Department of Health & Human Services

Centers for Medicare & Medicaid Services
Form Approved

OMB No. 0938-0391
Statement of Deficiencies (X1) Provider/Supplier/CLIA Identification Number 013430 (X3) Date Survey Completed 04/06/2023
Name of Provider or Supplier Hill Hospital Physicians Clinic Street Address, City, State 724 Derby Drive, York, AL
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)
J0135 PROVISION OF SERVICES

491.9(a) Basic requirements: (3) The laboratory requirements in paragraph (c)(2) of this section apply to RHCs, . . . 491.9(c) Direct services (2) Laboratory. These requirements apply to RHCs . . . . The RHC provides laboratory services in accordance with part 493 of this chapter, which implements the provisions of section 353 of the Public Health Service Act. The RHC provides basic laboratory services essential to the immediate diagnosis and treatment of the patient, including: (i) Chemical examinations of urine by stick or tablet method or both (including urine ketones); (ii) Hemoglobin or hematocrit; (iii) Blood glucose; (iv) Examination of stool specimens for occult blood; (v) Pregnancy tests; and (vi) Primary culturing for transmittal to a certified laboratory.


This STANDARD is not met as evidenced by:
Based on observation, clinic policy, and interviews with staff, it was determined the agency failed to ensure all basic requirements for laboratory services were available to patients served. This deficient practice had the potential to negatively affect all patients served by the clinic. Findings include: Clinic policy: Laboratory Services Provided at the Clinic Policy number: none provided Reviewed: 1/10/23 ...Hemoglobin or hematocrit... A tour of the clinic laboratory area was conducted on 4/5/23 at 12:15 PM with Employee Identifier (EI) # 1, Clinic Manager. A HemoCue Hb-201 hemoglobin testing unit was observed with a package of testing strips with an expiration date of 10/20/21. EI # 1 stated the clinic did not perform hemoglobin or hematocrit testing at the clinic and was unsure if they ever had. EI # 1 further stated the clinic sends all of their lab samples to the hospital for testing. In an interview conducted on 4/6/23 at 1:30 PM, EI # 1 confirmed the clinic failed to perform all required laboratory testing.