Even Grave Errors At Rehab Hospitals Go Unpenalized And Undisclosed

Rehab hospitals that thief group retrieve from awesome surgeries and injuries person go a highly lucrative portion of nan wellness attraction business. But national information and inspection reports show that immoderate tally by nan ascendant company, Encompass Health Corp., and different for-profit corporations person had uncommon but superior incidents of diligent harm and execute beneath mean connected 2 cardinal information measures tracked by Medicare.

Yet moreover erstwhile inspections uncover sedate cases of injury, national wellness officials do not pass consumers aliases enforce fines nan measurement they do for nursing homes. And Medicare doesn't supply easy-to-understand five-star ratings arsenic it does for wide hospitals.

In nan astir superior problems documented by regulators, rehab infirmary errors progressive diligent deaths.

In Encompass Health's infirmary successful Huntington, West Virginia, Elizabeth VanBibber, 73, was fatally poisoned by a c monoxide leak during building astatine nan facility.

At its infirmary successful Jackson, Tennessee, a patient, 68, was recovered dormant overnight, lying connected nan level successful a "pool of blood" aft an siren that was expected to alert nurses that he had gotten retired of furniture had been turned off.

In its infirmary successful Sioux Falls, South Dakota, a caregiver gave Frederick Roufs, 73, nan incorrect drug, 1 of 26 medicine errors nan infirmary made complete six months. He died 2 days later astatine different hospital.

"I tin still spot Fred laying successful nan furniture arsenic they unopen each small instrumentality off," said his widow, Susan Roufs. "They clicked 4 of them, and past nan emotion of my life was gone."

Encompass, which owns 168 hospitals and admitted 248,000 patients past year, has led nan translator of this niche industry. In 2023, stand-alone for-profit aesculapian rehabilitation hospitals overtook nonprofits arsenic nan places wherever nan mostly of yearly diligent admissions occur, a KFF Health News and New York Times study found. A 3rd of each admissions were to Encompass hospitals. Such accommodation are required to supply 3 hours of therapy a day, 5 days a week.

Across nan nation, location are now astir 400 stand-alone rehab hospitals, nan bulk of which are for-profit. These hospitals collectively make profits of 10%, much than wide hospitals, which gain astir 6%, and acold much than skilled nursing homes, which make little than 0.5%, according to nan astir caller information from nan Medicare Payment Advisory Commission, an independent legislature agency.

At nan aforesaid time, nan number of small, specialized units wrong acute attraction hospitals — wherever astir rehab utilized to beryllium provided — has dwindled. There are now astir 800 of those, and astir are nonprofits.

In its latest yearly report, Encompass, which is publically traded, reported an 11% nett profit successful 2024, earning $597 cardinal past twelvemonth connected revenues of $5.4 billion.

Federal information connected nan capacity of astir 1,100 of nan rehab accommodation show Encompass tends to beryllium amended astatine helping astir patients return location and stay there. In a two-year play ending successful September 2023, Medicare rated 233 rehab accommodation arsenic performing amended than nan nationalist complaint for this awesome metric, called "discharge to community." Most rehabs pinch amended organization discharge rates are for-profit, and Encompass owns 79 of them.

But information from Medicare besides reveals Encompass owns galore of nan rehabs pinch worse rates of perchance preventable, unplanned readmissions to wide hospitals. Medicare evaluates really often patients are rehospitalized for conditions that mightiness person been averted pinch due care, including infections, bedsores, dehydration, and kidney failures.

Encompass accounts for astir 1 successful 7 rehab accommodation nationally, but owned 34 of nan 41 inpatient rehab accommodation that Medicare rated arsenic having statistically importantly worse rates of perchance preventable readmissions for discharged patients. (Overall, rates of readmission aft discharge ranged from 7% to 12%, pinch a median of 9%.)

And it owned 28 of nan 87 rehab accommodation — 65 of which were for-profit — that had worse rates of perchance preventable readmissions to wide hospitals during diligent stays. (The median for these kinds of readmissions was 5%, and rates for individual rehabs ranged from 3% to 9%.)

Patrick Darby, nan executive vice president and wide counsel of Encompass, powerfully defended nan company's grounds successful written responses to questions. He dismissed Medicare's readmissions ratings of "better," "worse," and "no different than nan nationalist rate" arsenic "a crude scoring measure" and said "performance is truthful akin crossed nan board." He called nan violations recovered during wellness inspections "rare occurrences" that "do not support an conclusion of wide value concerns."

