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For the first time, providers, payers, and patients now have an enormous searchable database containing documents detailing about 8,000 serious federal safety rule violations—many of which have caused serious patient harm or death—at about 1,000 U.S. hospitals since January, 2011.
The documents, which resulted from federally authorized complaint investigations and are called "2567s," were released over the weekend by the Centers for Medicare & Medicaid Services after a long-standing request from and collaboration with the Association of Health Care Journalists. The AHCJ has organized the document files on a searchable website on its site, hospitalinspections.org.
AHCJ president Charles Ornstein, a senior reporter at ProPublica in New York, made the announcement about the database during a news conference Saturday at the organization's annual meeting in Boston. He said the documents "show deception, fraud, falsification, and medical errors that are inexcusable."
Also, he said, now members of the public can find out not only which hospitals in their cities or regions had incidents serious enough to prompt such investigations, but how often errors of a particular type occurred in any facility to receive such a federal investigation report in the last 26 months.
For example, hospital deficiencies may now be searched by keyword or phrase, such as "wrong site," "wrong patient," "infection," "sponge," "transfusion," or "falsified," to catalogue types and frequency of hospital errors, and often whether a patient death was involved. Some of the violations involved a declaration of immediate jeopardy, which are so serious and immediately threatening to patients or workers that the situation must be resolved within 24 hours.
Prior to CMS's release, these documents were available only after members of the public or news media filed Freedom of Information Act or state public records requests.
"It was a time-consuming process, and there would be no way to compare (various hospitals or regions of the country) except by spending a lot of time and spending many hours creating spreadsheets, and creating data tools to do that," Ornstein says. "What we wanted to do was make this easy for the public to access these reports."
The new database does not include documents about results of complaint investigations involving psychiatric hospitals or long-term care facilities. Routine inspection reports are also not included. However Ornstein's group said it was working to get disclosure of those files as well.
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Ornstein also said that the database would be updated quarterly.
In response to questions on Saturday, CMS spokeswoman Kathryn Ceja said in an e-mail, that the agency released the data with AHCJ because the government wants to "promote an informed citizenry, patient engagement in healthcare, quality improvement on the part of providers, and transparency in government."
She added that the release of these reports about acute care, including critical access hospitals, follows the release last year of a similar searchable database on nursing homes.
AHCJ uploaded CMS's responses to various questions about the database on a section of its website. For example, the agency explains the process that can result in a 2567. And it explains that state health department teams usually perform inspections at the request of CMS when a complaint seems serious enough to jeopardize federal reimbursement to a hospital.
Elizabeth Lietz, spokeswoman for the American Hospital Association who attended the meeting, said her organization was not told in advance by CMS that it was releasing this electronic database of 2567 documents.
The American Hospital Association plays down the value of having the public documents be more accesible. "Despite our hope that these data would help inform the public, the public has not found the data as useful as we anticipated... it is hard even for a seasoned healthcare policymaker to understand the CMS documents or thoughtfully apply them to making informed decisions," said Nancy Foster, quality and patient safety vice president of the American Hospital Association.
One important deficiency in the new electronic database is that hospitals' plans of correction—required if a hospital is to continue to receive reimbursement for care of Medicaid and Medicare patients—were not included because of technical difficulties. Those may still be provided to the public, but only through a federal or state information or public records act request.
Ceja explained why in an e-mail response: "CMS' efforts to make plans of correction available in a national, searchable electronic database are suspended indefinitely until there is more clarity with respect to the federal budget. Development of such capability requires a multi-year effort and design safeguards that can adequately maintain security in a system that imports data from thousands of external parties."
Ornstein said the journalism association has also put pressure on The Joint Commission to release results of its accreditation surveys of hospitals. "Given the government's steps to increase transparency around these vital reports, we once again call on The Joint Commission to do the same," Ornstein said in a letter March 13 to TJC president Mark Chassin, MD.
"In our previous exchanges, you have expressed concerns that the public release of The Joint Commission's inspection reports would compromise your efforts to improve hospital quality," he wrote. "The AHCJ board cannot accept the notion that patients are best protected by keeping hospital problems secret. Such reasoning also flies in the face of growing consensus among healthcare leaders and policy makers about the importance of transparency to improve medical care quality."
A spokeswoman for TJC, Elizabeth Zhani, who also attended the journalism meeting, said that Chassin is studying the AHCJ's request.
Funding for the AHCJ's website was provided by the Ethics and Excellence in Journalism Foundation.