Q&A: Parkland's Medicare crisis through the eyes of its clinical engineer chief

Threatened with cutoff from Medicare reimbursements due to numerous safety violations, Parkland Hospital in Dallas has been working hard to heal its own wounds. Its clinical engineering department has played a crucial role in the effort. In an interview with Healthcare Technology Management, the department’s director, Tom Collins, encouraged others to learn from the “intense experience” his team is living through as Parkland's compliance deadline approaches.

Thirteen surveyors from the Centers for Medicare & Medicaid Services (CMS) arrived unannounced July 11 to inspect Parkland institution for eight days, and found “significant deficiencies” in infection control, nursing services, medical records and other areas. On Aug. 9, they notified Parkland that it is in “immediate jeopardy” of losing Medicare funding if it fails to address the problems to CMS’ satisfaction prior to Sept. 2.

HTM: It's difficult to survive without Medicare participation. How is your department contributing to Parkland's efforts to comply with the call for corrective actions?
Collins: For starters, none of us have gone through anything like this before. But, speaking for clinical engineering [CE], we can help the departments and areas that are going through the process of quality improvement. During the past 10 months, clinical engineering has [put itself] through that process. I came on board 10 months ago [from the University of Chicago Medical Center] and we’ve gone through the process of revealing our policies, updating them if necessary; we’ve implemented a lot of new programs and best practices, looked at our preventive maintenance [PM] procedures and updated them to ensure that we’re providing the most efficient and productive service we can to our customers—the end users of the equipment.

Communication has been critical to our success, both letting the nursing leadership and the clinical staff on the floors know what we’re doing, and our goal is to deliver service excellence. We’ve done that through meetings with nursing leadership, we’ve implemented rounding by my staff on the floors with the clinical departments, and then also my leadership team follows up with rounding with the department managers and nurse receptionists and the various clinical departments.

HTM: So your department already had a quality improvement program underway when the surveyors arrived. How has that experience come in handy for the rest of the institution?
Collins: We’re now sharing what we’ve been doing over the past 10 months with the other departments that might benefit from our experience during this period when the hospital is under pressure. Because, for our part, clinical engineering made it through the CMS survey very successfully. Thus, we can share our best practices, what we’ve done over the last 10 months to get to this point, with other departments to ensure that there’s complete compliance across the whole institution.

HTM: Of the corrective measures CMS is calling for, do any directly involve medical equipment?
Collins: Some involve equipment, but none that falls under clinical engineering. There are some [measures] involving equipment maintained by facilities engineering, and we’re working with that department to describe our best practices and ask how they can maybe implement some of our best practices.

HTM: As a leader in your field, what have you learned from this crisis?
Collins: When CMS came in with [its] very tough survey in July, it was unlike anything I’ve ever been through after many years in this line of work. I’ve gone through many JCAHO [Joint Commission on Accreditation of Healthcare Organization] surveys, but this was JCAHO on steroids. It was much more intensive. The surveyors were going through not only our hospital but also our offsite clinics. We were being asked daily for service documentation on hundreds of pieces of equipment. Also, the surveyors were constantly going through the facility and through the offsite clinics looking at stickers. I was receiving daily feedback that surveyors had gone through departments and all CE equipment had current stickers except for one item.

All clinical engineers will empathize with me on this. One piece of equipment that had been put into storage to be traded in was pulled out the day a surveyor came through, and it had an out-of-date PM sticker. It was two weeks out of date. That was the one issue we had and, because of that one issue, we followed up with a communication to nursing leadership that staff must check PM stickers for current dates.

It’s been a humbling experience but also an uplifting one at the same time. It’s uplifting because my team delivered on service excellence. There’s no greater feeling than to know that we’ve gone through a lot of change and hard work over the last 10 months and it paid off. It was very uplifting to know that we went through more than a week of war, if you will, and came out very successful.

Of course, it was also very humbling to know that our team, the Parkland team, was cited by CMS for patient-related issues. We need to step up and meet [its] expectations—and we will.

HTM: You sound hopeful that Parkland will pass CMS’ follow-up survey, and avoid decertification on Sept. 2. What do you base that hopefulness on?
Collins: I’m not just hopeful; I know we will come out better than ever. Our patients deserve no less. When I see the caregivers here, I know there are a lot of really good professionals, good, caring people here. I know we are going to get through this, and we’re looking toward the future. We’re in the process of building a new hospital across the street to open in about three years. It will be a state-of-the-art facility. That’s where some of our issues have come from—our building is very old—and our ER sees upward of 150,000 patients a year. 

And the new facility is not just that; we’ve been working on building a culture of excellence here that will follow us into the new hospital. And we started on that before CMS ever came in here. Over the 10 months I’ve been here, I’ve been allowed and encouraged by senior leadership to build a state-of-the-art clinical engineering department. And they’ve allowed me to do what it takes to build that kind of department, and that paid off during the CMS survey.

That’s part of the reason I’m very confident that all departments within Parkland, that we as a system, will adapt and change and be successful.

To follow Parkland Health & Hospital System’s efforts to meet the conditions of participation laid out by the CMS, check here regularly.