Medicare threatened to cut off Mesa hospital due to serious repeat violations

MESA, AZ (AZFamily)—In back-to-back years, Medicare nearly cut off a Valley hospital due to serious repeat violations.

That’s the kind of thing that shuts facilities down and doesn’t happen often.

Arizona’s Family has been investigating Banner Baywood Medical Center in Mesa and how federal and state agencies say patient safety was at risk.

Just last year, the state health department handed down a civil penalty because a 76-year-old man died at another hospital after Banner Baywood failed to perform proper triage when he presented with symptoms of a stroke.

The facility is now back in good standing with federal and state agencies. Arizona’s Family spoke with experts who say this case is one of many that show a pattern of pervasive problems, and the buck stops with hospital leadership.

“The most disturbing part for me was the systemic piece,” said Will Humble. He previously served as the director of the Arizona Department of Health Services and has worked in public health for more than three decades.

He is talking about violations from the top down at Banner Baywood, a 342-bed hospital in Mesa. “It’s so unusual to see these kinds of findings at a large urban, complicated hospital,” said Humble.

Those findings include a heap of serious repeat issues that put patient safety at risk in 2022 and 2023, documented by DHS and the Centers for Medicare and Medicaid Services.

CMS is the federal agency that oversees medical providers and, through certifications, allows hospitals to bill Medicare and Medicaid for qualifying patients. “If you’re cut off from Medicare reimbursement as a hospital, that’s the end of your hospital,” said Humble.

CMS has almost cut Banner Baywood off more than once in recent years. Based on CMS data, Banner Baywood is the only short-term hospital in Arizona to receive letters that threaten termination consecutively in 2022 and 2023.

At one point, it even rose to the level of “Immediate Jeopardy,” when citations are so severe they have “caused or is likely to cause serious injury, harm, impairment, or death.”

“That is the major wake up call to a hospital,” said Humble.

“To be perfectly honest, I’d never seen anything like that,” said Brian Snyder. He is a partner at Snyder & Wenner. Last year, his law firm won Arizona’s largest medical malpractice verdict against a different Banner hospital.

“Medical malpractice is the third leading cause of death in the country and it’s for reasons just like we see in these complaints against Banner,” said Snyder.

The state health department found that in 2022, Banner Baywood did not have enough staffing to mitigate falls, and there were times when medications were not given properly. Investigators noted that both resulted in at least one patient’s death.

In response to the deficiencies, CMS sent a letter warning that their Medicare agreement would end if they didn’t fix things quickly.

“If you’re being threatened to get your money cut off by your major payer, that’s a red alert,” said Humble.

Banner Baywood turned in a plan of correction, but additional inspections that year found more problems and CMS sent more letters threatening to terminate participation in the Medicare program. “You’re risking the lifeblood of a hospital, which is money,” said Humble.

Then, last year, the state health department issued a $15,000 fine for “multiple, widespread deficiencies” found at Banner Baywood during an April survey.

“At a hospital 15 grand is chump change. It’s lunch money,” said Humble.

That investigation lists the CEO as the one to blame for a slew of issues, mainly due to inadequate staffing.

“It was the governing body part that was the most egregious to me because it’s systemic and it causes so many problems in so many different ways, not just the clinical outcomes,” said Humble.

Subsequent state inspections in 2023 led to further citations, causing CMS to send several more threatening letters.

“If you don’t have accountability, then you lose performance and, in this case, if you’re at a hospital and your performance slips, people die,” said Humble.

As of this year, the facility is in good standing with the state and the feds.

However, Humble and Snyder agree the fear of CMS termination is likely the only thing that triggered compliance. “It doesn’t take a rocket scientist to know what Baywood was really concerned about was losing their Medicare revenue, not the $15,000 fine from the state,” said Humble.

Arizona’s Family reached out to Banner, and they declined our interview request. They did not address specific violations or how the hospital fixed things, and sent the following statement:

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