Our continued coverage of the CMS Open Payments website includes transparency-related issues regarding the Physical Payment Sunshine Act and also a look at similar CMS projects. In particular, in August it was announced that CMS quietly stopped publicly reporting when hospitals leave foreign objects in patients' bodies or make a host of other life-threatening mistakes. But in September, CMS reversed course and will resume releasing data on hospital mistakes, including when foreign objects are left in patients' bodies or people get the wrong blood type. Recent reports suggest CMS's efforts are a part of the agency's larger transparency policy efforts we have seen over the past few years.
CMS's Hospital Compare website began reporting hospital-acquired condition (HAC) data in October 2011. The website includes data such as hospital rates of infections, mismatched blood transfusions, pressure ulcers, and objects left inside surgical patients.
In August, CMS cited National Quality Forum's (NQF) support for the decision to stop reporting particular sets of hospital data. Upon a closer read, NQF's support is analogous to an argument we make about Open Payments. Specifically, an NQF spokesperson argued that the panel decided to drop some of the data because it was not "appropriate for comparing one hospital to another." A majority of the quality forum's members represent consumers, insurers and others who buy health care, but the spokesperson acknowledges those who do not work full-time in the field — as hospital officials do — could find the process confusing. Similarly, stakeholders of Open Payments worry that data used to compare physicians to one another may be misunderstood. Or perhaps even worse, attributed to the wrong physician.
Another interesting perspective was reported in 2011 when CMS first started to release hospital data. Gregg Meyer, M.D., Senior Vice President for Quality and Patient Safety at Massachusetts General Hospital, attacked the credibility of CMS's data. He argued that administrative data is not a reasonable mechanism to use to select on hospital over another.
"I would argue that some of the institutions that have a relatively high number of HACs are safer by virtue of the fact that they are more open and transparent, they have a better reporting system in place and they are doing something about these conditions," Meyer concluded.
Ultimately, CMS reversed course, and now says it will make hospital mistake data on eight "hospital-acquired conditions" (HACs) available on its website. This decision comes in the face of opposition from hospital officials that argue some incidents, such as foreign objects left in bodies, don't happen often enough for the information to be reliable.
We will continue to report on the Hospital Compare website, as this is likely not the end of the controversy over what information is most appropriate to establish a sufficient level of "transparency". Already, according to CMS, the agency removed HACs that were rare events and therefore difficult to track reliably.