The Centers for Medicare & Medicaid Services remains acutely focused on patient harm and will introduce new measures addressing patient safety later this year, agency leaders said at an event in Baltimore Tuesday.
That was one topic of several broached with providers during visits to all 10 CMS regions in 2022 and 2023. They included a stop at a 2-star rated nursing home in Chicago, CMS Principal Deputy Administrator & Chief Operating Officer Jon Blum told providers at the CMS Quality Conference.
Dora Hughes, MD, acting chief medical officer and acting director of the CMS Center for Clinical Standards and Quality, said conversations with providers and new insights about the challenges they face will help inform additional patient safety-related conditions of participation, value-based payment measures or other tools that could be tweaked to prevent harm.
“We have been very strategic in leveraging our different levels of resources, our authority, our programs, truly coming together to really think through how we can elevate the importance of patient safety,” Hughes said. “How can we do more, do better? This is truly a CMS priority and our priority is certainly a [Centers for Disease Control and Prevention] priority and an overarching administration priority, and you will continue to hear more from us across the federal government on patient safety.”
Agency officials are working with other Health and Human Services branches and meeting internally to develop a 10-point patient safety strategy to be unveiled later this year.
That ongoing work includes a reevaluation of what harm is, a list that could evolve from the 29 “never events” envisioned by the National Quality Forum in 2021, said Michelle Schreiber, MD, CMS Deputy Director for Quality & Value and Group Director for the Quality Measurement and Value-Based Incentives Group.
“There are other new harms to consider, such as diagnostic excellence … EMR error, cybersecurity, or the future harm that may come from poorly designed artificial intelligence,” she explained. “Second, we’re very committed to ensuring that patients, caregivers and their voices are heard throughout patient safety.”
For instance, Schreiber said, CMS could encourage or require more communication about patient safety events, including use of the CANDOR method to address errors head-on. Other changes could be to require services in additional languages, a resident’s rights issue that has already begun to surface in some nursing home regulations.
More SNF connections
Schreiber said the agency has already adopted “a suite of new patient safety measures and will be introducing more this year.” She also noted those measures will play an increasing role in the agency’s value-based program.
CMS now has 27 pay-for-performance payment programs for specific settings or provider types, including a set of skilled nursing metrics that is expanding after years of facilities being judged by their hospital readmission data alone.
“We use these programs to drive accountability. We link payment to them, and we use them most importantly in our public reporting and our Care Compare sites so that the public can actually see this data and it can help them make informed decisions,” Schreiber said.
She added that the measures will also increasingly aim to drive equity among underserved populations and decrease
“We’ve all been making steady improvements, but we also recognize that during COVID that many of those improvements were sadly lost. There were many reasons for that, but one of them was that our safety systems really weren’t durable enough or resilient enough to withstand some of the challenges. We need to ensure that our safety systems are durable and are working because we know that patient harm is still occuring.”
In nursing homes in particular, CMS previously instructed surveyors to get back to the basics on some core issues — including resident mobility, weight loss, pressure ulcers and use of antipsychotic medications — that increased during the pandemic.
Later in the afternoon, Health and Human Services Inspector General Christi Grimm emphasized her office’s continued interest in patient safety standards, noting that prior OIG work has found that as many as one-third of all Medicare beneficiaries on a SNF stay had experienced “harm.”
“We may never get to zero harm, but making it our goal is extremely important so that everybody is doing what they can to minimize harm,” Schreiber said. “We can do this by making safety data transparent and promoting high-reliability techniques.”
