Citing dozens of deficiencies, CMS is terminating its Medicare agreement with Yorkville Endoscopy, the surgery center where Joan Rivers stopped breathing.

In a Jan. 9 letter to the surgery center, CMS has determined Yorkville Endoscopy "no longer meets the Conditions for Coverage (CFC) for a supplier of Ambulatory Surgical Center (ASC) services. Therefore, CMS is terminating the Medicare Health Benefits Agreement between Yorkville Endoscopy and the Secretary, effective January 31, 2015. As of January 31, 2015 Yorkville Endoscopy will no longer be eligible to receive federal funds for services provided to Medicare and Medicaid beneficiaries." Yorkville has 60 days to appeal the decision.

In 3 statements of deficiencies (here, here and here), CMS details numerous shortcomings, including failures to

• ensure that post-anesthesia evaluations for all patients are completed and documented by the anesthesiologist before patients are discharged;
• develop and carry out a quality-improvement program;
• ensure that all equipment is maintained and operated according to manufacturers' recommendations and federal guidelines;
• post a written notice of patient rights in a conspicuous place and make patient rights clear to non-English speaking patients;
• adequately investigate and address patient grievances; and
• adequately protect patient confidentiality.

CMS also cited the clinic for inadequate fire protection and alarms, and improper oxygen tank storage.

Yorkville was initially given a Jan. 7 deadline to address deficiencies found in a month-long investigation that began the day after Ms. Rivers died. But last week CMS said it was still reviewing findings from a follow-up survey in December.

Ms. Rivers went into cardiac arrest at the clinic on Aug. 28, during what was expected to be a routine throat procedure, and never recovered. In the wake of the tragedy, the clinic had reportedly outlined an improvement plan focused on five key areas. CMS concluded that the clinic had fallen far short of the achieving the improvement it needed to maintain accreditation.

Yorkville Endoscopy did not immediately respond to a request for comment.

Jim Burger