Grassley Works to Empower Patients, Boost Transparency Through Improved Data on Inpatient Psychiatric Facilities

WASHINGTON – Sen. Chuck Grassley (R-Iowa), a senior member and former chairman of the Senate Finance Committee, is pushing the Centers for Medicare & Medicaid Services (CMS) to provide clear and accessible information on inpatient psychiatric facilities (IPFs) to better support patients and their families. While CMS has supported web-based tools to find and compare providers, the agency lacks a tool for comparing IPFs so that families can make fully-informed decisions.

“This is the kind of information that patients and their families care about…In all states, patients and their families deserve to have access to all IPF inspection/survey reports through a user-accessible website, no matter whether the survey was performed by a state or local survey agency, CMS, or an accrediting organization,” Grassley wrote.

Grassley is an outspoken advocate for improved oversight and transparency at health care facilities that care for vulnerable Americans, such as nursing homes and IPFs. His past work revealed that inspection reports are completely inaccessible to consumers in most states. Grassley has previously called for improving the quality of information available to the public about nursing homes. He’s also pushed for greater transparency of financial relationships between drug makers and providers and of the misuse of psychotropic drugs in nursing homes and foster youth.

“Currently, a search for an IPF on the Care Compare website yields little to no information that would allow a consumer to determine the safety of the facility…There is no information regarding assaults, abuses, suicides, and [unauthorized departures], particularly information regarding facilities that have had repeated and/or potentially preventable events. There is no information regarding Medicare Conditions of Participation violations, citations, penalties, or enforcement actions,” Grassley continued.

Grassley requested the agency provide details on plans to improve public access to IPF data and any possible barriers to CMS’s progress.

Text of the letter to Acting CMS Administrator Carlton follows:

February 28, 2025

VIA ELECTRONIC TRANSMISSION

The Honorable Stephanie Carlton

Acting Administrator

Centers for Medicare & Medicaid Services

Dear Acting Administrator Carlton:

I have long advocated for improved oversight and transparency at health care facilities that care for vulnerable Americans, such as nursing homes and inpatient psychiatric facilities (IPFs).^[1]  My oversight has resulted in improvements to the Nursing Home Care Compare website, which has been found to help consumers find their way to higher quality nursing homes and encourage providers to improve quality.^[2]  Yet, after more than twenty-five years of the Centers for Medicare & Medicaid Services (CMS) supporting web-based tools for consumers to find and compare providers, the mechanism for comparing IPFs is still lacking. ^[3]  Like nursing home residents, psychiatric inpatients are at high risk for abuse, neglect, and harm, and the public deserves to be able to readily access information regarding quality, safety, and regulatory citations at IPFs in all states.^[4] 

According to a recent report, it took weeks to compile information regarding safety and regulatory issues at two IPFs because there is no place to readily access that information.^[5]  The report noted that, “the Centers for Medicare and Medicaid Services has a robust database of hospital inspections, quality of care and staff ratings.  However, when you try to search many inpatient mental health hospitals, every category says information is not available.”^[6]  In response to questions about the lack of information, the prior administration stated that “although CMS doesn’t give star ratings for psychiatric hospitals, consumers can still find valuable quality information by using [other] CMS resources."^[7]  However, a review of those resources found them to be insufficient.^[8]

Currently, a search for an IPF on the Care Compare website yields little to no information that would allow a consumer to determine the safety of the facility.  After searching for an IPF on Care Compare, the website launches a webpage showing that the facility’s “Overall Star Rating” and “Patient Survey Rating” are not available.^[9]  Under a drop down, Care Compare primarily presents process measures, including COVID-19 vaccinations for providers, influenza vaccinations and body mass index screenings for patients.^[10]  While there is information regarding potentially harmful mechanical restraints and seclusions, there is no data regarding physical holds and chemical restraints, which surveyors have also found to be used inappropriately and with incorrect technique.^[11]  There is no information regarding assaults, abuses, suicides, and elopements (unauthorized departures), particularly information regarding facilities that have had repeated and/or potentially preventable events. ^[12]  There is no information regarding Medicare Conditions of Participation violations, citations, penalties, or enforcement actions.^[13]  This is the kind of information that patients and their families care about.

