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The Centers for Medicare and Medicaid Services dropped a plan to suppress some safety reporting after pressure from patient advocates. The Leapfrog Group cheered the move.
The federal government is going to publicly report on how hospitals are faring in terms of patient safety, but hospitals won’t face penalties for faring worse than their peers.
The Center for Medicare and Medicaid Services announced that it would continue reporting on rates of complications from surgery, such as sepsis, and complications from medical care such as bed sores and falls. CMS will include the data in its star ratings. The CMS made the announcement as part of its final rule on Medicare payments to hospitals for the 2023 fiscal year.
With the move, the CMS reversed an earlier proposal to suppress reporting of safety measures, a plan which had elicited strong opposition from patient safety advocates and some groups representing employers. The agency will not be penalizing health systems under the Hospital Acquired Condition Reduction program, which reduces payments to hospitals if they have higher rates of infections or other complications.
The Leapfrog Group, a nonprofit group which serves as a watchdog for patient safety, applauded the CMS for vowing to publish the safety data. Leah Binder, president and CEO of the Leapfrog Group, told Chief Healthcare Executive Tuesday that it’s vital for the public to have access to that information.
“It’s a win for everybody,” Binder said. “The most important thing for us and the hundreds of people who were part of this campaign was transparency, public reporting of patient safety data by hospitals.”
CMS had planned to pause reporting due to the monumental challenges hospitals have faced in caring for patients in the COVID-19 pandemic. Hospitals have dealt with staff shortages, including doctors and nurses getting infected, and some healthcare workers have left their jobs due to the overwhelming stress. Hospitals have also endured financial woes due to rising labor costs, higher supply costs, and reduced volume as many people have put off treatment for health conditions due to the pandemic.
While acknowledging the difficulties health systems have faced, Binder said it’s critical to know how hospitals have fared in the pandemic.
“They need to know what went well and what did not go well and which hospitals were able to maintain safety through this emergency and which did not, so we all learn from this and do better,” Binder said.
Concerns of misleading the public
The American Hospital Association said it appreciates that hospitals won’t be facing penalties from CMS for the time being. But Stacey Hughes, the AHA’s executive vice president, said the association is concerned about the reporting of the safety data in the pandemic.
“We applaud the agency’s decision not to penalize hospitals under the Hospital Acquired Condition (HAC) Reduction and Value-Based Purchasing Programs next year, recognizing how quality performance has been affected by the COVID-19 pandemic,” Hughes said in a statement.
“However, we are concerned that CMS’ decision to publicly report pandemic-distorted data from the HAC Reduction Program’s patient safety indicator could mislead the public and fail to advance patient safety," Hughes said.
Binder said patients and employers paying for health plans deserve to know how hospitals are performing, even with the additional burdens of the pandemic.
“It allows all of us to make decisions for ourselves,” Binder said. “We still have the option to say we’re not going to go to a hospital that’s not performing. We retain decision making.”
The Leapfrog Group would have preferred to see CMS continue its policy of reducing payments for providers that are seeing a high number of hospital-acquired infections or other complications. But Binder said she understands the agency’s rationale.
“We can live with a pause in a payment program as long as there is full transparency,” Binder said. “We prefer they maintain consistency.”
Erosion of patient safety
Some of the federal government’s top health officials have said they are deeply concerned about the erosion of patient safety in the COVID-19 pandemic.
In an analysis published in the New England Journal of Medicine in February, leaders with CMS and the Centers for Disease Control and Prevention cited a sharp rise in infections and other worrisome indicators about declines in patient safety. The federal officials urged health systems to focus on improving the safety for patients and employees.
The Leapfrog Group issued a report in May that found declines in the patient experience, including staff responsiveness and communication about medication. Binder said those are indicators of concerns for patient safety.
Hundreds of people spoke out against the initial CMS plan to pause reporting on hospital safety, including groups representing employers. CMS acknowledged the feedback it received in announcing it would continue reporting the safety data.
Binder said she suspects the public outcry, including from employers, helped sway CMS to reconsider its plans. Employers have no other avenue to get information on hospitals and patient safety without the CMS reporting, she said.
“I think it had a very significant impact,” Binder said, adding, “It was clear from the tone of the final rule that CMS got an avalanche of public response and they responded accordingly.”
Hospital leaders have acknowledged they need to improve patient safety. Binder said she’s had more conversations with health system executives who have said it’s a critical concern.
“I’ve been talking to a lot of hospital leaders,” Binder said. “They’re passionate about this. They want to turn this around fast. They know it's a major problem. It’s a problem for patients, but it’s also a problem for their workforce. It’s a problem with burnout.”
“I’m seeing a lot of interest and real commitment to put patient safety back at the top of the priority list,” she said.
With CMS committing to reporting on patient data, Binder said her confidence in the agency’s leadership has been renewed.
“Prior to this proposed rule, their leaders have been very articulate in stating their transparency for patient safety,” Binder said. “CMS has reiterated that very strong commitment to transparency and putting patient safety at the top of their list of priorities.”
Measuring health equity
CMS also said it’s implementing new measures to track how hospitals are doing in improving health equity as part of the inpatient quality reporting program. The agency will evaluate hospitals in their commitment to equity by measuring their data collection and analysis, strategic planning and leadership engagement.
In addition, CMS plans to measure how hospitals are identifying “health-related social needs,” including food insecurity, housing instability and transportation needs.
The American Hospital Association supports measuring health equity, but Hughes said the group would like to see the measures refined.
“We believe the measures still need further improvements and clarifications to optimize their feasibility, accuracy and meaningfulness,” Hughes said in a statement. “We look forward to continuing to work with CMS to advance health equity.”