Hospitals still need to share safety data publicly

Patient safety advocates and organizations representing big buyers of employee health plans were ecstatic this week after CMS reversed its proposal in May to suppress composite scores on key hospital safety metrics.

The composite score, known as PSI 90, includes the incidence of 10 preventable and potentially fatal in-hospital injuries, such as pressure ulcers, falls leading to hip fractures, postoperative respiratory failure, and postoperative septicemia.

In a proposed rule issued in May, CMS argued that hospitals facing multiple pressures during COVID-19, such as staffing shortages, should temporarily take responsibility for their performance on these measures.

But representatives of consumer groups, including Bill Kramer, executive director of health policy for the Buyers’ Health business group, and Leah Binder of the Leapfrog Group, which uses the data for its hospital care Quality scorecard, fight back.

“Patients won’t be able to know if the provider they want to go to has more patient safety concerns, more risk providers, so clinicians as well as buyers policy makers won’t be able to identify and helping patients choose the hospital with the best patient safety record,” Cramer said in proposing the rule. Without this information, patients are more likely to suffer avoidable accidents, “where some of them will die.”

CMS reconsiders, in its final hospital expectancy payment system rule Acknowledging that on August 1, it would not proceed with its proposed rules to suppress the PSI 90 composite score. The agency said it found a way to publicly report PSI 90 data by combining the two pre-COVID quarters in 2019 and the two quarters during the COVID public health emergency in 2021. In doing so, it plans to exclude patient diagnoses with COVID from these datasets.

“Since the publication of the proposed rule, we have been able to identify a method for excluding patients diagnosed with COVID-19 that will allow us to calculate and publicly report valid and reliable measurements As a result,” the agency wrote in its final rule. “As such, based on this measure adjustment and stakeholder support for continued public reporting, we have not yet finalized our proposal to suppress the calculation and public reporting of the results of the CMS PSI 90 measure for FY 2023.”

The agency added that the adjustments are “an important step in providing transparency to consumers and maintaining the quality and safety of care.”

In response to CMS’s change of heart message At the time, Missy Danforth, vice president of healthcare ratings at Leapfrog Group, said that now, “this giant black hole in the publicly available data on these really serious medical and surgical complications won’t appear until sometime in 2024.”

Likewise, Kramer told MedPage Today in an email that public reporting of PSI 90 will allow consumers and purchasers The authors compared hospitals’ “preventable fatal error rate” with 25,000 hospitalized patients per year,” allowing patients and their families to see which hospitals have practices and prevention to avoid such medical errors even during the COVID-19 public health emergency. measures. In future epidemics and similar pressures,” Cramer wrote.

PSI 90 is part of the Hospital Acquired Condition Reduction Program, a scoring system that CMS typically implements a 1% Medicare pay cut for hospitals to the worst 25% because they The most preventable adverse events occurred.

However, CMS determined in its final rule that because of the hardship hospitals endured during the COVID-19 public health emergency, it “cannot fairly score hospitals,” which affects them revenue, so CMS will not impose penalties for fiscal 2023.

Binder In an interview with MedPage Today , Leapfrog Group prefers CMS to keep HAC reductions since the program went into effect in 2014 , the agency imposed fines on the worst-scoring hospitals. Penalizing these hospitals would prevent them from being reimbursed about $350 million in taxpayer dollars for the fiscal year, according to CMS.

“However, we do understand that there are political issues and sensitivities at CMS right now as they recover from the hardship and financially impose any penalties on hospitals” operating during the pandemic.

For Binder and Leapfrog, “The most important thing for all of us is transparency. That’s the solid foundation CMS has laid in this final rule. They’re really committed to bringing patients Safety is our number one priority, and we appreciate that.”

The American Hospital Association said in a press statement that it was pleased with the agency’s decision not to act in light of hospital-acquired conditions ( HAC) reduction programs and value-based purchasing programs penalize hospitals, which can mean up to a 2% reduction in payments for hospitals with low scores.

“However,” the AHA statement said, “we are concerned that CMS’ decision to publicly report pandemic-distorting data in the HAC Reduction Program’s Patient Safety Indicators may mislead the public and not promote patient safety.”