"The simplest and astir meticulous logic for EHC's occurrence is that our hospitals supply superior attraction to patients," he said, referring to Encompass by its firm initials.

Chih-Ying Li, an subordinate professor of occupational therapy astatine nan University of Texas Medical Branch astatine Galveston School of Health Professions, said successful an question and reply that a investigation study she conducted recovered nan profit position of a rehab installation was nan only characteristic associated pinch higher unplanned readmissions.

"The uncovering is beautiful robust," she said. "It's not for illustration huge, immense differences, but location are differences."

Alarming mistakes

VanBibber was admitted to Encompass' Huntington infirmary successful 2021 for therapy to fortify her lungs. At nan time, nan infirmary was undergoing a $3 cardinal description , and authorities regulators had warned nan institution that areas of nan infirmary occupied by patients had to beryllium isolated from nan building "using airtight barriers," according to a wellness inspection report.

In her room, which was astir 66 feet from nan building zone, she began having problem breathing, nan study said. When she told nan staff, they ignored her and unopen her door, according to a suit brought by her estate. Staff members yet noticed that she was "lethargic and gasping for air," and called 911.

When nan emergency aesculapian squad arrived, nan c monoxide detectors they wore sounded. By that time, VanBibber's humor oxygen levels were dangerously low, nan inspection study said. She died 3 days later from respiratory nonaccomplishment and c monoxide poisoning, according to nan inspection study and nan lawsuit. A plumber had been utilizing a gas-powered saw successful nan building area, but location were nary c monoxide detectors successful nan hallways, nan study said.

In tribunal papers, Encompass and its building contractors denied negligence for VanBibber's death. The lawsuit is pending.

Inspectors wished Encompass grounded to support a safe situation for each patients during building and didn't decently measure different patients for signs of poisoning, nan study said.

Since 2021, nan national Centers for Medicare and Medicaid Services, aliases CMS, which oversees wellness inspections, has recovered that 10 Encompass hospitals, including nan 1 that cared for VanBibber, had contiguous jeopardy violations, national records show. Such violations — for illustration nan ones that Medicare besides recovered successful relationship pinch nan deaths of Roufs and nan diligent who fell aft leaving his furniture — mean a hospital's nonaccomplishment to comply pinch national rules has put patients astatine consequence for superior injury, superior harm, superior impairment, aliases death.

Darby, nan wide counsel for Encompass, said nan institution regretted immoderate objective problems and had promptly addressed each specified findings to nan restitution of inspectors. He said Encompass that has an "excellent compliance record," including superior results from its legalization agency, and that its wide number of wellness citations was mini fixed really galore hospitals Encompass owns and really galore patients it treats.

Six different corporate-operated for-profit hospitals were besides cited, while nary of nan 31 stand-alone nonprofit rehab hospitals received specified violations from 2021 to 2024. (Inspection reports for wide hospitals do not systematically specify successful which portion of nan building a usurpation occurred, truthful rehab portion violations cannot beryllium identified.)

An alert called a furniture siren was astatine nan guidelines of contiguous jeopardies astatine Encompass hospitals successful Morgantown, West Virginia, and Jackson, Tennessee. The devices are pressure- and motion-sensitive and emit a sound and show a ray to alert unit members that personification astatine a precocious consequence of falls has near his aliases her bed.

In its Morgantown hospital, a caregiver technician discovered a diligent look down connected nan level pinch a ample gash connected her caput aft a defective siren did not spell off, an inspection study said. After she died, nan caregiver told inspectors: "We are having a batch of problems pinch nan furniture alarms."

Medicare is not authorized by rule to good rehab hospitals for information norm violations, moreover ones involving deaths uncovered during inspections, arsenic it has done pinch astir 8,000 nursing homes during nan past 3 years, imposing mean fines of astir $28,000.

The only action is to wholly trim disconnected a rehab hospital's reimbursement for each services by Medicare and Medicaid, which screen astir patients. That measurement would astir apt put it retired of business and is almost ne'er utilized because of its draconian consequences.

"Termination is typically a past edifice aft moving pinch nan supplier to travel backmost into compliance," Catherine Howden, a CMS spokesperson, said successful an email.

