Mar 16, 2023

First, Do No Harm

Lee Fleisher, MD., Michelle Schreiber, MD., and Jonathan Blum, Centers for Medicare & Medicaid Services

Ensuring patient safety is at the heart of the Hippocratic Oath: First, Do No Harm.

As the nation’s largest payer for health care, the Centers for Medicare & Medicaid Services’ (CMS) mission in our National Quality Strategy includes ensuring everyone is safe when they receive care. As we commemorate National Patient Safety Week, now is the perfect time to affirm our belief that no matter their background or circumstances, everyone deserves access to high-quality, safe, and equitable care. Protecting patients must always remain our first priority.

Improving patient safety has been the focus of numerous policy initiatives over the years. Yet, despite all the work that has been done, patient harm is still too common. A recent study found that when a patient is admitted to the hospital, harm occurs nearly 24 percent of the time. Another report revealed that nearly 1 in 4 Medicare patients have experienced harm in the hospital. What’s worse, a considerable portion of this is preventable. Prior to COVID-19, progress was being made to improve patient safety. However, since the beginning of the pandemic, patient safety performance significantly declined.

It’s time for all of us to focus our attention on patient safety and push for continued and significant improvements. CMS is using all the levers at our disposal, including expanded and improved measures of safety performance, increased transparency, and strong payment incentives to promote improved safety outcomes. 

We ensure health care providers focus on patient safety through our regulatory and oversight authorities, which require providers to adhere to robust health and safety standards. For example, we survey hospitals to ensure that, among other things, the facility and the doctors, nurses, and other staff have adequate qualifications, training, and experience to keep patients safe. And we hold facilities accountable when they fail to meet those standards.

CMS deploys a range of quality measures to encourage transparency in public reporting of the quality of care in facilities and to increase accountability. Publicly available information on quality empowers consumers to make decisions about where to go for care and drives hospitals and other providers to improve care by understanding how they perform in comparison to others. How a provider performs on certain quality measures can also impact how much CMS pays a provider in some of our quality programs. These programs aim to prioritize value in health care delivery and, if a provider does not commit to improve and show results, they can face financial penalties.

Additionally, CMS oversees a network of Quality Improvement Organizations that provide direct assistance to providers and share best practices to improve safety. Serious safety events are rarely the result of one individual error; rather, they are typically the result of several system flaws. This is one reason that safety is a key pillar in CMS’s National Quality Strategy and is a long-term initiative that aims to promote the highest-quality outcomes and safest care for all individuals.

Going forward, CMS is engaged in a number of initiatives to promote patient safety across our programs. We are working to incentivize health care providers to make meaningful improvements, rewarding providers for improved patient safety and penalizing those who do not meet standards. We will issue guidance for facilities to implement an effective, data-driven quality assessment and performance improvement program, including tracking and monitoring medical errors. Finally, CMS will update requirements for providers who participate in Medicare and Medicaid to better address inequities in quality of care and access.

Standardized safety systems have long been engineered in other industries, such as manufacturing, aviation, nuclear power, and the military. Some of the best of these ideas have been adopted by the health care sector and have led to error reduction, such as safety checklists, teamwork training, communication programs, and reporting and tracking of errors.

But there is still so much more to accomplish. The re-engineering of safe systems of care, across all settings, requires a renewed and ongoing commitment by providers, payers, and patient advocates together. Best practices include ensuring a culture of safety, improving teamwork and communications, and carefully analyzing errors to identify root causes. These best practices can be standardized across health care to build a more resilient and durable system of safety that extends from the C-suite and the Boardroom to every health care worker for the benefit of patients everywhere.

Patient and caregiver engagement is essential in developing long-lasting, meaningful safety improvements. CMS is committed to listening to their voices, and we encourage health care systems to include patients and their advocates in resolving safety issues. Specifically, engaging and protecting vulnerable populations and promoting equity is an essential step for safety.

CMS will continue to work with our partners to achieve our shared goals. All individuals deserve to receive health care that is safe and emblematic of medicine’s founding Oath: First, Do No Harm. Anything else is unacceptable.