Centers for Medicare and Medicaid Services
Office of Strategic Operations and Regulatory Affairs
Division of Regulations Development and Issuances
Attention: Reports Clearance Officer, Julie Brown
Room C5-16-03
7500 Security Boulevard
Baltimore, MD 21244-1850
Fax: (410) 786-3064
Office of Information and Regulatory Affairs
Office of Management and Budget
Room 10235
New Executive Office Building
Washington, DC 20503
Fax: (202) 395-6974
Attention: Brenda Aguilar, CMS Desk Officer
Re: Comments on the Hospital CAHPS CMS Pilot Test Questionnaire
To Whom It May Concern:
As organizations committed to ensuring that health care consumers are appropriately informed about their treatment options, we applaud the efforts of the Centers for Medicare and Medicaid Services (CMS), the Agency for Healthcare Research and Quality (AHRQ) and others to provide health care consumers with meaningful information that they can use to make more informed decisions about their selection of hospitals.
To further the goal of informed patient health care decision-making, we submit the comments below concerning Hospital CAHPS (H-CAHPS) CMS Pilot Test Questionnaire that patients complete soon after hospital discharge.[1] Our comments focus on the need for health care consumers to know which hospitals have institutional ethical or religious restrictions concerning certain health care services so that they can make informed decisions about where to obtain their care.
The Need for Additional Questions on the Questionnaire
Many religiously sponsored hospitals and health care organizations (which account for a significant portion of all health care organizations) refuse to provide or to forgo certain health care on the ground that doing so violates their ethical or religious rules. Often, nonsectarian hospitals that are affiliated with these religious entities are also governed by the religious restrictions. Patients (and prospective patients) are often unaware of these limitations, and therefore choose a hospital with limitations (or choose to be transferred to a hospital with restrictions) without knowledge of these service limitations.
This lack of information can be particularly problematic when patients enter a hospital for treatment of specific conditions and assume that related services would also be available if they so desired. For example, a pregnant woman who is contemplating a post-partum tubal ligation needs to know when she is planning her care that the local hospital where her obstetrician has privileges and that otherwise offers a wide range of services does not offer tubal ligation because of religious restrictions. It is not adequate to provide this information at or after her admission to the hospital. Having the information in a timely way would enable the prospective mother to evaluate whether she still wants to deliver at that hospital even with the restriction, or whether she would like to go elsewhere.
Accordingly, answers to the suggested additional survey questions could help consumers make informed choices about their hospital care and could also fill an important data gap concerning regulatory compliance. [2]
Suggested Language for Specific Questions
The draft of the questionnaire that appears in the HHS website (attached) includes sections that specifically address general experiences in the hospital (questions 19-44) and admissions (questions 45-47). To address the concerns raised above, we offer for your consideration the following questions that could be added in either of these relevant sections. Answers to these questions will facilitate patients' informed decision-making:
- When you were admitted, were you informed that the hospital had any religious or moral reasons for not giving patients care they might want (for example, some hospitals will not provide sterilizations)?
__ Yes
__ No
- If yes to the above question, were you informed which medical conditions or procedures were affected?
__ Yes
__ No
- At any time during your hospital stay, did the hospital refuse to provide some care for you because the hospital had a religious or moral objection to the care?
__ Yes
__ No
- If yes to the above question, did the hospital offer to help you find another health care provider for that care?
__ Yes
__ No
We welcome the opportunity to work with CMS, AHRQ, and others to provide any assistance toward creating and implementing these recommendations. Please feel free to contact us if we can provide additional assistance. Thank you for your attention.
Sincerely,
Abortion Access Project
American Civil Liberties Union
ACLU Washington National Office
American Medical Women's Association
Association of Reproductive Health Professionals (ARHP)
Center for Reproductive Rights
Connecticut Coalition for Choice
Education Fund of Family Planning Advocates of NYS
National Consumers League
National Health Law Program
National Women's Health Network
National Women's Law Center
Northwest Women's Law Center
Physicians for Reproductive Choice and Health
ENDNOTES
[1] In response to Emergency Clearance notice (Feb. 5, 2003, pp. 5889-5890) (Comments on the Hospital CAHPS CMS Pilot Test Questionnaire)(Document Identifier: CMS-10083).
[2] See, e.g., 42 CFR 搂 489.102 (notice requirements concerning religious or ethical objections to honoring advance directives)