As a result, because there's nary graduated penalty, moreover nan astir superior — and uncommon — contiguous jeopardy violations efficaciously transportation nary punishments truthful agelong arsenic nan infirmary puts steps successful spot to avert early problems.

"Only having a atomic limb has really wounded diligent safety," said Michael Millenson, a aesculapian value advocate.

One contiguous jeopardy incident did consequence successful a punishment, but only because nan infirmary was successful California, which allows its wellness section to rumor penalties. Encompass' Bakersfield infirmary paid a $75,000 good past twelvemonth for failing to power nan humor sweetener of a diligent who died aft her bosom stopped.

Rapid maturation and a troubled history

Encompass has accelerated its description successful caller years and now operates successful 38 states and Puerto Rico. It plans to unfastened 17 much hospitals successful Arizona, Connecticut, Florida, Georgia, Maine, Pennsylvania, South Carolina, Texas, and Utah by nan extremity of 2027, according to its latest report.

It often moves into caller markets by persuading section nonprofit hospitals to shutter their rehab units successful speech for an equity liking successful a recently built Encompass hospital, institution executives person told investors.

The president of Encompass, Mark Tarr, calls it a "win-win proposition": The section hospitals tin usage their emptied abstraction for a much lucrative statement of work and Encompass gets a "jump start" into a caller market, pinch partner hospitals often referring patients.

Tarr, who was paid $9.3 cardinal successful compensation past year, told investors that Encompass requires that nan existing hospitals motion a noncompete deal. Sixty-seven Encompass hospitals are associated ventures, mostly pinch nonprofit hospitals arsenic investors, according to nan company's June financial filing, nan astir caller available.

Darby said nan company's profits let it to build hospitals successful areas that deficiency intensive inpatient rehabilitation and amended existing hospitals. "High-quality diligent attraction is not only accordant pinch shareholder return, but value and shareholder return are successful truth captious to 1 another," he said.

The occurrence of Encompass is peculiarly notable fixed that it hardly survived what experts said was 1 of nan largest modern accounting scandals successful 2003.

The Securities and Exchange Commission charged that nan company, past known arsenic HealthSouth, overstated net by $2.7 cardinal to meet Wall Street expert quarterly expectations, starring to nan ouster of its laminitis and directors. In 2004, nan institution agreed to salary nan authorities $325 cardinal to settee Medicare fraud allegations without admitting wrongdoing. Darby credited nan company's caller leaders for obtaining a $2.9 cardinal judgement connected behalf of shareholders against nan company's founder.

The institution changed its sanction to Encompass successful 2018 aft acquiring Encompass Home Health and Hospice. In 2019, nan Justice Department announced nan institution had agreed to salary $48 cardinal to settee whistleblower suit claims that it misdiagnosed patients to get higher Medicare reimbursements, and admitted patients who were excessively sick to use from therapy. The institution denied immoderate wrongdoing, blaming independent physicians who worked astatine its hospitals. Darby said Encompass settled nan lawsuit only to "avoid much years of disbursal and disruption." He said nan Justice Department ne'er revenge a suit contempt years of investigation.

Medication harms

Rehab infirmary inspection reports are not posted connected Care Compare, Medicare's online hunt instrumentality for consumers. KFF Health News had to writer CMS nether nan Freedom of Information Act to get each its inspection reports for rehab hospitals. In contrast, Care Compare publishes each nursing location inspection reports and assigns each installation a prima standing for its adherence to wellness and information rules.

So group now choosing a rehab infirmary would not cognize that astatine nan Encompass infirmary successful Sioux Falls, South Dakota, successful 2021, a caregiver accidentally gave Roufs a humor unit supplier called hydralazine alternatively of hydroxyzine, his prescribed anti-anxiety medication, according to an inspection report. Roufs went into cardiac arrest. This type of error, called a "look-alike/sound-alike," is 1 hospitals and unit members are expected to beryllium particularly alert to.

Months before, an soul information committee had identified a inclination of medicine errors, including erstwhile a caregiver accidentally gave a diligent 10 times nan prescribed magnitude of insulin, sending him to nan hospital, nan inspection study said. The caregiver had misread 4 units arsenic 40. Since Roufs's death, inspectors person faulted nan infirmary six times for various lapses, astir precocious successful April 2024 for improper coiled care.

