OIG to CMS: Sharper Eye on Hospitals a Must

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Medicare must exercise much more stringent oversight of hospitals, according to a report issued today by the Office of Inspector General (OIG), U.S. Department of Health and Human Services.

The report explores how state agencies and the Center for Medicare and Medicaid Services (CMS) respond to allegations of serious adverse events at hospitals. While such allegations are investigated promptly, the report stipulates, the subsequent response leaves certain things to be desired.

Notably, reveals the report, CMS “rarely links its investigations to the quality systems it requires hospitals to maintain”. This, OIG says, is despite the fact that hospitals are establishing quality-improvement systems—in order to participate in Medicare..

Moreover, OIG states in the document that when state agencies refer adverse events to CMS, they are rarely requested to assess whether hospitals have fallen out of compliance with quality standards. According to OIG, quality improvement was added as a condition of participation in Medicare because “the hospital should take responsibility for improving its performance rather than relying on the survey process and the threat of punitive actions.”

Meanwhile, state agency responses to complaints alleging serious adverse events were revealed in the report to be generally timely, with problems often delineated therein. However, OIG says, state agencies and CMS often failed to review hospitals' compliance with conditions of participation (CoP) on quality assessment and performance improvement (QAPI) and the CoP on hospitals’ governing bodies; 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 their ability to learn from alleged events.

Furthermore, contrary to its policy, CMS was discovered to have informed the Joint Commission of few complaints, impeding the latter’s oversight of its accredited hospitals.

“We also found that hospitals investigated most alleged adverse events in our sample, and that they found state agency responses valuable, but disruptive,” the report reads. “Hospital corrective actions resulted largely in training coupled with policy and process changes.”

In its conclusions to the report, OIG recommends that CMS require all “immediate jeopardy” complaint surveys that bring to light the most serious adverse events to be followed by a review of whether the hospital in question is in compliance with the QAPI CoP, as well as ensure that state agencies monitor subsequent corrective actions for sustained improvements.

OIG also entreats the agency to amend guidance on disclosure to explain the nature of complaints to hospitals and improve communication with accreditors.

CMS reportedly concurs with the recommendations.

To read the report, click here: http://oig.hhs.gov/oei/reports/oei-01-08-00590.pdf