Healthcare Analytics, Population Health Management, Healthcare Big Data


CMS Rule to Raise Patient Safety, Hospital Quality, Care Access

A proposed rule issued by CMS will require hospitals to enhance patient safety efforts, improve quality, and expand access to care in order to participate in Medicare and Medicaid.

By Jennifer Bresnick

- A new proposed rule announced by CMS this week aims to address several critical lingering gaps in the nation’s efforts to improve patient safety, raise hospital quality, and increase access to services for many traditionally underserved populations.

Hospital quality, patient safety, antibiotic stewardship

The new standards would update the requirements that hospitals and critical access hospitals must meet in order to receive Medicare and Medicaid reimbursement. 

These revamped conditions for participation will focus on reducing preventable readmissions, demolishing barriers to care, cutting the rate of hospital-acquired conditions such as infections and pressure ulcers, and raise the level of antibiotic stewardship required to avoid the rise of untreatable superbugs.

“Working with tools provided by the Affordable Care Act, hospitals have taken significant steps to improve safety and quality in the past several years,” said Kate Goodrich, MD, MHS, Director of the Center for Clinical Standards and Quality.

“Already, efforts to reduce healthcare-associated infections have resulted in reducing health care costs by nearly $20 billion and saving 87,000 lives.”

READ MORE: FDA Antibiotic Stewardship Tool Offers Centralized Data Resource

“This proposal further supports hospitals’ safety and quality efforts by requiring all Medicare and Medicaid hospitals to have designated leaders in charge of specialized programs to prevent infections, improve antibiotic use, and follow nationally recognized guidelines,” she added. 

If finalized, the proposed rule would implement the following updates and changes to Medicare and Medicaid participation requirements:

• Hospitals and CAHs must have organization-wide infection prevention and control protocols, as well as antibiotic stewardship programs that address the rampant overuse of antibiotics by clinicians in the inpatient setting.  Leaders of these infection control and antibiotic stewardship programs must have designated leaders who are qualified through recognized training or certification processes

• CAHs and acute care hospitals must also establish and adhere to policies expressly prohibiting discrimination in care access or services based on race, color, religion, national origin, sex, gender identity, sexual orientation, age, and/or disability.

• Hospital Quality Assessment and Performance Improvement (QAPI) programs must include quality indicator data related to readmissions and hospital-acquired conditions.  CAHs will be required to develop, implement, and maintain their own QAPI programs to improve patient care quality.

READ MORE: Antibiotic Stewardship, Patient Safety Plans Get Industry Support

• Patient documentation must include support for all diagnoses, describe patient progress and responses to prescribed therapies, information to justify all admissions and hospitalizations, and contain discharge and transfer summaries, including discharge instructions provided to the patient.

• Hospitals must allow their patients to access their medical records in the form and format requested by the patient, including electronic and hard copy formats, if the data is “readily producible” in the format required.

The rule would also clarify certain provisions in the existing conditions of participation, such as changing the term “licensed independent practitioner” to “licensed practitioner” in order to give physician assistants more leeway to practice at the top of their licenses according to their qualifications and state regulations.

The rule adds to the sharp federal focus on patient safety, access to care, and hospital quality, all of which are central to the healthcare system’s broader goals of systemic reform. 

Recent research has found that nearly a third of antibiotic prescriptions may be unnecessary, and that more than three-quarters of hospitals routinely overprescribe the treatment.

READ MORE: Avoidable Admissions for Long-Term Care Dual Eligibles Down 31%

While hospitals have made great strides towards meeting their patient safety improvement goals, antibiotic resistance, poor adherence to infection control protocols, and inadequate reporting practices make it difficult to further reduce the incidence of hospital-acquired conditions.

On top of that, the ONC said this week, health IT tools may be compounding the problem.  Electronic health records, which are supposed to help providers improve patient safety and care quality, often contribute to the problem when used incorrectly.

“We know that we can help to reduce the potential of health IT-related safety events to ensure better outcomes for patients,” said Andrew Gettinger, MD, the ONC’s Chief Medical Information Officer and Director of Clinical Quality and Safety. “Working together, we have a tremendous opportunity to improve health care by improving the safety of health IT.”

As the health system makes progress with the thorny issue of health IT usability, providers may be able to leverage these tools to improve their population health management competencies, expand access to care, and reduce disparities in quality and outcomes produced by socioeconomic issues.

The proposed rule will help to achieve these goals by codifying a zero-tolerance policy for discrimination based on patient attributes, experiences, or conditions, said Cara James, PhD, Director of the CMS Office of Minority Health.

“This rule marks the first time that CMS has proposed explicitly to prohibit hospitals that accept Medicare and Medicaid from discriminating against patients,” she said.

“We know that barriers still remain in accessing quality care for communities that have been traditionally excluded or underserved. This proposal reinforces the principle that access to needed health services should not be blocked because of discriminatory practices.” 


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