Medicare’s Reporting Problem

January 12th, 2015

The Centers for Medicare & Medicaid Services has done a poor job of informing the Joint Commission of serious complaints against hospitals, thereby “impeding the Joint Commission’s oversight of its accredited hospitals,” according to a report released last week by the Health and Human Services’ Office of Inspector General (OIG).

Specifically, the report says that “contrary to CMS’s policy of notifying accreditors of all complaints against the hospitals they accredit, CMS regional offices notified accreditors of only 28 of the 88 sampled complaints against accredited hospitals.”

In addition, the report found that, although state agencies usually responded quickly to complaints of adverse events, those agencies and CMS “performed little longer-term monitoring to verify that hospitals’ corrective actions resulted in sustained improvements; and sometimes failed to disclose the nature of the complaints to the hospitals, thereby limiting hospitals’ ability to learn from alleged events.”

So what’s going on here? At a time when hospitals themselves are being held responsible for reporting bushels of data, why have the agencies that oversee them apparently dropped the ball in communicating both with the Joint Commission and hospitals themselves? And what kind of example does it set for hospitals, who are expected to report sentinel events to TJC, when CMS regional offices aren’t consistently sharing information with accrediting bodies?

As far as what the Joint Commission itself thinks of all this, here’s a passage from the OIG report: “Officials at the Joint Commission told us that its being unaware of complaints against its accredited hospitals compromises Medicare’s quality oversight system in several ways. First, it impedes the ability of accreditors to respond to complaints that may be related to adverse events or other problems at hospitals they oversee. This in turn can deprive accreditors of important information when reviewing a hospitals’s performance to determine whether to renew its accreditation. Finally, not sharing the results of the complaint surveys prevents accreditors from using the survey results to improve the consistency between the outcomes of accreditation surveys and those of State agencies. Such consistency is a key measure that CMS uses to assess the performance of accreditors.”

In his five-page response to the report (which is included in the report itself as “Appendix H”), CMS administrator Don Berwick doesn’t mention the Joint Commission by name and doesn’t suggest any need for CMS to change its current policy regarding the reporting of alleged adverse events to accrediting organizations. According to Berwick, “We will clarify the existing policy for the ROs [regional offices] and work with them to enhance compliance.”

Good enough? We’ll see.