In Final Ruling CMS Upholds Pledge to Transparency

August 3, 2018
Statement from Leah Binder, President and CEO of The Leapfrog Group, Regarding Fiscal Year 2019 CMS Inpatient Prospective Payment System (IPPS) Final Rule

In May, The Leapfrog Group issued a call to action on a CMS proposed rule that could potentially curtail or eliminate public reporting of safety measures and infection rates at hospitals. On August 2, CMS issued its final rule, and this statement addresses its provisions on transparency of key patient safety and infection measures. 


Overall, we are satisfied that in this final rule CMS pledges full and detailed public reporting of critical patient safety and infection measures. We are also gratified by CMS’ clear, bold language stating that patient safety and transparency are priorities.


Nonetheless, we are disappointed that CMS will remove critical patient safety and infection measures* from the Inpatient Quality Reporting Program (IQR), the program established during the George W. Bush Administration that gives the American public access to information on the performance of their hospitals. This rejects the strong recommendations in comments by Leapfrog and hundreds of consumer advocates, employers, and other payors and purchasers.


However, the good news is that CMS pledges to preserve a high level of transparency. CMS states they will publicly report the errors, injuries, and infections they removed from the IQR, and the information will be published on Hospital Compare and in a downloadable database, maintaining the dates and details the public accessed through the IQR.


In addition, we are pleased that CMS will include the patient safety and infection measures noted above in the Value Based Purchasing Program (reversing its proposal to remove them) as well as the Hospital Acquired Condition (HAC) Reduction Program. This means hospitals will continue to receive payment incentives for these measures in both programs established under the Affordable Care Act. No hospital should be paid a reward for excellence if they have a high rate of preventable infections or errors, so we commend CMS for retaining these key safety measures as a consideration in the Value Based Purchasing Program.


While we appreciate that CMS intends to maintain full transparency on patient safety and infections, as Leapfrog and others stated in our comments to the proposed rule, it is deeply concerning that CMS currently has little or no mechanism for publicly reporting measures that are not in the IQR. To address this problem, in this final rule CMS states they will delay removing the infection measures from the IQR by one year, giving the agency time to put the new public reporting infrastructure in place. We will watch closely to assure this happens smoothly, and we are glad to offer feedback and assistance to CMS in the process. There should be no compromise in public access to critical, life-and-death information about American hospitals.


We want to thank the hundreds of individuals, business leaders, health system leaders, business groups on health, and other citizens and organizations from almost all 50 states who came together in this action. You stood up for patient safety and transparency. CMS has listened, and we are grateful.


Read Leapfrog's full analysis of the CMS IPPS FY 2019 rule here.


*The following critical patient safety and infection measures will be removed from the IQR, but still publicly reported through Hospital Compare, the CMS database, and two payment programs:

  • 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
  • PSI 90 (Comprising the following PSIs)
    • 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
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