETED
                                                                             A. BUILDING         ______________________
                                                                                                                                           C
                                                                             B. WING _____________________________
                                                    240080                                                                             05/29/2012
 NAME OF PROVIDER OR SUPPLIER                                                      STREET ADDRESS, CITY, STATE, ZIP CODE
                                                                                       2450 RIVERSIDE AVENUE
  UNIVERSITY OF MINNESOTA MEDICAL CENTER, FAIRVIEW
                                                                                       MINNEAPOLIS, MN 55454
   (X4) ID            SUMMARY STATEMENT OF DEFICIENCIES                        ID                  PROVIDER'S PLAN OF CORRECTION                   (X5)
   PREFIX          (EACH DEFICIENCY MUST BE PRECEDED BY FULL                 PREFIX              (EACH CORRECTIVE ACTION SHOULD BE             COMPLETION
                  REGULATORY OR LSC IDENTIFYING INFORMATION)                  TAG               CROSS-REFERENCED TO THE APPROPRIATE               DATE
    TAG
                                                                                                            DEFICIENCY)



    A2408 Continued From page 8                                               A2408
          contractor (Accretive) in the manner in which they
          accomplished their work). Debt collection from
          patients was accomplished in three ways:
          collecting the patient's insurance co-payment at
          the time service was rendered, collecting the
          patient's co-insurance at the time service was
          rendered (the portion of the patient's charges that
          were estimated to be uncovered by the patient's
          insurance carrier), and collecting outstanding
          balances the patient had from former hospital
          services, at the time new service was being
          rendered. The contractor had designed
          computerized tools which provided financial
          information to the hospital's registration staff who
          registered patients for hospital services in the
          emergency departments. The hospital's
          registration staff were trained to utilize the tools to
          collect money from patients and check the
          patient's prior balance, at the point of service.
          Registration staff were trained by "scripting" their
          conversation with patients, to increase a better
          outcome with debt collection and cash flow. The
          training was assertive scripting and registration
          staff were coached and shadowed to increase
          success when patients owed the hospital money.

              During observations conducted of patients in the
              emergency department on 5/02/12 from 10:20
              a.m. to 11:30 a.m., Patient #1 was interviewed at
              10:50 a.m. in his ED exam room. He was alert,
              oriented, and talkative. He stated he presented to
              the ED that morning with a sudden onset of bright
              red rectal bleeding. When he arrived at the ED,
              he was roomed immediately and was seen by a
              physician within minutes of being roomed. Shortly
              after the physician left his exam room, a hospital
              employee came into his room with a cart that had
              a computer on it. The employee asked him some

FORM CMS-2567(02-99) Previous Versions Obsolete           Event ID: F4GY11            Facility ID: 00200                  If continuation sheet Page 9 of 13
                                                                                                                               PRINTED: 09/12/2012
  DEPARTMENT OF HEALTH AND HUMAN SERVICES                                                                                        FORM APPROVED
  CENTERS FOR MEDICARE & MEDICAID SERVICES                                                                                    OMB NO. 0938-0391
 STATEMENT OF DEFICIENCIES             (X1) PROVIDER/SUPPLIER/CLIA           (X2) MULTIPLE CONSTRUCTION                       (X3) DATE SURVEY
 AND PLAN OF CORRECTION                     IDENTIFICATION NUMBER:                                                                COMPLETED
                                                                             A. BUILDING         ______________________
                                                                                                                                         C
                                                                             B. WING _____________________________
                                                    240080                                                                           05/29/2012
 NAME OF PROVIDER OR SUPPLIER                                                      STREET ADDRESS, CITY, STATE, ZIP CODE
                                                                                       2450 RIVERSIDE AVENUE
  UNIVERSITY OF MINNESOTA MEDICAL CENTER, FAIRVIEW
                                                                                       MINNEAPOLIS, MN 55454
   (X4) ID            SUMMARY STATEMENT OF DEFICIENCIES                        ID                  PROVIDER'S PLAN OF CORRECTION                (X5)
   PREFIX          (EACH DEFICIENCY MUST BE PRECEDED BY FULL                 PREFIX              (EACH CORRECTIVE ACTION SHOULD BE          COMPLETION
                  REGULATORY OR LSC IDENTIFYING INFORMATION)                  TAG               CROSS-REFERENCED TO THE APPROPRIATE            DATE
    TAG
                                                                                                            DEFICIENCY)



