Who will guard the guards themselves?


Next time you research a medical facility in the Centers for Medicare and Medicaid Services’ Hospital Compare website, you will find fewer errors. Mind you, that is not to say that hospitals make fewer errors, but that the CMS has been tinkering with a list of hospital acquired conditions (HAC); potentially deadly yet preventable conditions that patients develop only after being admitted into a hospital and caused by malpractice on the part of the facility’s staff. Examples of HAC’s include embolisms, giving patients the wrong blood type, and leaving a surgical supply inside of a patient.

 It all started last summer when the CMS removed eight hospital acquired conditions from its hospital comparison website. These eight HAC’s were relegated to an excel spreadsheet that quality researchers, patient-safety advocates, and consumers were able to access. Though that list wasn’t necessarily user-friendly, it was something, but not it has been removed as well. Currently, the CMS reports the occurrence rate of 13 conditions -such as MRSA and sepsis after surgery-, but many others are left out. Unlike surgical sponges which are often left in, as pointed out above. All the while the CMS denied it was making these changes.

The Hospital Compare tool reported HAC’s occurring at thousands of acute care hospitals in the United States, where people stay up to 25 days for severe injuries or illnesses and/or while recovering from surgery. The data serves as a public service; as Leapfrog Group CEO Leah Binder put it, “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.” Moreover, the information may also be used to penalize hospitals. The 25% of hospitals with the highest HAC rates receive up to 1% less in reimbursement from Medicare, per the Affordable Care Act. The reliability of the reports, though, has been questioned by the CMS and the American Hospital Association. Nancy Foster, quality and patient-safety vice president for the latter, remarks that unreliability “defeats the purpose of being transparent” for both hospitals and patients. 

According to CMS spokesman Aaron Albright, the changes -made on recommendations from healthcare improving not for profit organization National Quality Forum- are meant to make the data “more comprehensive and most relevant to consumers.” The CMS says that the dropped HAC’s are rare and should never happen. However, it was reported last year that surgical instruments are left inside patients’ bodies two times as frequently as the government estimates says they are. Additionally, NQF spokesperson Ann Grenier questions the appropriateness of comparing hospitals, but certain experts think that removing hospital errors from public access is detrimental to consumers. For example, patient-safety advocate Helen Haskell though Hospital Compare would be strengthened rather than stripped.