The federal government this month quietly stopped publicly reporting when hospitals leave foreign objects in patients’ bodies or make a host of other life-threatening mistakes.
The change, which the Centers for Medicare and Medicaid Services (CMS) denied last year that it was making, means people are out of luck if they want to search which hospitals cause high rates of problems such as air embolisms — air bubbles that can kill patients when they enter veins and hearts — or giving people the wrong blood type.
CMS removed data on eight of these avoidable “hospital acquired conditions” (HACs) on its hospital comparison site last summer but kept it on a public spreadsheet that could be accessed by quality researchers, patient-safety advocates and consumers savvy enough to translate it. As of this month, it’s gone. Now researchers have to calculate their own rates using claims data.
Before the change, the Hospital Compare website listed how often many HACs occurred at thousands of acute care hospitals in the U.S. Acute care hospitals are those where patients stay up to 25 days for severe injuries or illnesses and/or while recovering from surgery. Now, CMS is reporting the rate of occurrence for 13 conditions, including infections such as MRSA and sepsis after surgery, but dropping others.
CMS said some of the new data include different, more reliable measurements of the same condition, such as the use of Centers for Disease Control and Prevention data on bloodstream infections.
CMS changed what it reports to make it “more comprehensive and most relevant to consumers,” spokesman Aaron Albright said in an e-mailed statement. He said the new measures received “strong support” from a partnership of the National Quality Forum, the public-private entity that reviews performance measures that might be used in federal or private reporting and payment programs, and CMS prefers to use NQF-endorsed measures because they “offer a rigorous and thorough review process.”
However, patient-safety advocate Helen Haskell said she believes some members of the hospital working group she was on thought they were voting to strengthen, not drop, the measures.
“When we voted, I certainly didn’t think it would result in the (hospital acquired conditions) being removed from Hospital Compare,” said Haskell, whose son died in 2000 of a reaction to medication after surgery. .
NQF spokeswoman Ann Grenier said the panel decided the data should be dropped because it wasn’t “appropriate for comparing one hospital to another.” A majority of the quality forum’s members represent consumers, insurers and others who buy health care, but she acknowledges those who don’t work full-time in the field — as hospital officials do — could find the process confusing.
The Affordable Care Act mandates that the 25% of hospitals with the highest rates of certain other HACs, including hip fractures or sepsis after surgery, receive up to 1% less in Medicare reimbursement.
Although CMS and the American Hospital Association question the reliability of the data on mistakes including foreign objects left behind after surgery, those data are considered reliable enough to penalize hospitals. Additional Medicare or Medicaid reimbursement is withheld if treatment is related to one of the eight HACs.
CMS said it’s working on new ways of measuring HACs that would represent some of the most common adverse events in hospitals; the HACs that are no longer publicly available are considered rare events that should never happen in hospitals. That makes them both harder to track — and, patient-safety experts say, more important for consumers to know about.
USA TODAY reported in March 2013 that foreign objects may be retained after surgery twice as often as the government estimates, or up to 6,000 times a year . Sponges, which can embed in intestines, account for more than two-thirds of all incidents, For patients who survive, the complications can last a lifetime, leading some to lose parts of their intestines.
The reporting of information about mistakes has to be reliable or it doesn’t benefit hospitals or consumers “and defeats the purpose of being transparent,” said Nancy Foster, quality and patient-safety vice president for the American Hospital Association
Other experts say consumers have a right to the information.
“People deserve to know if the hospital down the street from them had a disastrous event and should be able to judge for themselves whether that’s a reasonable indicator of the safety of that hospital,” said Leah Binder, CEO of the Leapfrog Group, which issues hospital safety ratings.
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