CMS Couldn’t Verify Hospital Safety During COVID and Won’t Be Able to Do So in Next Pandemic

CMS was unable to determine whether hospitals were maintaining quality and safety standards during the COVID-19 crisis. And unless changes are made to its regulatory powers, it won’t be able to make that determination during the next pandemic, either. At least, those are the findings of a new OIG report. Here’s a quick briefing on what the OIG said:

Current CMS Oversight System

Among other things, CMS is charged with ensuring that the roughly 4,700 hospitals certified to participate in Medicare and Medicaid meet specified quality and safety standards. To carry out this oversight mandate, the agency relies on surveys carried out by state survey agencies; in some cases, hospitals are deemed to be certified when they’re accredited by a recognized private organization.

In February 2019, CMS called on hospitals of the critical need to update their emergency preparedness plans to prepare for emerging infectious diseases. However, because accreditation organizations typically follow three-year quality and safety inspection cycles, the agency couldn’t make an immediate determination to ensure that all accredited hospitals, i.e., hospitals not inspected by state surveyors, were in compliance and wouldn’t be in a position to do so until 2022.

COVID-19 Exposes System’s Weakness

After COVID-19 emerged in the U.S., CMS requested, but couldn’t require, accreditation organizations to perform special targeted infection control surveys to prepare for COVID-19 patients. Because it was just a request, accreditation organizations performed no such special surveys; it was thus left to the state survey agencies to verify “compliance.” But as of Aug.17, 2020, only 13 percent of accredited hospitals were surveyed by state survey agencies. And because of CMS’ limited regulatory powers, there were 13 states in which not a single accredited hospital was surveyed.

As a result of these limitations, according to the OIG report, CMS couldn’t ensure that accredited hospitals would continue to provide quality care and operate safely during the COVID-19 emergency; and as long as these regulatory hurdles remain in place, the agency won’t be capable of monitoring accredited hospital compliance with quality and safety requirements the next time a pandemic hits the U.S. “CMS’ authority is not sufficient for it to fulfill its responsibility to ensure that accredited hospitals would maintain quality and safety during an emerging infectious disease emergency,” the report concludes.

Recommendations

The OIG report recommended that CMS make regulatory changes to allow it to require accreditation organizations to perform special surveys of hospitals CMS selects:

• After it issues new substantive participation requirements or guidance that it determines warrant additional validation to ensure timely compliance; and
• During a public health emergency to address the risks the emergency presents.