CMS can't ensure that hospitals are prepared for emerging infectious disease threats like COVID-19, according to a federal watchdog report released Monday.
Although the agency announced in February 2019 that hospitals had to plan for potential outbreaks, CMS can't confirm that all hospitals have updated their emergency preparedness plans during the pandemic because it only inspects them every three to five years, HHS' Office of Inspector General said in its report. That's mainly because CMS can't require accrediting organizations, which inspect about 90% of Medicare and Medicaid-approved hospitals, to carry out more frequent quality and safety surveys or targeted infection control inspections.
"CMS' limited authority creates a significant risk that it will not be able to ensure quality and safety at the nearly 4,200 accredited hospitals throughout the United States the next time an emerging infectious disease threatens the country," the report said.
The agency will have to wait until Feb. 1 to have that information.
In response to a wave of reports that hospitals had inadequate infection control practices, CMS directed state survey agencies, which certify about 10% of Medicare and Medicaid-approved hospitals, to conduct and prioritize targeted infection control inspections beginning in March 2020. State survey agencies stopped prioritizing those inspections in August but still do them as needed.
"The targeted infection control surveys were to use a survey tool provided by CMS to ensure that providers implemented actions to protect the health and safety of individuals in response to COVID-19," the report said.
CMS had asked accrediting organizations to do similar inspections, but they refused to do it, citing safety concerns.
"The organizations also said that, during this period when they believed it was not safe to perform targeted infection control surveys, they performed triennial reaccreditation surveys using remote access technology and placed additional emphasis on infection control," the report said.
But according to HHS OIG, accreditation organizations carried out just 148 triennial inspections and no complaint surveys involving infection control or emergency preparedness from March to August last year, leaving the remaining accredited hospitals largely unsupervised. State survey agencies served as a backstop, performing infection control surveys at about 13% of accredited hospitals during that period. However, they couldn't inspect hospitals in 13 states because they didn't have the authority to do it.
The federal watchdog recommended that CMS require accreditation organizations to perform special surveys after it issues new participation requirements or guidance and during a public health emergency to address the risks presented by the crisis.
CMS agreed with OIG's recommendation.
Hospitals can participate in Medicare and Medicaid if they get approval from a state survey agency or one of four accrediting organizations. State survey agencies certify hospitals every five years, while accrediting organizations survey hospitals every three years.