"The federal government doesn't count them, the state government doesn't count them, and they were not intended to be used in the reimbursement arena at all," Dalton says.
Of concern is what he called the "wide latitude" the federal immediate jeopardy definition gives state surveyors to call an IJ, if they feel like it.
For example, Dalton says, survey teams in some parts of the country or in some states may level IJs only when serious physical harm or death to a patient has occurred. But for survey teams in other states, an IJ might be levied when the harm is only psychological.
Neglect can provoke an IJ in some states, but not others. The possibility of harm might be applied in one region, but not another. The rules for what is and what isn't an IJ go on for 36 pages.
"It's unreasonable to start punishing hospitals economically for things that are somebody's perception of a situation," Dalton says.
He adds that it might appear North Carolina hospitals are worse than those in other southeastern states, when North Carolina enforces some of the most stringent quality outcome and process measure criteria in the country.
Danielle Lloyd, senior director for reimbursement policy with Premier Healthcare Alliance, a purchasing group that includes more than 2,400 hospitals, says she's hearing similar concerns. In particular, objections are coming from California, where hospital officials "think they're getting a lot more IJs than other states," Lloyd says.