He later added: "In any process involving a lot of humans doing the same job, there's likely to be some degree of inconsistency. But the regulations contain safeguards designed to keep any inconsistencies in CMS-sanctioned hospital inspections to a minimum."
CMS regional supervisors make sure that state survey teams in each state within that region apply the rules as consistently as possible, he explains. But I asked Cheevers how each region knows how the rules are being applied in other regions of the country if CMS doesn't keep the data.
"The CMS regional offices strive to enforce consistency in all of the states," he replied.
The California Hospital Association, as well as many other state hospital trade groups, say they want CMS to "address state-by-state inequities in the review of hospitals to ensure that variation in survey practice does not adversely affect one state or another."
The groups want CMS to provide additional training for their surveyors and "implement a review process by which any immediate jeopardy citations are reviewed by a second level beyond the state surveyor before being made final. As the implications of this citation increase, it accordingly becomes more and more critical that they be made only when appropriate."
For other parts of the proposed VBP regulations, such as process and outcome measures as well as patient experience scores, hospitals know how they look because those metrics have been posted on Hospital Compare for at least a year.
But that's not so for immediate jeopardies. It just seems like a big secret.
Several years ago, while reporting on a federal investigation of a particularly egregious lapse at one Southern California hospital, I was assured by Cheevers that plans were in place to post these reviews in one place on a federal website. It would happen soon, he said.
I'm still waiting.
Again, I think it's important that hospitals that fail to prevent harm to patients, or even fail to remedy potential harm, be punished or disincentivized accordingly. But until hospitals and the public know how these rules are being interpreted across the country, the system does seem quite a bit unfair.