An inspector calls: CMS moves closer to unannounced hospital infection control surveys

January 12th, 2015

The Centers for Medicare and Medicaid Services (CMS) continues to hone an infection control survey slated for use in the nation's hospitals by the end of the year, using expert feedback and "pre-testing" results to create a 42-page tool that assesses a wide array of issues. The writing on the wall? It says that all of this will eventually be tied to CMS payouts and reimbursements. Why? Because that's what CMS does better than anybody.

The survey includes sections on infection control programs and resources, coordination with other quality improvement programs, having systems in place to address multidrug resistant organisms, antibiotic stewardship, employee health, hand hygiene, needle use, environment services and cleaning and reprocessing of equipment.

Created in partnership with the Centers for Disease Control and Prevention, the CMS survey has been generally receiving favorable remarks for its design and attention to detail by experts contacted by Hospital Infection Control & Prevention. Indeed, some see it as an eventual game-changer, particularly as CMS begins adding the assessments into its conditions of participation and possibly factoring survey results into coverage and reimbursement formulas.

That could get the attention of senior hospital administrators and greater empower infection prevention programs, but the CMS program is still in a pilot phase. There are some areas of the survey -- i.e., the aforementioned emphasis on antibiotic stewardship -- that cannot be cited under current CMS regulation.

"We are still trying to emphasis the basics. We are having surveyors spend more time at the bedside," says Daniel Schwartz, MD, MBA, chief medical officer of CMS's Survey and Certification Group in Baltimore, MD. "But there are some things that we want to emphasize that we know are not in the regulations – that we are not able to cite."

As we previously reported, infectious disease societies frustrated at watching antimicrobial resistance increase for decades have taken the unusual step of asking the CMS to require hospitals to implement antimicrobial stewardship programs. In that regard, many observers see CMS inevitably regulating more infection prevention components as health care associated infections become a national issue.

While emphasizing that the new CMS survey is not a "pay for performance" initiative in its current form, Schwartz clarified that it is also designed to be more than an educational tool.

"This is what the surveyors will eventually use as part of their survey process," he tells HIC. "As we are developing this tool we are also very cognizant that hospitals will want to take a look at this. We think it will be a good self-assessment for hospitals, and to that extent it is very educational. But after we finish the pilot phase and we put this tool out in its final form then we are going to be expecting CMS surveyors to use this tool to assess infection control compliance."

For more on this important story see the June 2012 issue of Hospital Infection Control & Prevention.