Hospital complications kill thousands per year – CMS shouldn’t hide that data

In February, four leaders from the Centers for Medicare and Medicaid Services (CMS) and the Centers for Disease Control and Prevention (CDC) made a dismaying announcement in the pages of a leading medical journal: “Since the pandemic began, U.S. health care safety has declined severely.” They said a decade’s worth of progress in patient safety had evaporated. The leaders pledged to focus on patient safety as a top federal priority.  

Apparently, somebody in the Medicare program didn’t get the memo. Just two short months later, CMS proposed rules that, if finalized, will move us backward, not forward on patient safety. CMS proposed to suppress the data on 10 avoidable errors and accidents in hospitals that kill almost 25,000 people a year. That would mean the public could not compare hospital performance on more than half the measures of harm CMS makes available to the public.

Contained in a composite called PSI-90, the complications include preventable complications from surgery like blood leakage, kidney harm, breathing failure, sepsis, wounds that split open, and accidental cuts and tears, as well as preventable complications from medical care such as deep bed sores, lung collapse, falls that break a hip, and blood clots.

The risk of suffering one of these excruciating events is not the same for all patients. For all 10 complications, patients are at least twice as likely to encounter them if they use the worst hospital instead of the best. For instance, patients are four times more likely to die from a preventable blood clot and nine times more likely to have a surgical hemorrhage if they choose the wrong hospital. If CMS suppresses this data, patients will have no way of knowing their risk of death or harm at their local hospital.

Race and ethnicity play a role in patient risk as well. For instance, in a groundbreaking report analyzing millions of claims, Urban Institute researchers found that hospitalized Black patients were far more likely than their white counterparts to suffer from many of these medical and surgical complications, even at the same hospital. Black patients had a 27 percent higher rate of experiencing sepsis after an operation and a 15 percent higher rate of experiencing a kidney injury requiring dialysis.

CMS argues that it would be inappropriate to use and publicly release this patient safety data because of COVID, which makes it difficult to fairly calculate the data. We all recognize that hospitals were under tremendous strain in 2020 and 2021 during the peak of the pandemic. We respect the sacrifices health care workers made. But that doesn’t make it right to hide the data on what happened.

CMS says the suppression of PSI-90 is temporary, only for a year or two. But every day 68 people will die unnecessarily, and many more will suffer terribly. Americans deserve to know what federal officials know about where death and suffering occur.

The idea CMS would “suppress” any data is new, finalized in rulemaking last year. CMS hard-wired suppression with the new acronym, MSFs, or Measure Suppression Factors — vague guidelines that they will use to justify data suppression in the future. Nonetheless, CMS proposes to suppress PSI-90 without any justification from its own vaunted MSFs. More perplexing is why CMS needs to give itself suppression guidelines that thwart its legal obligation to inform the public.

Leaders of CMS have acknowledged that patients are not safe in American hospitals, and the work ahead to achieve patient safety is long and daunting. At Leapfrog, we believe transparency is key to sustained transformation. We would like to see real-time reporting on quality and safety derived from (patient de-identified) electronic medical records. CMS should report safety and quality for all facilities, like pediatric hospitals or urgent care clinics. We need more measures on safety, particularly medication safety, which is unreported today but the most common error made. CMS should not allow facilities to report their quality by the health care system instead of by the facility.

An ancient Chinese proverb reminds us that “a journey of a thousand miles begins with a single step.”  There’s a long journey ahead to save lives lost unnecessarily in American hospitals. Almost any step will work, but not a step backward.    

Leah Binder is the president and CEO of The Leapfrog Group, representing employers and other purchasers of health care calling for improved safety and quality in hospitals.