NEW HAVEN, CT—U.S. Senators Chris Murphy (D-Conn.) and Richard Blumenthal (D-Conn.) joined U.S. Congresswoman Rosa DeLauro (CT-03), John Larson (CT-01), Joe Courtney (CT-02), Jim Himes (CT-04), and Jahana Hayes (CT-05) in sending a letter to the Centers for Medicare and Medicaid Services (CMS) urging them to rescind a $450,000 “non-reporting” penalty imposed on Gaylord Hospital in Wallingford. Gaylord Hospital has provided patients throughout the state of Connecticut with high-quality care for more than one hundred years.

“While we fully support the reporting of quality measures, as they ensure Medicare beneficiaries receive effective, efficient, and safe care, we are very concerned the penalty imposed on Gaylord for ‘failing’ to report the number of patients with MRSA is disproportionate,” wrote the members. “Gaylord did submit data reflecting they had no patients with MRSA in June 2018, following the same process it had since 2012. Once it was notified of the issue, Gaylord re-submitted the ‘non-reported’ data and has since taken measures to ensure there is never a similar issue with quality measures submission. With the exception of this one month and one quality measure (patients with MRSA), Gaylord has never had any issues meeting all reporting requirements.”

“Withholding two percent of Medicare payments ($450,000) in 2020 represents one-third of the Gaylord’s operating margin,” continued the members. “A penalty of this magnitude will significantly impede the Hospital’s work to provide the level of care the quality measures are intended to achieve. Therefore, we support and hereby request an expedited review of Gaylord’s appeal and rescission of the penalty imposed.”

A full copy of the letter can be found below.

November 25, 2019

Kate Goodrich, MD, MHS

Director, Center for Clinical Standards and Quality

Centers for Medicare and Medicaid Services

U.S. Department of Health and Human Services

7500 Security Boulevard

Baltimore, MD 21244

Dear Director Goodrich,

We have reviewed your letter dated September 11, 2019 to Gaylord Hospital, which is located in Wallingford, Connecticut, informing Gaylord that its requested reconsideration of the $450,000 “non-reporting” penalty was denied for failure to submit one quality measure for one month in 2018. We are also aware that Gaylord Hospital will be filing an appeal with the Provider Reimbursement Review Board.

Gaylord Hospital has been serving patients who are either acutely ill or chronically disabled throughout the state of Connecticut for more than one hundred years. Originally a tuberculosis sanitarium, Gaylord now provides high-quality care and rehabilitation for illnesses or injuries related to the brain and nervous system, spine, bones and joints, and lungs.

While we fully support the reporting of quality measures, as they ensure Medicare beneficiaries receive effective, efficient, and safe care, we are very concerned the penalty imposed on Gaylord for “failing” to report the number of patients with MRSA is disproportionate. Gaylord did submit data reflecting they had no patients with MRSA in June 2018, following the same process it had since 2012. Once it was notified of the issue, Gaylord re-submitted the “non-reported” data and has since taken measures to ensure there is never a similar issue with quality measures submission. With the exception of this one month and one quality measure (patients with MRSA), Gaylord has never had any issues meeting all reporting requirements.

Withholding two percent of Medicare payments ($450,000) in 2020 represents one-third of the Gaylord’s operating margin. A penalty of this magnitude will significantly impede the Hospital’s work to provide the level of care the quality measures are intended to achieve. Our office is also informed it may be several years to resolve this issue through the PRRB process. Therefore, we support and hereby request an expedited review of Gaylord’s appeal and rescission of the penalty imposed. We are confident that Gaylord Hospital will continue its exemplary record of providing patients with high-quality care and rehabilitation in Connecticut.

Sincerely,

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