Patient safety advocate cheers CMS' reversal on quality reporting, but hospitals say the data are no good

The Centers for Medicare & Medicaid Services (CMS) has pulled back on plans to pause public reporting on certain hospital safety data in the wake of pushback from patient safety advocates.

In Monday’s release of the final Inpatient Prospective Payment System (IPPS), CMS detailed numerous changes from a fiscal year 2023 proposal it had laid out in April.

Among these was a decision to pause a composite measure of 10 patient safety indicators including pressure sores, falls and sepsis called PSI 90.

The agency would have stopped calculating these composite indicators in hospitals’ quality ratings for Medicare reimbursement and stopped publishing them as part of the Star Ratings found on the government’s Care Compare website.

CMS said at the time its decision was intended to shield hospitals that had been harder hit by the COVID-19 pandemic and, subsequently, received a financial and publicity hit compared with hospitals in less impacted regions.

The agency now seems to have split the difference, announcing Monday that it would maintain public awareness while seeking to avoid the unintended financial penalty.

“CMS will include the measure in Star Ratings in alignment with the feedback we received,” the agency wrote. “Although this measure will be publicly reported, it will not be used in payment calculations in the HAC to avoid unintentional penalties related to the uneven impacts of COVID-19 across the country.”

CMS will also be making “technical update[s]” to PSI 90 regarding the minimum volume threshold for 2023 and risk adjustment for history of COVID-19 diagnosis for 2024, according to a fact sheet accompanying the release.

The agency’s decision received a warm welcome from The Leapfrog Group, a patient safety watchdog that has been petitioning the government via letters, reports and informational webinars to keep the hospital quality measure available to the public.

The agency’s new approach manages to continue reporting composite measures responsible for 25,000 deaths per year without the confounding influence of COVID-19, Leapfrog said in a release.

More broadly, the group said it signals the agency’s “powerful support for transparency” and suggests similar data suppression proposals aren’t on the horizon.

“We were gratified to hear CMS reinforce their longstanding commitment to transparency and patient safety,” Leapfrog President and CEO Leah Binder said in a statement. “We thank CMS for their leadership—for listening to and championing patients and families, patient safety advocates, employers, purchasers, clinicians and all Americans who are deeply concerned about patient safety.”

Also calling for the rollback was the National Alliance of Healthcare Purchaser Coalitions. The nonprofit representing private and public sector members had written to CMS (PDF) warning that the data were vital to purchasers’ decisions when building high-quality networks which, alongside safety concerns, would lead to higher costs and the perpetuation of inequities.

On the other side of the fence is the American Hospital Association (AHA). The industry group welcomed IPPS 2023’s rate increase and the decision not to penalize hospitals’ reimbursement over the quality measures but was “concerned that CMS’ decision to publicly report pandemic-distorted data from the [Hospital Acquired Condition] Reduction Program’s patient safety indicator could mislead the public and fail to advance patient safety,” AHA Executive Vice President Stacey Hughes wrote in a Monday statement.

Following the release of the final rule, a representative of AHA also pointed to a mid-July blog post penned by Akin Demehin, AHA’s senior director of quality and patient safety policy. Here, Demehin warned that PSI 90’s individual measure weights and other parts of the risk and reliability adjustment models were set with a pre-pandemic industry in mind.

“As a result, any reported measure results likely would be unfairly skewed against hospitals highly impacted by the pandemic, and would result in misleading data for the public,” he wrote. “In other words, the reporting of PSI data would not only fail to advance patient safety, but it actually could serve to undermine it by sharing inaccurate data with hospitals and the public alike.”