OIG says CMS lacks authority to ensure hospital safety during pandemics

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Being ready for any future potential pandemics has emerged as a strategic concern in American healthcare, but a new report suggests there's more work to be done to ensure preparedness. The U.S. Department of Health and Human Services' Office of the Inspector General delivered a report this week claiming that the Centers for Medicare and Medicaid Services lacks adequate authority to ensure hospitals are adequately prepared for the next pandemic.

OIG offered a few specific examples. While CMS announced in February 2019 that it was critical for all hospitals to plan for emerging infectious diseases, the agency couldn't determine that all accredited hospitals had updated their emergency preparedness plans to include this planning until 2022, due to accreditation organizations' quality and safety inspection cycles, OIG said.

Also, when the pandemic first hit U.S. shores, CMS requested – but could not require – accreditation organizations to perform special targeted infection control surveys to help accredited hospitals prepare for COVID-19 patients. 

But accreditation organizations performed no such special surveys and, as of August 17, 2020, state survey agencies only performed these surveys at about 13% of accredited hospitals, and had not performed any in 13 states because of CMS's limited authority over accredited hospitals.

These limitations, according to the OIG, meant that CMS couldn't ensure that accredited hospitals would continue to operate safely and provide quality care during the public health emergency – casting doubt on the agency's ability to handle future infectious disease threats.

WHAT'S THE IMPACT?

To meet the objective of ensuring that hospitals maintain quality and safety and respond to risks during an emerging infectious disease outbreak, CMS developed the Emergency Preparedness Rule and related guidance. It used its existing survey system to identify noncompliance with the Emergency Preparedness Rule and require corrective action, and it responded to infection control risk when COVID-19 first emerged. 

CMS also referred hospitals to advice from the Centers for Disease Control and Prevention. It provided training opportunities and engaged in a communications campaign both before and after the emergence of the coronavirus.

While the OIG said these efforts were "commendable," they weren't enough. CMS added "emerging infectious diseases'' to the definition of the all-hazards approach on February 1, 2019. But because hospitals were not expected to add emerging infectious disease to their plan until their next annual update, not all hospitals would have updated their plans until February 1, 2020. 

And because accreditation organizations are only required to perform re-accreditation surveys every three years, CMS can't determine whether all 4,200 accredited hospitals updated their emergency preparedness plans to include emerging infectious diseases until February 1, 2022, OIG said.

When the pandemic first hit, according to OIG, CMS couldn't evaluate current infection control compliance at the nearly 4,200 accredited hospitals to determine if they were prepared to safely handle a surge of infectious patients. Although CMS requested accreditation organizations to perform COVID-19-related targeted infection control surveys, the accreditation organizations did not perform any as of January 2021. 

Some accreditation organizations said that it was unsafe to perform these special surveys and only performed triennial "virtual" accreditation surveys through remote technology, though they said they placed an additional emphasis on infection control. During the period when CMS directed state survey agencies to reprioritize surveys (March 4 through August 17, 2020), accreditation organizations performed 148 triennial surveys and no complaint surveys involving infection control or emergency preparedness. 

THE LARGER TREND

OIG recommended that CMS make regulatory changes to allow it to require accreditation organizations to perform special surveys after it issues new participation requirements or guidance, and, during a public health emergency, to address the risks.

For its part, CMS reviewed OIG's draft report and concurred with the recommendation. CMS also indicated that, in March 2021, it updated its State Operations Manual to include additional planning considerations and preparedness guidance that expanded on emerging infectious diseases.
 

Twitter: @JELagasse
Email the writer: jeff.lagasse@himssmedia.com