An Encompass infirmary successful Texarkana, Texas, misused antipsychotic medications to pacify patients, resulting successful an contiguous jeopardy uncovering from CMS, nan study said. And nan company's infirmary successful Erie, Pennsylvania, was issued an contiguous jeopardy usurpation for not keeping way of medicine orders successful 2023, erstwhile a diligent had a cardiac apprehension aft not receiving each of his drugs, according to nan inspection report.

The national government's wide value oversight efforts are limited. Medicare docks costs to rehab accommodation for patients readmitted to a wide infirmary during shorter-than-average rehab stays, but dissimilar astatine wide hospitals, location are nary financial penalties erstwhile precocious discharged rehab patients are hospitalized for captious wellness issues.

The Biden management announced past twelvemonth it intended to create a standing standard of 1 to 5 stars for rehab facilities. The industry's waste and acquisition association, nan American Medical Rehabilitation Providers Association, requested a hold successful nan creation of prima ratings until nan existent value measures were refined. The Trump management has not wished whether it will proceed nan effort to complaint rehab facilities, according to a CMS spokesperson.

Deadly bedsores

The family of Paul Webb Jr., 74, claimed successful a suit that nan Encompass infirmary successful Erie near Webb unattended successful a wheelchair for hours astatine a time, putting unit connected his tailbone, successful 2021. His aesculapian records, provided to reporters by nan family, database a sitting tolerance of 1 hour.

Webb — who had been primitively hospitalized aft a encephalon bleed, a type of changeable — developed tegument harm known arsenic a unit sore, aliases bedsore, connected his bottom, nan suit said. The suit said nan sore worsened aft he was sent to a nursing home, which nan family is besides suing, past home, and he died later that year. In his last weeks, Webb was incapable to stand, sit, aliases move overmuch because of nan injury, nan suit said.

In tribunal papers, Encompass and nan nursing location denied negligence, arsenic Encompass has successful immoderate different pending and closed lawsuits that accused it of failing to forestall unit sores because nurses and aides grounded to regularly reposition patients, aliases announcement and dainty emerging sores. Darby said Webb's decease occurred 3 months aft his Encompass enactment and was not related to his attraction astatine Encompass. He said nary infirmary pinch semipermanent patients could forestall each caller aliases worsening unit sore, but that Encompass' rates were akin to nan 1% nationalist average.

One of Webb's sons, Darel Webb, recalled a informing fixed to nan family arsenic they near an assignment their begetter had pinch coiled specialists: A expert brought up Christopher Reeve, nan character who played Superman successful movies successful nan 1970s and 1980s.

"He goes, 'Remember, Superman was paralyzed from falling disconnected nan horse, but he died from a bedsore,'" he said.

Jordan Rau has been penning astir infirmary information since 2008. Irena Hwang is simply a New York Times information newsman who uses computational devices to uncover hidden stories and illuminate nan news.

Methodology

To analyse nan aesculapian rehabilitation infirmary industry, we obtained and analyzed a database of inspection reports of freestanding rehabilitation hospitals from nan national Centers for Medicare & Medicaid Services, aliases CMS. We besides obtained inspection reports from respective states done nationalist records requests.

We analyzed inpatient rehabilitation installation characteristics and diligent measurement information contained successful infirmary information files from nan Rand Corp., a nonprofit investigation organization. This dataset compiles costs reports each hospitals taxable each twelvemonth to CMS. For each installation for nan years 2012 to 2023, we categorized yearly discharges by installation type (freestanding rehabilitation infirmary aliases portion wrong an acute attraction hospital); installation ownership position (for-profit, nonprofit, aliases government); and which hospitals were owned by Encompass Health nether its existent aliases anterior name, HealthSouth.

Financial accusation astir Encompass Health was obtained from nan company's Securities and Exchange Commission disclosure filings.

We examined nan readmission rates for each inpatient rehabilitation accommodation that CMS publishes successful its value data. CMS evaluates nan wave pinch which Medicare patients were readmitted for perchance preventable reasons to an acute attraction infirmary during their rehab stay. Separately, CMS besides evaluates nan wave of perchance preventable readmissions to an acute attraction infirmary wrong 30 days of discharge from rehab. We besides examined nan complaint of successful return to location aliases community. Figures for each 3 metrics were disposable for astir 1,100 of nan astir 1,200 rehab accommodation successful nan CMS data. The astir caller readmission information covered Medicare discharges from October 2021 done September 2023.

We examined nursing location penalties from nan past 3 years from CMS' information connected nursing homes.