CMS' new safety measures are a welcome addition for Peter Silver, MD, senior vice president, chief quality officer and associate chief medical officer of New Hyde Park, N.Y.-based Northwell Health.
CMS solidified plans to add seven new measures to its Hospital Inpatient Quality Reporting program in its Hospital Inpatient Prospective Payment System final rule released Aug. 1.
Dr. Silver said the measures closely align with health systems' efforts to eliminate preventable harm and each plays an important role in improving safety.
One of the most notable is the patient safety structural measure, which hospitals will be required to report on in 2025. The measure will assess whether hospitals have a structure and culture that prioritizes safety across five domains:
- Leadership commitment to eliminating preventable harm
- Strategic planning and organizational policy
- Culture of safety and learning health system
- Accountability and transparency
- Patient and family engagement
"From our governing board to the safety huddles that occur daily in our inpatient units, accountability to patient safety, minimizing patient harm, and optimizing outcomes is part of our culture, and we commend CMS for setting this as the standard," Dr. Silver told Becker's of the new measure.
The Leapfrog Group President and CEO Leah Binder also commended the measure, saying it will "make a profound difference in hard-wiring patient safety into hospitals" and represents "a giant leap" toward national safety improvements in an Aug. 2 statement.
Alongside the structure measure, CMS will also require hospitals to report on a new Age-Friendly measure in 2025. The measure assesses hospitals' ability to improve care for patients 65 and older receiving inpatient, surgical or emergency services. Measure domains include understanding patients' healthcare goals, responsibly managing medications and addressing social vulnerability, among other factors.
"As our population ages, the implementation of Age-Friendly healthcare becomes imperative, and we at Northwell have already been addressing this by achieving Age-Friendly designation for all our adult hospitals," Dr. Silver said.
The aging inpatient population has led to a national increase in falls with injury, which now represent a leading complication of inpatient care, according to Dr. Silver. CMS estimates that 700,000 to 1 million inpatient falls occur annually, more than one-third of which cause injury and up to 11,000 of which result in death.
"This is a difficult problem — balancing the need to optimize mobility for our older patients but reducing the risk of harm from a fall — but one that is very important, and that we have been addressing with improved risk assessment, enhanced rounding, and in some areas, video surveillance of high risk patients," Dr. Silver said.
To support hospitals in these efforts, CMS is implementing a new electronic clinical quality measure for acute inpatient falls that result in major or moderate injury beginning in 2026.
Though CMS' Patient Safety Indicator 90 composite measure does contain a fall-related component, the new measure will allow hospitals "to assess the rate of falls that result in a wider range of injuries, in a much larger patient population," CMS said in its final rule.
The agency is also implementing two additional measures in 2026 that require hospitals to report standardized infection ratios for central line-associated bloodstream infections and catheter-associated urinary tract infections among oncology patients, specifically.
These measures will supplement existing hospital CAUTI and CLABSI measures, which exclude data on inpatient oncology patients.
Northwell has achieved a significant decrease in CAUTI and CLABSI rates over the past year, but Dr. Silver said it's still important to take a focused look at oncology patients who are more susceptible to infection and at higher risk for poor outcomes.
"I do have a concern with the risk adjustment methodology of this measure, as not all cancer patients are the same in terms of their immunosuppression and risk, but overall this is still a commendable measure," he said.