A few citations from CMS-approved accrediting organizations have grown sharply in prevalence, while a long list of others has faded.
For decades, accreditors have surveyed and cited hospitals for deficiencies in care and operations. Over the last eight years, one citation has climbed more than any other since 2017: supervision of contract staff.
In 2017, just 0.5% of hospitals were cited for failing to supervise contract staff, according to CMS’ Citation Frequency Reports obtained by Becker’s. The tag barely registered before the COVID-19 pandemic — 0.3% in both 2018 and 2019 — but as pandemic-era workforce shortages pushed hospitals to lean on contract and travel clinicians, citations followed: 1.6% of hospitals in 2021, 2.1% in 2022, 2.5% in 2023, 4.3% in 2024 and 4.7% in 2025.
Within nine years, the citation went from one of the rarest on CMS’ list to one affecting nearly 1 in 20 surveyed hospitals.
A cluster of Emergency Medical Treatment & Labor Act-related citations — covering hospitals’ obligations to screen, stabilize and appropriately transfer emergency patients — has risen alongside the contract staff citation. Citations for general EMTALA compliance (Tag A2400) more than doubled, from 2.6% of hospitals in 2017 to 6.4% in 2025, peaking at 6.8% in 2024. Medical screening exam citations (A2406) rose from 2.2% to 4.9%, and appropriate transfer citations (A2409) doubled from 1% to 2%.
Patient rights and nursing also became more common. The broad patient rights condition (A0115) grew from 3.5% to 5.8% of hospitals, nursing services (A0385) from 2.3% to 4.5%, and patient rights: care in a safe setting (A0144) from 4.4% to 6.5% — the single most frequently cited tag in 2025.
What’s fading
The decline column is dominated by infection control and the physical-environment rules that govern a hospital’s building and equipment. The steepest fall belongs to the infection control program citation (A0749), which fell from 5% of hospitals in 2017 — among the most common citations that year — to 1.6% in 2025. Many of these downward trends accelerated after 2019, coinciding with pandemic-era exemptions to certain survey and reporting requirements.
These 14 citations have become less common since 2017:
- Infection control program (A0749)
- Physical environment (A0700)
- Infection control professional (A0748)
- Facilities, supplies, equipment maintenance (A0724)
- Data collection and analysis (A0273)
- Infection prevention, control and antibiotic stewardship (A0747)
- Patient care assignments (A0397)
- Unusable drugs not used (A0505)
- Patient rights: notice of grievance decision (A0123)
- Maintenance of physical plant (A0701)
- Patient rights: grievances (A0118)
- Medical record services (A0450)
- Patient rights: restraint or seclusion (A0168)
- Form and retention of records (A0438)
The shifts play out against a changing survey landscape. The number of active hospital providers in CMS’ reports fell from 5,699 in 2017 to 4,719 in 2025, even as the total number of surveys rose from about 4,100 to roughly 5,800; which means hospitals are being surveyed more often, and a rising share of them is being cited for staffing and emergency-care failures.
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