CMS modifies hospital inspection program amid coronavirus pandemic

• Hospital inspections by CMS will be targeted to locations where the CDC believes the coronavirus is likely to proliferate.
• Almost 150 nursing homes have COVID-19 cases.
• Inspectors are being warned not to interfere with clinicians during the outbreak.

Federal officials are reorienting their usual hospital inspection regime to target providers in areas that are predicted to see a surge in COVID-19 cases, according to a senior Trump administration official.

Seema Verma, administrator of the Center for Medicare & Medicaid Services (CMS), told reporters this week that her agency was taking the “extraordinary step” of redirecting state and federal inspectors of hospitals and other providers to new schedules based on COVID-19 projections from the Centers for Disease Control and Prevention (CDC). The CDC will use federal data, such as Medicare claims data, to predict where the virus next might affect clusters of patients.

The facility inspectors also will use a new protocol that focuses on the steps required by providers to stop the spread of the coronavirus.

Hospital inspections by the Joint Commission have been suspended during the coronavirus crisis, Verma said.

CMS also will encourage hospitals and other providers to perform a voluntary self-assessment of their ability to prevent the spread of the coronavirus within their facilities. Verma encouraged patients and the public to ask their local hospitals and other providers for the results of that self-assessment.

Inspections “over the next few weeks,” according to a CMS release, will be limited to:

• Complaints and facility-reported incidents at the “immediate jeopardy” level
• Targeted infection-control inspections
• Self-assessments using a coming infection-control checklist

The impact of the changes on nursing homes

The inspection changes also apply to nursing homes, 147 of which in 27 states have at least one resident with COVID-19, according to the CDC. That caseload is a tiny share of the more than 15,000 U.S. nursing homes but concerning due to the vulnerability of the elderly and people with underlying illnesses to the virus.

For instance, Life Care Center nursing home in Kirkland, Washington, had 81 residents sickened with COVID-19, and 26 deaths.

State and federal inspections that were concluded March 16 found three “immediate jeopardy” situations, meaning instances in which a patient’s safety is in imminent danger, at the facility:

• Failure to rapidly identify and manage ill residents
• Failure to notify the Washington Department of Health about the increasing rate of respiratory infection among residents
• Failure to incorporate a sufficient backup plan when the primary clinician became ill

The findings resulted in unspecified monetary penalties and plans for unannounced inspections. The facility can seek to remediate the findings, Verma said.

Inspect but don’t interfere

Verma said during the COVID-19 outbreak, CMS has instructed state and federal inspectors to avoid interfering with clinicians at the facilities they inspect.

“They may see things where there are lapses in protocols, and those are things that they can then rapidly communicate with the management of the hospital or the nursing home,” Verma said. “But we have been very clear to our surveyors that we need to let doctors, nurses and health providers on the front lines [keep] their top priority as the patient and we do not want to interfere with that process.”