Leapfrog Group Decries Possible Rollback of Patient Safety Measures

As CMS proposes to alter how it reports patient safety data, the Leapfrog Group released a report saying more hospitals are reporting infections since 2015.

The percentage of hospitals taking part in Leapfrog's survey that reported zero infections has fallen dramatically since 2015. Leapfrog measures hospitals on 5 healthcare-acquired infections (HAIs), and while most take part in the survey, not all do. The rating organization called the trend troubling, saying it puts patients at higher risk for numerous complications and longer recoveries.

Most hospitals responding to the 2017 Leapfrog Hospital Survey had fewer infections than would have been expected. But some facilities still have extremely high standardized infection ratios (SIRs), the report said.

To track these infections, Leapfrog relies on these SIRs, which are adjusted for risk factors that may impact infection rates, allowing for comparisons among diverse hospitals.

Factors in these ratios can range from the type and size of a hospital to the type of unit reporting within a facility, and whether or not a hospital is affiliated with a medical school.

A SIR of 1 means the number of HAIs is exactly what would have been expected. Less than 1 means there were fewer HAIs than expected, and more than 1 indicates more HAIs than expected.

Individual facilities reporting as part of the same health system (under the same Medicare Provider Number) sometimes show significant variation on HAIs. Leapfrog reports by individual facility for transparency purposes.

While HAIs are common, they are also largely preventable. Leapfrog said each day, around 1 out of 25 patients in US hospitals contracts an HAI. Of the approximately 2 million patients who acquire an HAI annually, an estimated 90,000 will die.

Selected HAIs can be reduced by as much as 70% with the right interventions, Leapfrog said.

The cost of a single case can range from just under $1,000 to nearly $50,000, depending upon the type of infection, costing hospitals between $28 billion and $45 billion, the report said. Overall, infections cost the economy $147 billion a year, Leapfrog said.

This drives up healthcare costs, as they are passed along to insurers and employers, as well as to patients themselves in the form of higher out-of-pocket costs, the report said.

The 2017 Leapfrog Hospital Survey reports on 5 infection measures:

• Central line-associated blood stream infections in ICUs and select wards (CLABSI)
• Catheter-associated urinary tract infections in ICUs and select wards (CAUTI)
• Inpatient, hospital-onset Methicillin-resistant Staphylococcus aureus infections (MRSA)
• Inpatient, hospital-onset Clostridium difficile infections (C. diff )
• Colon-Surgical site infections following major colon surgery (SSI)

In a rare action alert sent last week, Leapfrog said the proposed rule change by CMS would remove 15 critical measures from the Inpatient Quality Reporting Program (IQR), a federal program that publicly reports safety and quality information by hospitals.

The IQR was established by statute in 2005 in response to calls for increased transparency about patient safety. 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 in Hospital Compare.

"Transparency is non-negotiable," said Leah Binder, president and chief executive officer of Leapfrog, said in an interview with The American Journal of Managed Care® (AJMC®).

CMS said it was making the changes to reduce the reporting burden on facilities as part of its “Meaningful Measures” initiative and would keep some of the measures elsewhere. But Binder said by taking the measures out of the IQR, they would be violating the statute.

Without a financial incentive, hospitals will not report on patient safety, she said. While CMS said some of the information will be reported in other programs that work differently, they will not be reported in a way that is understood by the public, Binder said.

In a letter it plans to send to CMS, Leapfrog said it believes "that all measures related to patient safety must be publicly available in a format that is usable by patients, families, employers, and the public at large."

The American Hospital Association sent a statement to AJMC® saying it supported removing multiple measures. “Hospitals and health systems have long supported transparency on quality and have long shared safety and quality data with the public because patients and their families deserve clear, meaningful information to make health care decisions," said Akin Demehin, AHA's director of policy. "The “de-duplication” approach CMS developed not only maintains the public reporting of these important safety measures, but it also begins to reduce the unnecessary administrative burden in quality programs that has long concerned hospitals. Currently, hospitals have to review multiple different reports for each CMS quality program — all of which might tell them something different about their performance because the scoring approaches are different. By moving measures into just one program, hospitals can spend less time deciphering different reports, and more time doing what actually matters – improving care."

The AHA is "committed to continuing the dialog with CMS and other stakeholders in the health field about the goal we share—providing the public with accurate, meaningful information about quality,” he said.

One of those stakeholders, the New Jersey Health Care Quality Institute (NJHCQI), also urged CMS to reject the proposal.

"Transparency not only empowers individuals with information to choose safe care, but also works to incentivize institutions to improve internal processes to avoid harm," said Linda Schwimmer, president and chief executive officer.