Patient groups oppose CMS plan to suppress reporting on some safety measures

The agency said some data would be skewed by the COVID-19 pandemic. Critics say the move could harm patients and deprives the public of vital information.

Consumer advocates are urging the Centers for Medicare and Medicaid Services to drop a proposal that would limit reporting on patient complications in hospitals.

Critics say suppressing the reporting on safety measures could hurt patients and prevent the public from obtaining critical information. The Leapfrog Group, a watchdog organization focused on patient safety, said the CMS plans are ill-timed after a recent federal report on Medicare patients suffering complications in hospitals.

CMS is planning to curb reporting on 10 measures of hospital complications as part of a proposed rule for the 2023 fiscal year. The agency plans to stop reporting on rates of complications from surgery, such as blood leakage, sepsis, accidental tears, as well as complications from medical care such as bed sores, lung collapse, falls that break a hip, and blood clots.

Hospitals can face financial penalties for lagging in certain patient safety areas. CMS said it is still planning to collect the information but said it would be unfair to use the data as a punitive measure, since hospitals were so profoundly affected by the COVID-19 pandemic. Hospitals have battled staff shortages, burnout and financial difficulties throughout the pandemic.

Leah Binder, president and CEO of The Leapfrog Group, told Chief Healthcare Executive she’s mystified at why CMS wouldn’t continue reporting on those measures. She acknowledges hospitals have faced enormous challenges during the COVID-19 pandemic in caring for patients.

“I have a deep respect for them, and so does everyone, really, have an enormous respect for what hospitals accomplished during the pandemic and how hard it’s been for them,” Binder said in an interview. “That said, we still need to know what happened to patients in hospitals during the pandemic. And we need to know if they got hurt or killed from other medical errors unrelated to COVID-19.” (The story continues after the video.)

The Leapfrog Group uses data from CMS as part of its ratings on hospital safety. The group argues the measures that would be suppressed involve serious and preventable complications that kill 25,000 people annually and harm 94,000 people each year.

The CMS plan to reduce reporting on some complications is part of the 2023 Hospital Inpatient Prospective Payment System proposed rule. CMS is accepting comments on the proposed rule until June 17.

‘Too much is at stake’

The Leapfrog Group has engaged in an online campaign encouraging CMS to reconsider its proposal, and is urging critics to send letters to the agency.

Binder said the timing is especially bad following a May report on hospital complications from the Office of Inspector General of the U.S. Department of Health and Human Services.

One in four Medicare beneficiaries (25%) experienced patient harms in hospital stays in 2018, the inspector general’s report found. In addition, 12% of Medicare patients in hospitals experienced adverse events “that led to longer hospital stays, permanent harm, life-saving intervention, or death.”

The inspector general’s report recommended that CMS should expand reporting of common, preventable and high-cost events. In the report, CMS concurred with that recommendation.

Citing the inspector general’s report, Binder said she’s baffled that CMS is now moving to reduce reporting on some hospital complications.

“It’s ironic, CMS said, ‘We need more data, not less.’ Then they turn around and say, ‘Let's have less data reported.’ It was very unfortunate,” Binder said.

Binder said she understands the COVID-19 pandemic has affected hospitals and the pandemic would likely have an impact on patient safety metrics. But she said that’s not a reason to suppress data, even if it’s only done temporarily.

“We just don't go around suppressing data because it’s uncomfortable or we want to be nice,” Binder said. “That’s not how it works. Too much is at stake. Patients are entrusting their lives to these hospitals and we need to know how safe they are. If they’re not safe, we need to know that, regardless of how our feelings might be hurt.

“CMS should not withdraw its responsibility to Medicare beneficiaries by saying, ‘We’re just going to hold off on it for a couple years,’ she said. “That’s not how it works. We need to know.”

Providing accurate data

Lee Fleisher, CMS’ chief medical officer and director of CMS’ Center for Clinical Standards and Quality, said the policy change reflects the need to offer reliable data.

“Throughout the COVID-19 Public Health Emergency (PHE),  CMS’ top priority has been ensuring access to safe, comprehensive health care, and patient safety will always be our primary concern,” Fleisher said in a statement.

“An important part of CMS’ commitment to patient safety is ensuring public access to the highest quality data regarding the performance of health care facilities: We want the public to have complete trust in the data and will only be providing data we have determined has a high confidence of credibility and accuracy," Fleisher said.

A CMS spokesperson said via email that some patient safety data could be skewed by the pandemic, and some hospitals were affected differently by the pandemic in different ways.

“Safety, transparency and quality of care of patients is not enhanced by the use of skewed or inaccurate data, and, in fact, could result in negative impacts on patients,” the CMS spokesperson said.

“We haven’t stopped data collection on these measures and are not proposing to do so in the IPPS proposed rule,” the CMS spokesperson said. “The proposed policies are intended to ensure that these programs do not reward or penalize hospitals based on circumstances caused by the PHE for COVID-19 that the measures were not designed to address. Examples of the types of external factors that the PHE has had that may affect quality measurement include changes to clinical practices to accommodate safety protocols for medical personnel and patients, as well as unpredicted changes in the number of patient stays and facility-level cases.”

Federal officials, including some at CMS, have previously voiced concerns about setbacks in patient safety during 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 pointed to 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. They also said the government would consider more oversight to spur providers to improve.

The U.S. Labor Department in March launched a three-month period of increased inspections of hospitals and nursing homes treating COVID-19 patients.

A ‘hot button’ issue

In light of declines in patient safety during the pandemic, groups serving employers, such as the Leapfrog Group and others, argue now is not the time to offer less information.

It’s a “hot button” issue for employers, said Bill Kramer, executive director for health policy for the Purchaser Business Group on Health.

“Employers are increasingly frustrated with the lack of transparency in the healthcare industry generally and useful information on patient safety specifically,” Kramer told Chief Healthcare Executive.

“While all hospitals are under enormous stress, some hospitals did a better job of continuing strong patient safety performance in this crisis. And others did not,” Kramer said. “We need to know not only in the aggregate what happened, we need to know hospital by hospital.”

Employers are seeking hospital-specific information because that’s key to their benefits plans and in deciding which health systems are part of their preferred provider networks, Kramer said.

He also said CMS should continue reporting that information to advance patient safety and to spur improvement in the healthcare system.

“The public needs to know the degree and the nature of these patient safety issues, these avoidable harms and deaths, so we can learn from that and strengthen hospitals’ ability to manage patient safety during future public health emergencies,” Kramer said.