Hospitals Will Still Have to Share Safety Data Publicly

Patient safety advocates and organizations representing large purchasers of employee health plans rejoiced this week after CMS reversed its proposal in May to suppress a composite score of key hospital safety metrics.

The composite score, called the PSI 90, includes the rates of 10 preventable and potentially lethal in-hospital harms such as pressure ulcers, falls resulting in a hip fracture, postoperative respiratory failure, and postoperative sepsis.

In its proposed rule issued in May, CMS argued that hospitals were struggling with multiple pressures such as staffing shortages during COVID-19, and should get a break from being held accountable for their performance on these measures while they were under such duress.

But representatives of consumer organizations including Bill Kramer, executive director for health policy for the Purchaser Business Group on Health and Leah Binder of the Leapfrog Group, which uses the data for its hospital quality of care scorecards, fought back.

“Patients will be unable to know whether the provider they want to go to has more patient safety problems, more risky providers, so clinicians as well as purchasers and policymakers will be unable to identify and help patients choose those hospitals with the best patient safety record,” Kramer said when the rule was proposed. Without that information, patients are more likely to suffer from avoidable accidents, “and some of them will die as a result.”

CMS reconsidered, acknowledging in its final Inpatient Prospective Payment System rule on August 1 that it would not go ahead with its proposed rule to suppress the PSI 90 composite scores. The agency said it found a way to publicly report the PSI 90 data by combining two pre-COVID quarters in 2019 and two quarters during the COVID public health emergency in 2021. In doing so, it plans to exclude from those datasets patients with a COVID diagnosis.

“Since the publication of the proposed rule, we have been able to determine a method for excluding patients with a diagnosis of COVID-19 that will allow us to calculate and publicly report valid and reliable measure results,” the agency wrote in its final rule. “Therefore, based on this measure adjustment and stakeholder support for continued public reporting, we are not finalizing our proposal to suppress the calculating and public reporting of CMS PSI 90 measure results for the FY 2023.”

The agency added that these adjustments provide “an important step in providing transparency and upholding quality of care and safety for consumers.”

In responding to the news that CMS had changed its mind, Missy Danforth, Leapfrog group’s vice president for healthcare ratings, said that now, there won’t be “this huge black hole in publicly available data for these really serious medical and surgical complications until sometime in 2024.”

Likewise, Kramer told MedPage Today in an email that public reporting of PSI 90 will allow consumers and purchasers to compare hospitals’ rates of “preventable errors that kill 25,000 hospitalized patients each year,” enabling patients and their families to see which hospitals had practices and precautions that avoided such medical errors, even during the COVID public health emergency.

“These high performers should be seen as models of excellence for other hospitals as they strive to ensure quality in future pandemics and similar stresses,” Kramer wrote.

PSI 90 is part of the Hospital Acquired Condition Reduction program, a scoring system in which CMS usually imposes a 1% Medicare pay cut on hospitals in the worst performing 25%, in that they had the most preventable adverse events.

However, in its final rule, CMS determined that because of the difficulties hospitals endured during the COVID public health emergency, it “would not be able to score hospitals fairly” in a way that would affect their revenue, so CMS is not imposing the financial penalty for the 2023 fiscal year.

Binder said in an interview with MedPage Today that the Leapfrog Group prefers that CMS would maintain the HAC reduction penalty, which was established by the Affordable Care Act, and impose financial penalties against the hospitals that had the worst scores as the agency has done since the program took effect in 2014. According to CMS, penalizing those hospitals would avoid reimbursing them some $350 million of taxpayer funds for the fiscal year.

“However, we do understand that there are political issues and sensitivities right now for CMS in penalizing hospitals financially for anything” as they recover from the hardships of operations during the pandemic.

For Binder and Leapfrog, “the most important thing for all of us is transparency. And that’s something that CMS has made a firm foundation in this final rule. They are really committed to putting a priority on patient safety, and we credit them for that.”

In a press statement, the American Hospital Association said it was pleased with the agency’s decision not to penalize hospitals under the Hospital Acquired Condition (HAC) Reduction Program as well as the Value Based Purchasing Program, which can mean up to a 2% reduction in payment for poorly scoring hospitals.

“However,” the AHA statement said, “we are concerned that CMS’ decision to publicly report pandemic-distorted data from the HAC Reduction Program’s patient safety indicator could mislead the public and fail to advance patient safety.”

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