CMS is not doing enough to identify hospitals that may be gaming the system and reporting inaccurate quality data, according to a recently released HHS Inspector General report. Hospitals are responsible for self-reporting quality data to CMS as part of the inpatient quality reporting program, and this data is used to determine financial penalties.
In 2016, CMS met its regulatory requirement to validate IQR data when it randomly reviewed the data of 400 randomly selected hospitals as well as 49 hospitals targeted for failing to report half their healthcare-associated infections or for having low passing scores in the prior year's validation process.
However, "CMS selected none of these [targeted] hospitals using analysis-based criteria, such as aberrant data patterns or rapid changes in reporting," the report reads. In fact, CMS staff identified 96 hospitals with aberrant data patterns, but did not target them for validation even though the agency can select up to 200 targeted hospitals for review, according to the report.
"To identify potential gaming or other inaccurate reporting of quality data, we recommend that CMS make better use of analytics to ensure the integrity of hospital-reported quality data and the resulting payment adjustments," the OIG recommended.
Specifically, the OIG report suggested CMS "identify hospitals with questionable patterns of data, prioritize hospitals that most warrant further review, and include those hospitals in the targeted sample for data validation."
Peter Pronovost, MD, PhD, senior vice president for safety and quality at Baltimore-based Johns Hopkins Medicine, told NPR this illustrates a larger problem in the industry.
"There are greater requirements for what a company says about a washing machine's performance than there is for a hospital on quality of care, and this needs to change," he said. "We require auditing of financial data, but we don't require auditing of quality data, and what that implies is that dollars are more important than deaths."