Health systems saw deepened racial disparities and worse care outcomes during the COVID-19 pandemic as their performance on the Centers for Medicare and Medicaid Services' quality measures steeply declined, according to a recent report.
Hospitals and post-acute care providers were showing improvement—or at least stability—on almost 90% of CMS' quality measures from 2016 through 2019, according to the agency's 2024 national impact assessment, published Wednesday. But the triennial report said health systems were largely unable to sustain that forward momentum due to pandemic-era challenges, highlighting the need for strategic quality improvement efforts to get back on track.
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Facilities' performance dropped across 47% of CMS’ individual quality measures in 2021 compared to scores from before the pandemic. Quality scores deteriorated to varying degrees across each measure category as hospitals and post-acute care facilities dealt with staffing shortages and an influx of high acuity patients in 2020 and 2021.
Health systems performed the poorest on the wellness and prevention category, earning lower scores on 69% of related measures in 2021 than they had before the pandemic. Likewise, systems fared worse on 55% of measures in the behavioral health category, 54% of safety measures, 52% of chronic conditions measures and 50% of seamless care coordination measures.
Facilities’ infection control efforts were hit especially hard. Compared with pre-pandemic levels, central line-associated bloodstream infection rates were 94.1% worse across acute care facilities in 2021. Rates of Methicillin-resistant Staphylococcus aureus infections and catheter-associated urinary tract infections were 54.6% and 33.8% worse respectively.
Health systems also had performance lapses on quality measures for depression screening, high blood pressure control and care transitions for records from inpatient psychiatric facilities.
Quality measure performance varied by patient demographic, as well. In 2021, persistent health equity gaps led facilities to consistently perform poorly on various measures for patients in certain racial and ethnic groups.
Patients of color fared worse than their white counterparts on 89% of affordability and efficiency measures and 78% of chronic conditions measures in 2021. Racial disparities were especially prevalent in quality measure performance tied to preventive screenings, management of diabetes and follow-up visits.
“Perspectives from focus groups underscore the critical need to develop equity measures that address bias in care delivery and deficits in cultural competency, unmet health-related social needs, access and health literacy,” CMS said in its assessment report.
Though health systems fared poorly overall on quality measures during the pandemic, CMS eased some of its reporting requirements at that time, lessening the blow to facilities’ reimbursement tied to value-based programs.
The pandemic exacerbated staffing and infection control issues, so the decline in measure performance is unsurprising, said Bob Lane, president and CEO of the American College of Health Care Administrators, in an email statement.
“Now that we’re moving out of the pandemic era, our leaders are committed to applying these lessons learned toward even greater improvements than were achieved prior to the public health emergency,” Lane said.
Akin Demehin, senior director of quality and patient safety policy with the American Hospital Association, also acknowledged the effect of the pandemic on quality scores, but said in an email statement that health system leaders realize the need for constant quality advancement. The providers consistently work to eliminate care disparities and reassess their approaches to delivering care, Demehin said.
CMS said in the report that regaining the progress made in quality measure performance from before the pandemic "will necessitate strategic actions to return to prepandemic levels and improve the resilience of the health care system."
In the event of future public health emergencies, the agency recommends health systems take advantage of telehealth capabilities, safety-enhancing technologies and screening programs to improve facilities' care quality.