    A2408 Continued From page 9                                               A2408
          questions such as his name and address, and
          verified his insurance information. "While a nurse
          inserted my IV," the employee asked him to pay
          his $75.00 insurance co-payment, which he paid
          with a credit card.

              The registration process was started after the
              MSE was initiated but before the MSE was
              completed, the patient was asked to pay a $75.00
              co-pay. According to documentation on the ED
              log, Patient #1 was admitted to the hospital for
              stabilization of his EMC.

              Patient #32's medical record indicated that she
              arrived by ambulance to the emergency
              department (ED), from an urgent care, on
              03/18/12 at 11:00 a.m. She had symptoms of
              chest discomfort, chills, sweats, and an elevated
              temperature of 101 degrees. The patient was
              roomed and triaged at 11:07 a.m.


              A medical screening examination (MSE) was
              initiated by a physician at 11:31 a.m., at which
              time an intravenous infusion of sodium chloride
              was started.


              Patient #32's diagnostic tests included blood
              drawn for laboratory studies. The record indicates
              that other tests and treatments were ordered.


              The chest x-ray and EKG was obtained at 11:40
              a.m. The chest x-ray confirmed a diagnosis of
              left-sided pneumonia.



FORM CMS-2567(02-99) Previous Versions Obsolete           Event ID: F4GY11            Facility ID: 00200              If continuation sheet Page 10 of 13
                                                                                                                               PRINTED: 09/12/2012
  DEPARTMENT OF HEALTH AND HUMAN SERVICES                                                                                        FORM APPROVED
  CENTERS FOR MEDICARE & MEDICAID SERVICES                                                                                    OMB NO. 0938-0391
 STATEMENT OF DEFICIENCIES             (X1) PROVIDER/SUPPLIER/CLIA           (X2) MULTIPLE CONSTRUCTION                       (X3) DATE SURVEY
 AND PLAN OF CORRECTION                     IDENTIFICATION NUMBER:                                                                COMPLETED
                                                                             A. BUILDING         ______________________
                                                                                                                                         C
                                                                             B. WING _____________________________
                                                    240080                                                                           05/29/2012
 NAME OF PROVIDER OR SUPPLIER                                                      STREET ADDRESS, CITY, STATE, ZIP CODE
                                                                                       2450 RIVERSIDE AVENUE
  UNIVERSITY OF MINNESOTA MEDICAL CENTER, FAIRVIEW
                                                                                       MINNEAPOLIS, MN 55454
   (X4) ID            SUMMARY STATEMENT OF DEFICIENCIES                        ID                  PROVIDER'S PLAN OF CORRECTION                (X5)
   PREFIX          (EACH DEFICIENCY MUST BE PRECEDED BY FULL                 PREFIX              (EACH CORRECTIVE ACTION SHOULD BE          COMPLETION
                  REGULATORY OR LSC IDENTIFYING INFORMATION)                  TAG               CROSS-REFERENCED TO THE APPROPRIATE            DATE
    TAG
                                                                                                            DEFICIENCY)



    A2408 Continued From page 10                                              A2408
          Patient #32 received oral and intravenous
          antibiotics at 12:57 p.m. The patient received
          further treatment, education and instructions, and
          was discharged to home on a course of oral
          antibiotic therapy.


              The hospital did not have an established system
              in place to identify the time the registration
              process began. There was no documentation in
              Patient #32's medical record identifying the time
              that Patient #32 was registered by hospital staff,
              however, according to Patient #32's interview, the
              registration process occurred between her blood
              draw and her chest x-ray.


