OIG: CMS lacks the teeth to ensure hospitals are ready for emerging infectious diseases

A federal watchdog found the Centers for Medicare & Medicaid Services (CMS) lacked the authority to ensure that accredited hospitals had appropriate emerging infectious disease preparedness plans in place during the COVID-19 pandemic.

In a report released Monday, the Department of Health and Human Services Office of Inspector General (HHS OIG) found that CMS was only able to request, not require, that private accreditation organizations perform special targeted infection control surveys among the roughly 4,200 hospitals to which they provide accreditation.

These accreditation organizations suspended their normal reaccreditation surveys and had not performed any of the requested special surveys as of January 2021, with some saying that doing so would be unsafe, the OIG wrote. They instead opted to perform virtual accreditation surveys that “placed an additional emphasis on infection control.”  

The OIG noted that a fraction of accredited hospitals were still surveyed last year by state survey agencies, over which CMS does have authority, but that these and other mitigation efforts did not come close to achieving the agency’s overall emerging disease preparedness goal.

“CMS’ limited authority creates a significant risk that it will not be able to ensure quality and safety at the nearly 4,200 accredited hospitals throughout the United States the next time an emerging infectious disease threatens the country,” the OIG wrote in the report.

RELATED: OIG: Hospitals face challenge balancing COVID-19, routine care amid increase in burnout among staff

CMS’ addition of emerging infectious diseases to hospitals’ required emergency preparedness plans came in 2019 but did not take effect until February 2020, the OIG wrote.

With accrediting organizations only required to conduct a reaccreditation survey once every three years, the agency would not be able to ensure all hospitals were compliant with the new infection control guidance until 2022 without the special surveys.

The OIG said that the actual controls CMS laid out for hospitals in 2019 were “well-designed and implemented,” but recommended regulatory changes that would allow the agency to require private accreditation organizations to perform special surveys during a public health emergency or after CMS issues substantive new participation requirements or guidance.

The OIG conducted its audit from April 2020 through April 2021. The watchdog said that it provided a draft report that included its recommendations to CMS and, in a letter from CMS Administrator Chiquita Brooks-Lasure dated June 2, 2021, received a warm response from its fellow HHS entity.

“CMS concurs with making regulatory changes to require [accrediting organizations] to perform special surveys of hospitals based on CMS' discretion,” Brooks-Lasure wrote in the response letter. “As OIG acknowledged, CMS' authority over [state survey agencies], and their ability to conduct complaint surveys, mitigated the extent of the effect of [accrediting organizations] not performing targeted infection control surveys.”