The Centers for Medicare and Medicaid Services has proposed a rule to strengthen its oversight of accreditation organizations (AOs). Among other things, the rule seeks to address potential conflicts of interest by imposing limitations on the paid consulting services that OAs provide to the healthcare facilities they accredit.
Each year, accrediting organizations (AOs) with a CMS-approved program survey more than 9,000 accredited healthcare providers and providers participating in the Medicare/Medicaid program for compliance with health and safety requirements.
CMS said that in recent years it has identified several concerns related to AO’s performance:
• Providers and providers that have been terminated from the Medicare/Medicaid program but retain accreditation despite significant quality and safety concerns;
• ABs provide paid consulting services to the suppliers and suppliers they accredit, which could affect the integrity of the on-site inspection process and diminish public confidence by creating conflicts of interest;
• Inconsistent survey results due to different AO standards or practices (such as AOs notifying facilities in advance of the date of their on-site surveys, contrary to CMS policies).
The proposed changes seek to strengthen oversight of OAs, reduce conflicts of interest, and strive for greater consistency of survey processes. Here is a summary:
• Hold AOs accountable to the same standards as state survey agencies that also conduct surveys on behalf of CMS.
• Ensure that OAs remain independent reviewers by addressing conflicts of interest and imposing certain limitations on the paid consulting services that OAs provide to the health care facilities they accredit.
• Prevent AO conflicts of interest by prohibiting owners, surveyors, and other AO employees, as well as their immediate family members who have an interest in or relationship with an AO-accredited healthcare facility, from participating in surveys and have input into the survey results and participation in pre- or post-survey activities for that facility, or have access to survey records related to that facility.
• Address potential and actual conflicts of interest by requiring AOs to provide specific information to CMS on how they will monitor, avoid, and manage conflicts of interest and the fee-based consulting services they provide.
• Improve AO performance by requiring poorly performing AOs to submit a publicly reported plan of correction to CMS.
• Improve national survey consistency and standardization by more closely aligning requirements for OA survey activities and staff training with those of SA.
Currently, CMS has approved nine AOs to inspect and accredit Medicare-certified facilities, including the Joint Commission, URAC, and the National Association of Boards of Pharmacy.
In response to the proposed rule, Shawn Griffin, MD, CEO and president of URAC, issued a statement: “As the nation’s most comprehensive healthcare accreditation organization, URAC strongly supports the new CMS rule that particularly addresses the conflicts of interest in accreditation organizations. URAC prides itself on not offering consulting services, which can create a conflict of interest because it is like giving an organization seeking accreditation the answers to the “test,” defeating the purpose of accreditation being a rigorous test of quality. While we work closely with organizations seeking accreditation, we are careful not to have any conflicts of interest in the process. “We believe this new rule will improve the quality of healthcare by ensuring that organizations implement best practices and quality standards on their own, prior to receiving the ‘gold star’ of accreditation.”
The changes outlined in the NPRM affect all OCs except those that accredit clinical laboratories and non-certified providers, including providers of advanced diagnostic imaging (ADI), home infusion therapy (HIT), and diabetes self-management training. (DSMT), as well as durable medical equipment (DME) suppliers and durable medical equipment, prosthetics, orthotics and supplies (DMEPOS) suppliers.
