| Statement of Deficiencies | (X1) Provider/Supplier/CLIA Identification Number 531310 | (X3) Date Survey Completed 05/03/2012 |
| Name of Provider or Supplier Powell Valley Hospital | Street Address, City, State 777 Avenue H, Powell, WY | |
| For information on the provider's plan to correct this deficiency, please contact the provider or the state survey agency. | ||
| (X4) ID Prefix Tag | Summary Statement of Deficiencies
(Each deficiency should be preceded by full regulatory or LSC identifying information) |
| C0195 | AGREEMENTS - CREDENTIALING & QA CFR(s): 485.616(b) Each CAH that is a member of a rural health network shall have an agreement with respect to credentialing and quality assurance with at least - (1) one hospital that is a member of the network; (2) one QIO or equivalent entity; or (3) one other appropriate and qualified entity identified in the State rural health care plan. This STANDARD is not met as evidenced by: Based on review of contracts, credentialing files, and staff interview, the facility failed to have a credentialing services agreement with a qualified entity for credentialing any physician, midlevel practitioner, or certified registered nurse anesthetist. The findings were: Review of credential files revealed the credentialing process that resulted in approval for these professionals did not include the services of another qualified entity. Review of provided contracts showed no evidence there was an agreement for credentialing services by another qualified entity. Interview with the CEO on 5/3/12 at 8:30 AM revealed an agreement was in place with the Quality Improvement Organization for quality assurance, but he had not found an agreement with any entity for credentialing. At 10 AM that day, the CEO stated there was no agreement for credentialing services to be provided by an outside agency. |