Trump administration rule could stop public reporting of hospital infections despite death toll
This was originally published on USA TODAY
Federal health regulators will have to stop releasing data on hospital infections — which affect one in 25 hospital patients every day — under a proposal set to take effect in November, according to an analysis by patient safety advocates.
The Centers for Medicare and Medicaid Services' (CMS) plan, part of a complex 500-page proposed rule, could halt the public disclosure of the "super bug" MRSA, post-operative sepsis and surgical site infections, as well as accidents and injuries ranging from bedsores to respiratory failure after surgery.
If the proposed rule is finalized, CMS' Hospital Compare website won't show the infections or safety measures as to do so, the data would have to be in a program the Trump administration said hospitals should no longer have to report infections and other safety problems to.
More than 600,000 hospital patients a year contract an infection and sepsis alone kills about 270,000 people a year.
Leapfrog Group, a hospital rating organization, urged patient safety advocates to contact regulators or sign Leapfrog's letter to CMS protesting the plan. Anew hospital infection report out from Leapfrog Wednesday found the percentage of hospitals reporting to the Leapfrog Hospital Survey and achieving zero infections is way down since 2015.
"I am shocked that they want to reverse course on this," says Jeanine Thomas, who founded the MRSA Survivors Network after nearly dying of the infection after ankle surgery 18 years ago. "In fact, they should do more."
CMS chief medical officer Kate Goodrich said the agency "is committed to transparency of quality and cost information" and denied that it was proposing to remove the information from Hospital Compare. She also emphasized that the changes are up for public comment.
Hospitals apparently hadn't been lobbying for the change, but the American Hospital Association said the amount of data required by different federal programs was burdensome and the change would allow them to focus more on patient safety.
"I'd never see them having the gall to be that outrageous," says Leah Binder, Leapfrog's CEO. "But I'm sure they are not going to complain."
Transparency can only get worse, she added.
"It's highly unlikely we'll get the level of information we get now and I think we won’t get anything," says Binder.
The Inpatient Quality Reporting Program, which contains the safety data at issue, was established in 2005 during the George W. Bush administration. That's also when Hospital Compare began disclosing some hospital safety measures. Consumers, businesses, some health care providers and policymakers pushed the moves as a way to increase transparency by paying hospitals through Medicare to report on errors, injuries, and infections.
“The public should be concerned whenever there is a national effort in health care to withhold information, to not provide us with accurate information about hospital infections and other harms, or to otherwise adversely impact transparency," says infection control expert Larry Muscarella, who owns LFM Healthcare Solutions and the blog Discussions in Infection Control. "In my opinion, such efforts are suspect unless independently documented to improve patient care and reduce spiraling costs.”
The information CMS would no longer release includes what's known as "never events," because they are preventable and therefore should never happen. Binder calls them the "things most of us are afraid of."
Thomas, who has a rare form of cancer known as a sarcoma, had 11 surgeries in the last three years at Loyola University Medical Center in Chicago which then had a C rating from Leapfrog. (It now has a B.) She says she convinced herself that one in 25 odds weren't too bad, but then was "beside herself" when she contracted the bacterial skin infection cellulitis.
CMS will put include certain infection and safety measures in a program that penalizes the worst-performing hospitals — those with safety scores in the worst-performing 25 percent of hospitals — by reducing their reimbursement from the Medicare program by 1 percent. This "value-based purchasing" program was part of the Affordable Care Act (ACA).
Efforts to reduce hospital-acquired conditions, such as adverse drug events and injuries from falls helped prevent an estimated 8,000 deaths and save $2.9 billion between 2014 and 2016, according to a CMS report out June 5.
Currently, if hospitals don't report safety data, they get penalized by losing up to a quarter of the financial incentives available to them.
The change would give hospitals that have really bad infection rates the incentive to just stop reporting the data they get penalized for, says Thomas of the MRSA network. The penalty for not reporting, she says, is far less than hospitals can make by giving people infections because they aren't using sterile practices and then treating them for those infections.
Why less transparency?
"It's amazing that anyone would allow the hospitals to become less transparent," says Gene Leonard, whose wife Carol died after contracting a strep infection and then sepsis while at Medstar Washington Hospital Center early last year.
Publicity surrounding infection rates and other patient safety information "needs to be more pronounced," says Leonard. He notes his family didn't learn of the timing of the leaks and poor sanitation at Washington Hospital Center until his family's lawyer requested documents from Washington's health department under the Freedom of Information Act after USA TODAY reported on the leaks.
Two of the Leonard's three daughters are doctors and one of the physicians, Erica Leonard, said she did online research about the surgeon but not the hospital, due to the relatively minor nature of the procedure.
Carol Leonard's thyroid cancer surgery is known as a "clean" surgery because it carries such a low risk of infection due to contamination. The lawsuit claimed that Leonard contracted a strep infection and then sepsis while in the hospital.
"We would have acted a lot differently," Gene Leonard says, if the family knew how poorly Washington Hospital Center was rated a D by Leapfrog and two stars by CMS.