Accreditors Can Keep Their Hospital Inspection Reports Secret, Feds Decide

This article originally appeared on ProPublica on August 3, 2017.

Reversing course, federal health officials withdrew a proposal that would have required private accrediting organizations to publicly release reports of problems they found in health care facilities. Accreditors and hospitals had panned the idea; consumer advocates and business groups supported it.

By Charles Ornstein

Federal health officials have backed down from a controversial proposal that would have required private accreditors to publicly release reports about errors, mishaps and mix-ups in the nation’s hospitals and health care facilities.

The Centers for Medicare and Medicaid Services had proposed in April that accreditors publicly detail problems they find during inspections of hospitals and other medical facilities, as well as the steps being taken to fix them. Nearly nine in 10 hospitals are directly overseen by these accreditors, not the government.

But in a notice released Wednesday afternoon, the government withdrew the proposal. CMS said that federal law prohibits the agency from disclosing the results of inspections performed by the accrediting organizations and that the proposal — though it required accreditors, not the agency, to release the reports — “may appear as if CMS was attempting to circumvent” the law.

“CMS is committed to ensuring that patients have the ability to review the findings used to determine that a facility meets the health and safety standards required for Medicare participation,” the agency said in a fact sheet. “However, we believe further review, consideration, and refinement of this proposal is necessary to ensure that CMS establishes requirements, consistent with our statutory authority, that will inform patients and continue to support high quality care.”

The government’s proposal, and subsequent about face, comes as federal officials have grown increasingly concerned that private accreditors aren’t picking up on serious problems at health facilities.

Health care facilities that receive federal funding are required to comply with Medicare’s requirements and thus are subject to government oversight. But the law allows hospitals, ambulatory surgery centers, home health agencies and hospices to pay private, national accrediting organizations for such oversight instead.

Every year, CMS and state health agencies inspect a sample of hospitals and other health care facilities accredited by private organizations, in order to validate the work of the groups. In a report to Congress last month, CMS noted that its reviews in fiscal year 2015 found that accrediting organizations often missed serious deficiencies found soon after by state inspectors.

Leah Binder, president and CEO of The Leapfrog Group, a coalition of employers that advocates for quality and transparency in health care, criticized the CMS decision to back down.

“This is disgraceful, unfair to patients as well as employers and other purchasers of health care,” she said in an email. “The public deserves full transparency on how the health care industry performs. Instead, transparency has been sacrificed to accommodate special interests that lobby to avoid disclosing embarrassing information about health care quality.”

The government’s proposal to make accreditors’ reports public was strongly protested by accreditors and the hospitals that pay them for their services. Some questioned its legality; all challenged its wisdom. The Joint Commission, for instance, said the proposal would increase costs and decrease patient safety. “The provision will adversely affect the collaborative efforts of accrediting bodies and healthcare organizations to improve patient safety and engage in continuous quality improvement,” the commission said in a June letter. “Ultimately, there will be increased patient harm and lower quality.”

Another accreditor, the Center for Improvement in Healthcare Quality, raised similar concerns. “Knowing that survey [inspection] reports are public knowledge will only incentivize hospitals and other healthcare entities to go back to the days of ‘hiding’ quality of care issues from accreditors, rather than working with us to improve the quality and safety of care rendered to patients.”

But consumer groups, business alliances and a group representing health care journalists were supportive, saying consumers deserve more information about the quality of hospitals. The Medicare Payment Advisory Commission, an independent agency that advises Congress on Medicare policy, had urged CMS to implement the requirement as soon as possible, saying it would “enable Medicare beneficiaries to make more informed decisions” about where to seek health care.

Consumer Reports and its publisher, Consumers Union, likewise supported the proposal. “Such survey [inspection] results provide insight into hospital quality that is not now transparent. … Consumers have a right to know this critical information that is used to determine if facilities are in compliance with health and safety requirements for Medicare patients, and thus, all patients.”

Though accreditors have to be approved by the secretary of Health and Human Services, they rarely take punitive action against the organizations they oversee. Of the 4,010 hospitals listed on The Joint Commission’s website, more than 99 percent have full accreditation and only eight are on track to lose their “gold seal of approval.”

On its website, The Joint Commission allows users to check the accreditation status of hospitals but provides scant information on inspection findings, even when hospitals are described as receiving a “preliminary denial of accreditation.” For one hospital, the explanation is: “Existence at time of survey of a condition, which in The Joint Commission’s view, poses a threat to patients or other individuals served.” The threat itself is not specified.

Other smaller accrediting organizations provide even less information.