Leapfrog Issues a Call to Action

June 12, 2018

Leapfrog Urges Preservation of Transparency of Infection and Other Safety Measures

Leapfrog is issuing a call to action for individuals and organizations to help us counter a significant threat to the transparency of the safety of American hospitals. We call on the

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Centers for Medicare and Medicaid Services (CMS) to not withhold or curtail public information on deadly infection rates and rates of accidents and injuries in American hospitals, which are among the leading causes of death in the United States.

We are asking that supporters of transparency send a letter (or sign ours) commenting on this year’s CMS proposed rule for the Inpatient Prospective Payment System (IPPS).  That proposed rule would remove certain critical measures from the one and only federal program that exists to publicly report safety and quality information by hospital: the Inpatient Quality Reporting Program (IQR). The IQR was established in 2005 during the George W. Bush Administration, in response to calls from consumers, business leaders, visionary providers, and policymakers for increased transparency.  Under the IQR, hospitals are paid by Medicare to report on errors, injuries, and infections, and that information is publicly reported for patients and others.

The following are the infection measures slated for removal from the IQR:

  • Catheter-associated urinary tract infection (CAUTI)
  • Clostridium difficile (C. Diff)
  • Central line-associated bloodstream infection (CLABSI)
  • Methicillin-resistant Staphylococcus aureus (MRSA)
  • Surgical site infection (SSI) – hysterectomy and colon
  • Postoperative sepsis rate

In this same proposed rule, CMS is also proposing to remove an important patient safety composite measure, which includes rates of accidents and injuries common in hospitals, from the IQR.  This composite and the specific measures within it need to continue to be available to the public in the IQR:

  • PSI 03 – Pressure Ulcer Rate
  • PSI 06 – Iatrogenic Pneumothorax Rate
  • PSI 08 – In-Hospital Fall with Hip Fracture Rate
  • PSI 09 – Perioperative Hemorrhage or Hematoma Rate
  • PSI 10 – Postoperative Acute Kidney Injury Requiring Dialysis Rate
  • PSI 11 – Postoperative Respiratory Failure Rate
  • PSI 12 – Perioperative Pulmonary Embolism or Deep Vein Thrombosis Rate
  • PSI 13 – Postoperative Sepsis Rate
  • PSI 14 – Postoperative Wound Dehiscence Rate
  • PSI 15 – Unrecognized Abdominopelvic Accidental Puncture/Laceration Rate

Among the reasons given in the proposed rule for removing infections from the IQR is the amount of time hospitals spend counting them, about 2 million hours. Yet studies suggest that infections cost the economy $147 billion a year and untold suffering and grief. The least we should expect of hospitals is that they record the problem accurately, especially when the IQR pays them for doing so.

The proposed rule would preserve the measures in certain other CMS programs that came about as part of the Affordable Care Act (also known as Obamacare). Those programs tie a portion of Medicare payments to performance on infections and other preventable patient harm. While we agree Medicare should scale its payments to the actual quality of services delivered as those programs do, that’s no substitute for letting consumers decide for ourselves how well a hospital is doing—the central purpose of the IQR. Moreover, the measures in the IQR allow employers, health plans, and other purchasers—who pay for the majority of Americans’ health care—to structure their own contracts and purchasing programs to get better value. 

Even as the proposed rule would move these safety measures out of the IQR, it would also confine each measure to just one Obamacare payment program, meaning financial penalties for infections and errors would be reduced. Infection and other safety measures should be included in all payment programs, because quality and cost-effectiveness are nullified when safety is absent. No hospital should be paid a reward for excellence if they have a high preventable infection rate.

The bottom line: Moving the measures out of the IQR means that timely data on infections and other patient safety information may no longer be made available to the public. The public deserves full transparency of safety and quality measures, and a full commitment to the IQR.

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