              Patient #32 was interviewed on 05/25/12 at 1:05
              p.m. She stated she was taken by ambulance
              from an urgent care to the ED on 03/18/12. She
              had symptoms of chest pain and difficulty
              breathing. She thought she was having a heart
              attack. She had never had an emergency room
              encounter in her lifetime and when they
              transported her from the urgent care to the ED in
              an ambulance, she was anxious and "scared out
              of my mind." When she got to the ED, the staff
              roomed her immediately, assisted her into a
              hospital gown, and applied a cardiac monitor. The
              physician came in to examine her right away,
              indicating lab studies and a chest x-ray would be
              completed. After the lab drew the blood work, an
              employee came into her exam room. She had a
              rolling cart with a computer on it and asked her
              some general questions like her name and
              address, and then told her that she owed the
              hospital $672.00 for services she had received so
              far that day. She told the employee to leave her

FORM CMS-2567(02-99) Previous Versions Obsolete           Event ID: F4GY11            Facility ID: 00200              If continuation sheet Page 11 of 13
                                                                                                                               PRINTED: 09/12/2012
  DEPARTMENT OF HEALTH AND HUMAN SERVICES                                                                                        FORM APPROVED
  CENTERS FOR MEDICARE & MEDICAID SERVICES                                                                                    OMB NO. 0938-0391
 STATEMENT OF DEFICIENCIES             (X1) PROVIDER/SUPPLIER/CLIA           (X2) MULTIPLE CONSTRUCTION                       (X3) DATE SURVEY
 AND PLAN OF CORRECTION                     IDENTIFICATION NUMBER:                                                                COMPLETED
                                                                             A. BUILDING         ______________________
                                                                                                                                         C
                                                                             B. WING _____________________________
                                                    240080                                                                           05/29/2012
 NAME OF PROVIDER OR SUPPLIER                                                      STREET ADDRESS, CITY, STATE, ZIP CODE
                                                                                       2450 RIVERSIDE AVENUE
  UNIVERSITY OF MINNESOTA MEDICAL CENTER, FAIRVIEW
                                                                                       MINNEAPOLIS, MN 55454
   (X4) ID            SUMMARY STATEMENT OF DEFICIENCIES                        ID                  PROVIDER'S PLAN OF CORRECTION                (X5)
   PREFIX          (EACH DEFICIENCY MUST BE PRECEDED BY FULL                 PREFIX              (EACH CORRECTIVE ACTION SHOULD BE          COMPLETION
                  REGULATORY OR LSC IDENTIFYING INFORMATION)                  TAG               CROSS-REFERENCED TO THE APPROPRIATE            DATE
    TAG
                                                                                                            DEFICIENCY)



    A2408 Continued From page 11                                              A2408
          room and the employee complied. She was
          "angry, scared, and appalled" that a hospital
          employee would ask her for money when she
          thought she was having a heart attack. She felt
          this was "unethical." Shortly after the employee
          left the exam room, she was taken for a chest
          x-ray. The physician then updated her that she
          had pneumonia and intravenous antibiotics were
          administered. The physician advised her that she
          should be hospitalized overnight, but she opted to
          discharge because she had already been
          informed that she owed the hospital $672.00 and
          she wasn't sure she had the financial resources
          to pay the bill. Patient #32 stated that the
          hospital's debt collecting practices discouraged
          her from considering overnight hospitalization for
          further treatment and monitoring of her condition.

              Twenty-four minutes after Patient #32 was
              roomed in the ED on 03/18/12 with symptoms of
              chest discomfort, sweats, and chills, hospital staff
              told Patient #32 she owed $672.00 for services
              the patient incurred so far that day and asked her
              to pay the bill. This payment was requested by
              hospital staff before the patient received a
              complete medical screening examination to
              determine any necessary stabilizing treatment the
              patient required. The patient was asked for
              money before cardiac issues were ruled out and
              before she received any stabilizing treatment to
              address her emergency medical condition related
              to her diagnosis of pneumonia.

