CMS has proposed requiring private accrediting organizations (AOs), like the Joint Commission, to publicly release what have been confidential survey reports of hospitals. Dozens of AOs and the facilities they inspect asked the agency to take that change out of the final Medicare Inpatient Prospective Payment System (IPPS) rule for 2018, arguing the reports shouldn’t be treated like healthcare quality data.
In the proposed regulation, CMS said the change would provide additional transparency to consumers, as well as correct disparities between inspections done by AOs and state regulators. Several commenters said they understood and supported the general goal of greater transparency, but argued making these survey reports and the resulting corrective actions taken by hospitals would only confuse consumers and paint an unfair picture of a hospital’s safety record.
“These reports are almost unreadable to the general public and actually provide little useful information to enable consumers to make informed decisions,” wrote Barry Arbuckle, PhD, president and CEO of the five-hospital MemorialCare Health System in southern California. “We are concerned these lengthy reports will be misinterpreted by patients, when they are making decisions about their healthcare needs and providers.”
Hospitals raised other concerns as well. Kaiser Permanente said Joint Commission surveys include elements of performance well beyond CMS minimum standards. Advocate Health Care, the largest health system in Illinois, said safety issues identified in AO reports are often corrected immediately, leading patients to be worried about deficiencies which have already been addressed.
Louisiana Hospital Association President and CEO Paul Salles said the proposal could have the exact opposite effect than CMS intended.
“Releasing the information AOs collect on hospitals and other healthcare organizations would make providers less candid about their weaknesses on surveys; it would diminish the open and confidential dialogue essential for improvement efforts,” Salles wrote.
The AOs themselves were even more strongly opposed to publicly releasing the reports. The largest accrediting body, the Joint Commission, criticized CMS for having “obscured” the radical change by placing it in an 1,800-page regulation related to inpatient payments, along with bashing the substance of the rule. It argued making survey reports public would hamper AOs’ ability to create new standards, increase costs on health systems, expose proprietary information and create a culture of adversity between the inspectors and healthcare organizations.
“We do not shy away from transparency but we stand firmly for quality improvement and patient safety,” wrote Joint Commission President and CEO Mark Chassin, MD, MPP, MPH. “We recommend that CMS revisit this proposal and work with AOs, consumers, and other stakeholders on an initiative to identify what information can be best utilized by the public rather than simply releasing the raw survey reports and plans of correction.”
Several AOs said the change wouldn’t hold up in court, as a portion of the Social Security Act says the HHS Secretary cannot broadly release confidential survey reports. It may also violate one of President Donald Trump’s own executive orders that all new regulations be budget-neutral, according to the Accreditation Commission for Health Care.
Of the more than 8,000 comments on the IPPS rule, a few did express support for the change. The praise came from groups likely to make use of the data—the Association of Health Care Journalists (AHCJ), consumer research and magazine publisher Consumer Reports, the Medicare Payment Advisory Commission (MedPAC) and the Leapfrog Group, which publishes hospital safety grades.
“We support this proposed revision in the strongest possible terms,” wrote Leah Binder, Leapfrog’s president and CEO. “Making private, national accrediting organization reports publicly available would be a significant step toward increased transparency in health care, and fully justified when accreditation reports are used to deem providers eligible to receive public funding. Leapfrog strongly believes that the best way to improve the quality, safety and affordability of health care in the United States is through transparency and public reporting, and consumers deserve to know how their providers perform.”