Proponents say it is long overdue, but the public could finally get to see confidential reports about mistakes in American hospitals that put patient safety at risk. The CMS wants to force private health care accreditors to outline the issues they find when inspecting medical facilities across the United States.
There is genuine concern amongst regulators that private accreditors are not finding obvious problems at medical facilities, are ignoring them, or are not fully realizing the extent of the issue. It is especially problematic because private accreditors oversee 90% of hospitals in the U.S. with no input from the government.
A Life-saving Measure
The Centers for Disease Control and Prevention (CDC) publishes an annual list chronicling the leading causes of deaths in the United States. According to a study conducted by Johns Hopkins University School of Medicine, medical mistakes are the third most common cause of death in the country. The CDC’s list places respiratory disease at #3 with 150,000 deaths a year (as at 2016), but Johns Hopkins researchers claim that medical errors result in 250,000 deaths a year.
Medical blunders are by far the leading cause of death in U.S. hospitals. If the research from Johns Hopkins is accurate, it is a frightening increase. A study by the Institute of Medicare in 1999 said that 98,000 people died due to medical mistakes. According to Dr. Martin Makary of Johns Hopkins, people die from poorly coordinated care and system-wide failings.
The figure represents 10% of total deaths in the United States each year and is a staggeringly high amount, especially since we live in an era where patient safety is supposedly the number one priority. Makary said that the patient safety efforts are futile as long as there is no system in place to study medical errors or ensure there are safeguards in place.
Private Accreditors Are Not Doing Enough
The CMS performs annual inspections on a sample of privately accredited hospitals and healthcare facilities to check their performance. In a 2016 report, the CMS discovered that private accreditors routinely missed serious issues later picked up by state inspectors.
In 2014, state officials analyzed 103 hospitals reviewed by a private accreditor within the previous 60 days. The results were astounding. While state officials found 41 serious issues, the accreditor missed 39 of them. In other words, accrediting organizations missed almost everything. This raises a very pertinent question: Are these private organizations capable of identifying and citing serious health deficiencies? If the answer is no, and all evidence suggests a major overhaul is necessary, the results of their hospital inspections must become public.
In contrast to the inaction of private accrediting bodies, the CMS took steps to post government inspection reports online a few years ago. There is also a tool called “Nursing Home Inspect,” created by ProPublica, which enables you to find nursing home deficiency reports. Government reports offer a detailed look at what went wrong, including patient abuse, medication errors, and operations on the wrong patient. The reports also respect the privacy of staff by not naming those involved.
What Are Private Accrediting Organizations Afraid Of?
The largest private accreditor is The Joint Commission, and like the rest of companies in the industry, it has not followed the CMS’s transparency measures. Instead, it has its own disclosure methods; so, while some hospital inspections are public, others remain private. The CMS’s new proposal will force accreditors to make every inspection public.
It is a huge step in the right direction because, at present, patients are in the dark when it comes to determining the quality of the hospitals they visit. They would certainly think twice about trusting a facility if they know it has a track record of medical errors. Surely, high-quality hospitals have nothing to fear.
The problem is that healthcare facilities must meet Medicare conditions of participation to receive federal funding. Failure to meet these minimum standards means a facility loses its Medicare funding. While this sanction is relatively rare, it would potentially cripple a facility financially and force its closure.
Given the high rate of patient mortality due to medical errors, the ratings of hospitals from The Joint Commission are suspiciously high. The CMS provides funding to state health departments for conducting checks, but facilities can pay national accrediting organizations for inspections. For example, The Joint Commission conducts random checks at hospitals at least once every 39-month period, more if there are complaints about a facility. There are over 4,000 hospitals on The Joint Commission’s website. Only seven are in danger of losing its “gold seal of approval,” and only 1% lack full accreditation.
Despite the obvious benefits of making inspections public, the American Hospital Association (AHA) is not on board fully. While it supports the notion of giving the public useful information, it does not believe that detailed health inspection reports fit that description. The concern is that the nature of these reports will mean that only medical professionals will understand them. A spokesperson for the AHA said the organization favors the idea of releasing a 1-2 page summary of inspection findings with pertinent points and their importance.
It is wrong that private accreditors can hide in the shadows. The public deserves to know what happens behind closed doors during Hospital inspections, so they can have the information to make an informed choice. Critics of accreditors say these private entities are guilty of putting patient safety behind the interests of the facilities that pay them.
For example, a 2002 story in the Chicago Tribune outlined how The Joint Commission gave its seal of approval to facilities with a history of under reporting patient deaths due to medical mistakes. Recently, BuzzFeed reported a story where The Joint Commission approved a psychiatric hospital in Oklahoma despite disturbing reports of patient mistreatment.
One thing is clear: Too many patients are dying due to medical errors in American hospitals. The hope is that the CMS’s new initiative will help reduce this number significantly.