CMS does not have adequate authority to ensure that hospitals will be ready for the next pandemic, and wasn’t able to regulate them well enough to know whether they were maintaining quality and safety during the COVID-19 crisis, according to a new HHS Office of Inspector General report.
As COVID-19 first emerged in the U.S., CMS requested that hospitals perform targeted infection control surveys, but could not require them. Accrediting organizations have done no such surveys and state agencies have performed very few, according to the report released Monday.
OIG recommended CMS develop regulations that allow it to require special surveys during public health emergencies and after substantive new guidance is released. The agency agreed with the recommendation.
While all hospitals that receive Medicare or Medicaid reimbursement are required to meet federal quality and safety standards, nine in 10 facilities accomplish this through one of the four private accrediting organizations.
Routine surveys by these organizations are done about every three years. Many said they did not think on-site surveys were safe when COVID-19 infections rates were high. The Joint Commission, for example, suspended those visits in March 2020.
OIG did not fault CMS for its oversight of hospitals during the pandemic, saying the agency’s controls were “well-designed and implemented.” CMS simply did not have the authority to make sure hospitals were prepared, according to the report.
“Because CMS has limited authority over accreditation organizations, it could not achieve its control objective of ensuring that accredited hospitals maintain quality and safety and respond to risks during the COVID-19 emergency,” according to the report. “Moreover, CMS’s limited authority creates a significant risk that it will not be able to ensure quality and safety at the nearly 4,200 accredited hospitals throughout the United States the next time an emerging infectious disease threatens the country.”
CMS had added emerging infectious disease to requirements for hospitals’ emergency plans in February 2019, but the regulation did not kick in until February 2020, and because of the frequency of accreditation surveys, the agency can’t be sure all hospitals are in compliance until February 2022.
CMS has discussed more oversight of accrediting organizations in recent years. In February 2020, then-CMS Administrator Seema Verma said the agency had noticed inconsistencies in how facilities were inspected and in standards used. She called that unacceptable and also raised concerns about potential conflicts of interest between accreditors and hospitals.
Also, reporting from The Wall Street Journal in 2017 shed light on hospitals that received the accreditation from the Joint Commission, which monitors about 80% of U.S. hospitals, despite a lack of compliance with safety requirements.