              Patient # 28's medical record was reviewed and
              indicated that an ambulance was called to her
              workplace on 02/03/12 because she had a
              sudden onset of sharp abdominal pain that
              worsened when taking deep breaths. The patient

FORM CMS-2567(02-99) Previous Versions Obsolete           Event ID: F4GY11            Facility ID: 00200              If continuation sheet Page 12 of 13
                                                                                                                               PRINTED: 09/12/2012
  DEPARTMENT OF HEALTH AND HUMAN SERVICES                                                                                        FORM APPROVED
  CENTERS FOR MEDICARE & MEDICAID SERVICES                                                                                    OMB NO. 0938-0391
 STATEMENT OF DEFICIENCIES             (X1) PROVIDER/SUPPLIER/CLIA           (X2) MULTIPLE CONSTRUCTION                       (X3) DATE SURVEY
 AND PLAN OF CORRECTION                     IDENTIFICATION NUMBER:                                                                COMPLETED
                                                                             A. BUILDING         ______________________
                                                                                                                                         C
                                                                             B. WING _____________________________
                                                    240080                                                                           05/29/2012
 NAME OF PROVIDER OR SUPPLIER                                                      STREET ADDRESS, CITY, STATE, ZIP CODE
                                                                                       2450 RIVERSIDE AVENUE
  UNIVERSITY OF MINNESOTA MEDICAL CENTER, FAIRVIEW
                                                                                       MINNEAPOLIS, MN 55454
   (X4) ID            SUMMARY STATEMENT OF DEFICIENCIES                        ID                  PROVIDER'S PLAN OF CORRECTION                (X5)
   PREFIX          (EACH DEFICIENCY MUST BE PRECEDED BY FULL                 PREFIX              (EACH CORRECTIVE ACTION SHOULD BE          COMPLETION
                  REGULATORY OR LSC IDENTIFYING INFORMATION)                  TAG               CROSS-REFERENCED TO THE APPROPRIATE            DATE
    TAG
                                                                                                            DEFICIENCY)



    A2408 Continued From page 12                                              A2408
          arrived by ambulance to the emergency
          department (ED) on 02/03/12 at 5:25 p.m. with an
          emergency medical condition.

              The patient was triaged and roomed at 5:27 p.m.
              A medical screening examination (MSE) was
              initiated by a physician at 5:43 p.m. Laboratory
              studies were drawn at 5:45 p.m. Before the
              completion of the MSE and prior to the stabilizing
              treatment the registration took place at the
              patient's bedside and during this registration, the
              patient was asked to pay an outstanding debt.
              According to Patient #28's interview, the
              registration process began immediately after the
              lab staff drew her blood sample.

              Patient #28 was interviewed on 05/29/12 at 10:10
              a.m. She stated she was having significant
              abdominal pain with burning pain in her back,
              when she arrived in the ED on 02/03/12. She was
              taken to an exam room immediately upon arrival
              where she was greeted and assessed by a nurse,
              who started an intravenous infusion. Shortly
              afterward, a physician came into her room and
              examined her. The physician asked her many
              questions and assessed her pain. Laboratory
              personnel drew blood samples. After the lab staff
              left her exam room, an employee came to her
              bedside, registered her as an ED patient, and
              asked her to pay her bill from a previous visit,
              which was $527.00. She was "speechless" that
              someone would ask her for money, in the midst
              of "agonizing" pain that was so intense she could
              not "think clearly." She thought this practice was
              rude and uncaring, and it made her fearful that
              ED staff would not treat her acute condition if she
              didn't pay the money.


FORM CMS-2567(02-99) Previous Versions Obsolete           Event ID: F4GY11            Facility ID: 00200              If continuation sheet Page 13 of 13

				
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