"We are concerned that sharing a detailed report may not be the most useful or effective strategy for informing the public," Nancy Foster, vice president of quality and patient safety at the American Hospital Association, said in a statement. Foster suggested it might be more useful to require accreditors to provide a summary of the reports with key takeaways.
Experts favoring the rule reject claims that the data won't help consumers. "The audits being done by these agencies are not revealing the level of problems that seem to exist," said Michael Abrams, co-founder of Numerof & Associates, a healthcare consulting firm. He points to the roughly 700,000 people who develop an infection at U.S. hospitals and the estimated 250,000 people who die each year due to medical errors.
The CMS and others have questioned how effective accreditation organizations are at finding problems. A 2014 report on 103 acute-care hospitals by state officials found accreditors missed 39 serious deficiencies after their reviews. These gaps "raise serious concerns" about private accreditors' ability to "appropriately identify and cite health and safety deficiencies during the survey process," the CMS noted in the proposed rule.
In its comment letter, the Joint Commission, which accredits nearly 21,000 healthcare organizations across the country, argued that the rule would actually harm transparency, suggesting that clients are more comfortable sharing concerns and issues because they know the reports are confidential .
The rule would "make providers less candid about their weaknesses on our surveys, (and) it would chill the open and confidential dialogue that is the foundation of our improvement efforts," the Joint Commission said.
Both the Joint Commission and the ACHC are also concerned the rule would be expensive and disruptive. Saying it would have to deploy new software and hire additional staff, the Joint Commission predicted startup costs for the rule would cost it $3.97 million in the first year, and $2.3 million in startup expenses for subsequent years.
Since the CMS only audits only 10% of providers, private accreditation organizations carry the lion's share of the load.
Yet the relationship between private accreditors and providers has an "inherent potential for conflict of interest," said François de Brantes, director of the Center for Payment Innovation at the Altarum Institute. Providers pay a fee for accreditors' services.
Releasing the reports publicly would empower providers to maintain quality standards and improve care, de Brantes said. It also would enable providers who perform well to tout their achievements to consumers, fostering competition.
Concerns about administrative burden and cost aren't an excuse to reject the rule, de Brantes said. "Patients won't stop coming. But what might happen is that things improve."
Abrams said it's important for accreditors to invest in ways to make the reports easy to understand. If that means they have to charge providers more for services to swallow the cost, so be it, he said. "They can charge hospitals just a little bit more."
The proposed rule reflects a growing push from consumers for more information about where they receive care, Abrams said. "Consumers are beginning to see healthcare like the other things they purchase," he said.