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CMS Needs to Come Clean on Immediate Jeopardy

Cheryl Clark, for HealthLeaders Media, March 17, 2011

All hospitals try to avoid situations that cause immediate jeopardy to the health and safety of any patient – that's a given. And it's right that when those tragedies occur, hospitals suffer serious penalties.

But the proposed Value Based Purchasing regulations that would exclude hospitals that receive federal IJs from earning Medicare incentive payments has some officials extremely, and in my opinion justifiably, upset.

There's concern that the rules under which these citations are imposed from state to state are not fairly or equitably interpreted or applied. And as of July 1, there's a huge amount of money at stake. That's when the first performance period for VBP incentives would begin. Any hospital that gets an IJ within the following nine months is automatically disqualified for that fiscal year.

These are serious citations, but incomprehensibly, neither the Centers for Medicare & Medicaid Services which issues them, nor the states whose survey teams investigate these incidents, will say which hospitals have received them, for what kinds of harm, nor will they say how many occur in a given year or in a given region. A spokesman for CMS says the agency doesn't know because it just doesn't track them.

But some hospital trade groups in various states are talking among themselves and discerning that these penalties are skewed toward some states and away from others.

The North Carolina Hospital Association explains the problem:

"We have had IJ issues here, and it seems to us in talking to our colleagues around the southeast, that IJs were much more frequent in North Carolina than in other southeastern states," said Don Dalton, spokesman for the NCHA. "We asked CMS to count them, and tell us how many of these are handed out, but nobody seems to be able to give us the data."

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1 comments on "CMS Needs to Come Clean on Immediate Jeopardy"


wilcox (8/30/2011 at 6:26 PM)
I am a former surveyor, and after many years of contact with both federal and surveyors, I can confirm that the discrepancies among surveyors are real and astounding. Some surveyors base their findings of deficiencies on their own preferences and interpretations, despite a lack of supporting evidence of how a practice fails to comply with professional standards of practice. In some instances, surveyors themselves, are not knowledgeable about certain practice. This is not meant as a criticism, rather it should give each side an opportunity to share information. Of even greater concern regarding state surveys (which are contracted by CMS), is that there are well-known facilities with political connections that are often able to have their citations reduced in scope and severity, or eliminated altogether. Or some surveyors simply develop a fondness for certain facilities, and then find it difficult to cite those facilities.