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July 7, 2022

Inside CMS' plan to halt quality and safety initiatives and penalties for FY 2023

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    To help ease the burden on strained health care systems, CMS in April proposed suspending certain quality and safety initiatives and associated penalties for fiscal year (FY) 2023—a move that has garnered both support and backlash from industry experts, Mari Devereaux reports for Modern Healthcare.

    Proposed rule would pause safety initiatives and penalties for FY 2023

    In April, CMS published a proposed rule that would pause the calculation and reporting of hospitals' composite Patient Safety Indicators (PSI) 90 data for the Hospital-Acquired Condition Reduction Program (HACRP) in FY 2023.

    Under the proposed rule, CMS would not impose financial penalties or weighted payment adjustments related to HACRP or the Hospital Value-Based Purchasing Program in 2023.

    Notably, CMS is still collecting quality data and will continue to make information on safety measures—like hospital-acquired infections—publicly available. However, the agency has not said when it plans to resume the reporting of hospitals' composite PSI 90, or their associated penalties.

    CMS plans to adjust quality measurement and reporting rules in anticipation of future infectious disease outbreaks, according to an agency spokesperson.In addition, the proposed rule would require hospitals to report data about Covid-19 and seasonal influenza through April 2024, Devereaux writes.

    "CMS's top priority is to ensure access to safe, comprehensive healthcare, and patient safety will always be our primary concern," said Lee Fleisher, CMS' CMO and director of the Center for Clinical Standards and Quality. "An important part of CMS's commitment to patient safety is ensuring public access to the highest quality data regarding the performance of healthcare facilities."

    Industry experts remain divided

    Following CMS' release of the proposed rule, many industry experts have spoken out in favor—and in opposition—of the plan.

    Akin Demehin, senior director for quality and patient safety policy for the American Hospital Association, noted that CMS should find a balance between transparency and fair evaluations of hospital performance during an emergency. According to Demehin, using metrics that were impacted by pandemic conditions would complicate that effort.

    "No one designed any CMS quality measurement and value programs to account fully for the once-in-a-century pandemic," Demehin said. Since the pandemic impacted some hospitals more than others, equitable comparisons may be difficult, he added.

    Kate Beller, EVP of government relations and policy development for the American Medical Rehabilitation Providers Association—one of the trade groups that asked CMS to delay the Inpatient Rehabilitation Facility Quality Reporting Program—noted that employee turnover, stress, and burnout will continue to impede health systems' ability to comply with quality measures and data collection.

    "These challenges are going to persist, and even if it's not under the public health emergency, waivers are a relief," Beller said. "We hope that the penalties and compliance thresholds for the quality reporting program are assessed closely to make sure that they are in line with where the field currently is and the ability to handle more extensive reporting going into next year."

    However, some industry leaders have argued that suspending quality measures and penalties could lead to data suppression. Leah Binder, president and CEO of the Leapfrog Group, said collecting less quality data at a time when quality is most challenged is the wrong approach.

    "We are not in support of suppressing data," she said. "We believe that in a public health emergency, we need all the information we can get on how safe people are in hospitals."

    Binder suggested CMS consider refining its technical measures to account for the pandemic instead of suspending them altogether. This could include using Covid-19 as a risk factor for 30-day mortality and readmission measures.

    Separately, Bill Kramer, executive director for health policy at Purchaser Business Group on Health, warned that the industry will not be able to learn from the hospitals that maintained safety during that pandemic if CMS does not revise its proposed rule and publish this data.

    "Hospital leaders and clinical leaders need to make sure their systems are working and remain in place to ensure quality," Kramer said. "We know that usually problems of patient safety are not caused necessarily by one single error or random events, but are usually caused by a breakdown in quality management."

    Similarly, Harold Miller, president and CEO of the Center for Healthcare Quality and Payment Reform, said "it would be better to have an adjusted measure that isn't perfect than to exclude the data entirely and give all hospitals a pass," Devereaux writes.

    "If you say, 'We're just not going to pay attention anymore because it's a pandemic,' it isn't fair to the patients who are getting those infections," Miller said.

    In addition, suspending the quality measures also raises the question of whether the measures themselves are valuable if they cannot be used during a pandemic, he added.

    "Many hospitals will experience flu outbreaks, natural disasters, floods, tornadoes, hurricanes, fires," Miller said. "If we suppress [measures] for COVID, why shouldn't we be suppressing them for some of these other things? Are there no other circumstances that affect individual hospitals that should require them to have their measures adjusted or suppressed?" (Devereaux, Modern Healthcare, 7/5)

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