Hospitals need to look beyond CMS for quality, safety issues

Of 86 potential inpatient complications identified in a new report, only 22 are tracked by the CMS, meaning that hospitals may want to look beyond CMS measures while making quality and safety improvements.

“There are a number of important conditions that would be missed if you limited your improvement efforts strictly to the CMS HAC list, or other lists associated with government payments,” Premier's chief medical officer, Dr. Richard Bankowitz, said of the findings.

Although the CMS measures are critical to quality and safety improvement efforts, the Premier analysis suggests broadening the list of complications could help provide a more comprehensive assessment of patient care.

The report identified 86 potential “high-impact” complications, defined as events that significantly increased inpatient mortality, increased costs by at least 20% and increased length of stay by 18% or more. Of those, 64 were unrelated to CMS payment measures.

Of 49,827 potential deaths associated with the 86 complications, CMS measures account for only 2% of the total, according to the report. Of the $4 billion in added costs, the federal list accounts only for 13% of the total.

Premier notes that CMS monitors for events such as sepsis, accidental lacerations or punctures, patient falls, surgical-site infections and hypoglycemic coma. However, the agency does not look at other potential complications, such as acute renal failure, hypotension, respiratory failure, transfusion reactions or GI perforation, considered to be high impact in the report.

“Some of these conditions seemed to be occurring relatively frequently, and some had a surprising association with increased mortality,” said Bankowitz, who pointed to examples such as renal failure, which he said happened in about two out of every 100 hospital admissions, and diabetes insipidus, which was associated with a nearly 16% increased risk of mortality.

The report examined more than 5.5 million discharge records from nearly 530 inpatient facilities in the Premier database for federal fiscal 2013. It identified only a broader list of potentially costly conditions, said Bankowitz. But the next step is to create a model to understand the causes and determine which are potentially preventable.

In the meantime, Premier has narrowed its list to a top 10, which it will encourage hospitals to use to understand the frequency of the events in their own institutions and determine if they need action.

Among the 10 listed, only two—sepsis and pulmonary embolism—are included in CMS payment measures. The others include acute renal failure, hypotension, respiratory failure, aspiration pneumonia, gastrointestinal ulceration, cerebral infarction and ventilator-associated pneumonia.

“Don't stop working on measures that are related to payment; they are important. But do not focus exclusively on them,” Bankowitz said. “You will find there are many possibly preventable sources of harm that are highly impactful to patients and families, and highly impactful to costs,” he said.

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