The Office of Inspector General has released a report in which it outlines shortcomings and failures by Medicare to respond adequately to alleged serious adverse events.
The OIG relied on a random sample of "immediate jeopardy" complaints as a basis for alleged serious adverse events since no national database of adverse events exists. Immediate jeopardy complaints are the most serious types of complaints regarding alleged patient safety violations at hospitals.
OIG's review revealed that state agency responses, on behalf of Medicare, to complaints alleging serious adverse events were generally timely and often found problems. However, state agencies and Medicare often failed to review hospitals' compliance with the CMS' conditions of participation on quality assessment and performance improvement and the hospital's governing body. The OIG also found other shortcomings by state agencies and Medicare:
• Performed little longer-term monitoring to verify that hospitals' corrective actions resulted in sustained improvements.
• Sometimes failed to disclose the nature of the complaints to the hospitals, therefore limiting hospitals' ability to learn from alleged events.
• Informed The Joint Commission of only few complaints.
The OIG has offered several recommendations to CMS, including that the agency amend guidance on disclosure to explain the nature of complaints to hospitals and improve communication with accreditors.
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The OIG relied on a random sample of "immediate jeopardy" complaints as a basis for alleged serious adverse events since no national database of adverse events exists. Immediate jeopardy complaints are the most serious types of complaints regarding alleged patient safety violations at hospitals.
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OIG's review revealed that state agency responses, on behalf of Medicare, to complaints alleging serious adverse events were generally timely and often found problems. However, state agencies and Medicare often failed to review hospitals' compliance with the CMS' conditions of participation on quality assessment and performance improvement and the hospital's governing body. The OIG also found other shortcomings by state agencies and Medicare:
• Performed little longer-term monitoring to verify that hospitals' corrective actions resulted in sustained improvements.
• Sometimes failed to disclose the nature of the complaints to the hospitals, therefore limiting hospitals' ability to learn from alleged events.
• Informed The Joint Commission of only few complaints.
The OIG has offered several recommendations to CMS, including that the agency amend guidance on disclosure to explain the nature of complaints to hospitals and improve communication with accreditors.
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