Inspection reports from the Joint Commission and other private hospital accreditors may soon become public under a proposed rule change recently released by CMS, Charles Ornstein reports for ProPublica/NPR's "Shots."
CMS is accepting comments on the proposed rule between April 28 and June 13. According to Ornstein, the proposed change follows CMS' decision several years ago to begin releasing inspection reports online for nursing homes and some hospitals online to provide more transparency.
The change was included in the CMS Inpatient Prospective Payment System proposed rule, which was released Friday, and relates to how hospitals are approved to participate in Medicare. Currently, hospitals must either be approved by the government or by a private accreditor organization, such as the Joint Commission. "Nearly nine in 10 hospitals are directly overseen by those accreditors, not the government," Orenstein writes.
However, regulators have raised concerns that private accreditors' assessments are not rigorous enough. For instance, in 2014, state officials inspected 103 acute-care hospitals that had been reviewed by an accreditor in the prior two months. The state inspections identified 41 serious issues, 39 of which private accreditors had missed.
In addition, private accreditors do not typically release their inspection findings publicly, potentially leaving patients in the dark about serious safety issues, Ornstein writes.
Moreover, according to Ornstein, private accrediting organizations typically do not provide as much detail as government inspection reports. For example, while government inspection reports do not identify patients or medical staff, they do provide detailed descriptions of the identified problem, such as medication errors or patient abuse. In contrast, private accreditors typically only provide opaque descriptions of safety issues, even at hospitals that they list as being in danger of losing accreditation, Ornstein writes.
Under the proposed rule, CMS would mandate that private accreditor organizations publicly release detailed findings from their hospital inspections, as well as the hospital-submitted quality improvement plans aimed at resolving those issues.
According to the rule, the change would "address some of the challenges" related to the accuracy of accreditor surveys and "provide a more comprehensive picture to health care consumers and the public in general." The proposed rule states, "[CMS believes] it is important to continue to lead the effort to make information regarding a health care facility's compliance with health and safety requirements" publicly available.
Patient safety and health care transparency advocates praised the proposed rule. Rosemary Gibson, a patient safety expert, said, "Right now the public has very little information about the places where they're putting their life on the line, and that's just not acceptable."
The Joint Commission said it was still reviewing CMS' proposal, according to Orenstein. However, one of its competitors, the Healthcare Facilities Accreditation Program, said it supported transparency but needed more details.
Gary Ley, executive director of the Healthcare Facilities Accreditation Program, said they had not yet received gotten feedback from hospitals. "It would be a major change for them … It's hard not to support the goals but we have to look at the execution," he added.
The American Hospital Association said consumers should have "useful information" about health care quality, but worried full inspection reports were too blunt an instrument.
Nancy Foster, AHA's VP of quality and patient safety, said, "It's important that the information shared with consumers has a clear purpose, is transparent, and is readily understood by folks from all walks of life, not just those with deep expertise in health care." Instead of a "detailed report," she suggested that a brief, "accurate summary" of a full report with "key takeaways, " as well as a hospital's plans for improvement, might be a better tool to inform the public about quality issues (Orenstein, ProPublica/NPR's "Shots," 4/18; CMS proposed rule, Federal Register, accessed 4/19).
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