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August 8, 2017

Your hospital inspection reports won't become public after all

Daily Briefing

    CMS last week withdrew a proposal that would have required the Joint Commission and other private hospital accreditors to make their inspection and quality improvement reports public within 90 days of visiting a facility.


    The agency had issued the proposal in April in response to concerns that private accreditors' assessments—which currently are not typically publicly released—are not rigorous enough and do not provide as much detail as government reports. 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.

    Tips from a Joint Commission expert on ambulatory care quality and safety

    Hospitals must either be approved by the government or by a private accreditor organization, such as the Joint Commission. About nine in 10 hospitals are overseen by an accreditor rather than the government.

    Industry, advocates were at odds on proposal

    The proposal had drawn criticism from accreditors as well as the hospital industry.

    Accreditors had said that the proposed rule would confuse consumers, compromise their ability to be candid with providers, and generate significant administrative expenses.

    The Joint Commission in comments had stated, "Ultimately, there will be increased patient harm and lower quality." The Joint Commission also had said it would have needed to implement new software and hire additional staff to comply with the proposed rule at a cost of about $3.7 million in the first year.

    Separately, the Center for Improvement in Healthcare Quality had said making the reports public would " only incentivize hospitals and other health care entities to go back to the days of 'hiding' quality of care issues from accreditors."

    In addition, Nancy Foster, VP of quality and patient safety at the American Hospital Association, in a statement had said making the information public "may not be the most useful or effective strategy for informing the public."

    By contrast, patient safety advocates had supported the proposal, saying private accreditors have fallen short in protecting patients form harm.

    Consumer Reports and its publisher, Consumers Union, had said the inspection findings would "provide insight into hospital quality that is not now transparent. ... Consumers have a right to know this critical information that is used to determine if facilities are in compliance with health and safety requirements for Medicare patients, and thus, all patients."

    CMS changes course

    CMS announced Wednesday that it has withdrawn the proposal. The agency cited federal law barring it from releasing findings from the accrediting organizations, saying that the proposal "may appear as if CMS was attempting to circumvent" the law.

    The agency stated that it "believe[s] further review, consideration, and refinement of this proposal is necessary to ensure that CMS establishes requirements, consistent with our statutory authority, that will inform patients and continue to support high quality care."

    Advocates disappointed

    Leah Binder, president and CEO of The Leapfrog Group, a coalition of employers that advocates for quality and transparency in health care, took issue with CMS' reversal. She called the move "disgraceful, unfair to patients as well as employers and other purchasers of health care." She added that "transparency has been sacrificed to accommodate special interests that lobby to avoid disclosing embarrassing information about health care quality" (Ornstein, ProPublica, 8/3; Castellucci, Modern Healthcare, 8/3).

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