Medicare and Medicaid services centers are responding to the Covid-19 epidemic scandal by offering to hide a rating from the public that allows customers to compare hospital safety records and waive about $ 350 million in fines for about 750 hospitals. Worst patient-safety track record.
CMS Chief Medical Officer, Dr. Lee Fleischer said these safety metrics were not designed to accurately calculate how an epidemic could affect the hospital system, including patient growth and staff shortages.
“The safety, transparency, and quality of patient care is not improved by using biased or inaccurate information, and indeed, can have negative consequences for patients,” he said. “CMS wants the public to have full confidence in the data and provide data on quality while we have high confidence in its reliability and accuracy.”
But advocates for patient safety argue that CMS is hooking hospitals off the hook for their epidemic performance, and many deny the loss of transparency that would cause such data suppression.
Patricia Kelmer, director of healthcare campaigns at the nonprofit U.S. Public Interest Research Group, said CMS “wants to keep patients, payroll and insurers in the dark about what happened during the epidemic.” He added that without penalties, hospitals would not be forced to change before the next crisis that strains the health system.
“There was no comma in the law that said, ‘You don’t have to pay this fine unless it’s an epidemic,'” Kelmer said.
The proposed rule comes after CMS officials publicly acknowledged in the New England Journal of Medicine that hospital-acquired infections – such as urinary tract and staph infections, as well as central-line bloodstream infections – had declined significantly during the epidemic. Also, a May federal report using data from 2018 found that even before the epidemic, 1 in 4 Medicare patients were hospitalized, nearly half of such incidents are preventable.
The Lipfrog Group, a nonprofit patient advocacy group, estimates that more than 24,000 people die each year due to patient safety issues measured by CMS ratings.
The metrics that CMS seeks to suppress are displayed on Medicare’s Care Comparison website, formerly known as Hospital Comparison. The site allows consumers to view a wide range of quality metrics for hospitals, including mortality and admissions rates. These scores will continue to appear under the CMS proposal, but the site will not report data from PSI 90 or “Patient Safety and Adverse Events Composite,” including how often patients have serious complications from potential preventable medical harm, such as falls and sepsis. CMS will release other security data publicly, although the epidemic has complicated it as well.
The fines that CMS seeks to waive are issued annually through the Hospital-Acquired Condition Reduction Program, which was created by the Affordable Care Act. But since PSI 90 will not be available and CMS officials are wary of some metric counts isolated by the epidemic, they say punishing hospitals, as they have done in the past, would not be reasonable.
The poorest-performing hospitals will be exempt from the 1% Medicare payment reduction that CMS would otherwise have implemented throughout the upcoming federal fiscal year, beginning October 1. CMS plans to resume fines in the next fiscal year, starting October 2023.
CMS’s proposal to pause such punishment is reasonable, says Andrew Ryan, a professor of health care management at the University of Michigan’s School of Public Health, who has written extensively on the hospital’s quality program. He noted that the metrics that these financial penalties include are easily skewed by a variety of patient mixes – such as those triggered by covid surge or lockdown.
But Lisa McGiefert, co-founder of the Patient Safety Action Network and president of the board, said she was tired of hearing about the hospital’s administrative strain that would make data reporting, and CMS said it would be difficult to adjust how it compares to hospitals.
“If you die or lose your mother, it’s a real burden,” McGift said.
A 2021 KHN investigative series details the gaps in CMS supervision in tracking and holding hospitals accountable for patients diagnosed with covid disease after hospitalization.
As the epidemic continues, the agency did not add hospital-acquired covid infections to its patient safety quality metrics, Fleischer said. Martha Sharan, a spokeswoman for the Center for Disease Control and Prevention, said a joint effort by the CDC, CMS and the National Quality Forum, a nonprofit aimed at improving the quality of patient care, would establish such metrics as “an emergency post-emergency consideration.”
The U.S. Department of Health and Human Services currently maintains universal, state-by-state reporting of Covid-19 hospital-initiation data, but, as KHN has previously reported, such data does not hold individual hospitals accountable. Patient safety experts say the HHS report is probably a low count because it only tracks hospital-initiated covids that appear 14 days later.
Separately, CMS could still further regulate private accrediting agencies that oversee most hospitals in the United States, following an HHS Inspector General report from June 2021 that found that “CMS failed to ensure that accredited hospitals provide quality care and operate safely. COVID-19 Emergency will continue “and cannot guarantee safety going forward. The report cites CMS’s loopholes in enforcing accreditation agencies to conduct a special, covid-stimulating infection control survey for hospitals to ensure patient safety.
Seema Verma, who served as CMS administrator under President Donald Trump, said hospital-acquired infections are a chronic problem that exacerbates covid – and that most Americans are unaware of when they decide to take care.
He called for more transparency so that patients can decide which hospital is safe for them. He also called for a change in the accreditation system, which he said was fundamentally flawed due to conflicts of interest between the consulting firms of accredited agencies and the hospitals they visit.
“The American public should have faith that those who are conducting the survey have no financial interest in the organization they are conducting the survey,” Verma said.
In the United States, about 90% of hospitals choose to pay privately recognized organizations instead of government inspectors, certifying them as safe. But academics have shown that such agencies were not associated with lower patient mortality, and CMS also has data on how accredited agencies fall short of government inspectors. A possible CMS rule to deal with conflict of interest concerns was supposed to be posted in April but has not yet been published.
Fleischer declined to say when he would expect such a rule to be proposed, but said that CMS had agreed with the Inspector General’s report last summer on the failure of the CMS authority. Fleischer said his company wants to require accredited agencies to conduct special surveys of hospitals based on CMS considerations.
“There will be an opportunity to comment on this,” he said. He added that the agency’s highest priority is to ensure “patients have access to safe, equitable, quality healthcare”.
Patient advocates say the agency needs to do better – and press the public to do so.
“Those who suffered during the epidemic deserve to be held accountable,” McGiffart said. “Honestly, I’m a little shocked at how the American public is being treated that hospitals can’t do what they need to do to keep patients safe during an epidemic.”
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