While Care Compare provides access to inspection reports for nursing homes, this capability is missing from the hospital section of the website.^[14]  In all states, patients and their families deserve to have access to all IPF inspection/survey reports through a user-accessible website, no matter whether the survey was performed by a state or local survey agency, CMS, or an accrediting organization, such as The Joint Commission.  While some hospital inspection reports may be accessible through the CMS 2567 Statement of Deficiencies data file, this is not a consumer-facing or readily accessible resource.^[15]  Additionally, my past oversight work revealed that inspection reports from accrediting organizations are completely inaccessible to consumers in most states.^[16]  Despite my advocacy on the issue, in 2017, CMS reversed course on a proposal to require accrediting organizations to post provider survey reports on their public-facing websites, but noted that, “CMS is committed to ensuring that patients have the ability to review the findings used to determine that a facility meets the health and safety standards required for Medicare participation.”^[17]  Seven years later, it still doesn’t appear that patients, or even CMS, have the ability to readily conduct that review.^[18]  There also still appears to be incongruity between safety violations and accreditation.^[19] 

For Congress to understand CMS’s current actions to increase the relevance of information regarding IPFs on the Care Compare website as well as any barriers impeding CMS’s progress, please provide answers to the following questions no later than March 14, 2025.

1. Does CMS plan to take steps to improve how information regarding IPF quality, safety, and regulatory issues are displayed on Care Compare?  If not, why not?  If so, please describe.

1. Are there any barriers to displaying information regarding patient harm, including abuses, assaults, suicides, and elopements with harm, for IPFs on Care Compare?

1. Are there any barriers to displaying citations, safety violations, licensure suspensions or limitations, immediate jeopardy findings, Medicare program terminations, monetary penalties, enforcement actions, or any other remediation actions for IPFs on Care Compare?

1. Are there any barriers to integrating the CMS 2567 Statement of Deficiencies data file in a user-accessible way on Care Compare?

1. What surveys are included in the CMS 2567 Statement of Deficiencies data file and which surveys are excluded?  For example, does the data file contain surveys conducted by all state and local survey agencies?  Are there any circumstances in which the file would contain surveys conducted by accrediting organizations?

1. Why are the findings from the following surveys/inspections not included in the 2567 Statement of Deficiencies data file posted on the CMS Hospital website?^[20]  What are the barriers to making the following reports accessible on Care Compare?
1. The survey that corresponds with the nine patient rapes at Options Behavioral Health Hospital.^[21]
2. The February 2022 survey with immediate jeopardy findings for Brynn Marr Hospital.^[22]
3. The survey that corresponds with the sexual assault at Psychiatric Institute of Washington.^[23]
4. The survey conducted at Holly Hill Hospital after the escape of five children in March 2024.^[24]
5. The survey that corresponds with Aurora Vista Del Mar’s loss of permission to admit involuntary patients.^[25]
6. The survey that corresponds with the suicide at Morton Plant North Bay Hospital Recovery Center.^[26]

1. How does CMS assess the usability and relevance of the information regarding IPFs on the Care Compare website from the perspective of patients and their families?

1. How does CMS validate the data currently contained in Care Compare for IPFs?  For example, what was CMS’s process for validating Harborview Medical Center’s 2022 restraint rate of 22.44 hours per 1000 patient care hours, when the national average was 0.32, and the 2022 seclusion rate of 81.73, when the national average was 0.36?^[27] 

1. How does the data currently contained in Care Compare for IPFs inform the survey/inspection process?  For example, have surveyors examined the restraint and seclusion practices at Harborview Medical Center?^[28]

1. How does CMS “ensur[e] that patients have the ability to review the findings used to determine that a facility meets the health and safety standards required for Medicare participation,” including when those findings come from accrediting organizations?^[29]

1. What role does CMS play in the accreditation process for IPFs?  How do the deficiencies listed in the CMS 2567 Statement of Deficiencies data file factor into accreditation?

1. How does CMS partner with the Substance Abuse and Mental Health Services Administration (SAMHSA) on the Inpatient Psychiatric Facility Quality Reporting (IPFQR) program and ensure consistency between the IPFs listed on the Care Compare website and the IPFs listed on the FindTreatment.gov website?^[30]  How does CMS use data collected through the National Substance Use and Mental Health Services Survey (N-SUMHSS)?^[31]

Thank you for your prompt review and response.  If you have any questions, please contact my Judiciary Committee staff at (202) 224-5225.

Sincerely,

Charles E. Grassley

Chairman

Committee on the Judiciary

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