In response to potential plans by the CMS to limit the consulting relationships they can have with provider customers, accreditation organizations are defending the arrangements.
CMS Administrator Seema Verma didn’t mince words last week during a speech at the agency’s Quality Conference in Baltimore when she said it’s “a glaring conflict of interest” when accreditors act as consultants to their clients.
The CMS currently has a proposed rule under review by the Office of Management and Budget in response to its request for information in December 2018 asking for feedback from accreditors regarding protocols for establishing and disclosing relationships with providers they both sell consulting services to and accredit for participation in Medicare.
The Joint Commission, which is the leading accreditor of hospitals, once again defended its business framework of acting as both an accreditor and consultant in response to Verma’s comments. A “robust” firewall maintains the integrity of the accreditation process, a spokeswoman at the Joint Commission said in a statement. She added that the association submitted comments to the agency explaining “the value” of their consulting services when the RFI was issued.
Organizationally, the accreditation arm is a separate legal entity from its consultancy arm, called Joint Commission Resources. The consultancy division also doesn’t allow its surveyors to be consultants. Furthermore, it doesn’t provide consultants with any information that isn’t public nor train them on how to interpret Joint Commission standards. Instead, consultants rely on the detailed surveys that surveyors leave with their hospital clients. Finally, consultants can’t help customers appeal survey findings, be in contact with a customer during a survey or be on site when surveyors are present.
Despite this, it does appear the Joint Commission benefits financially from having a consultancy arm. The Joint Commission was contractually set to receive $6.5 million in 2017 in fees for shared services and $1.2 million in royalties from Joint Commission Resources, according to the two organizations’ IRS Form 990s filed on GuideStar. The Joint Commission received $18.8 million in total that year from JCR.
A Joint Commission spokeswoman said it’s “dangerously inaccurate” to say it receives money from JCR. The $18.8 million from JCR was reimbursement for expenses the Joint Commission had previously paid on their behalf, she said.
While the American Hospital Association, which has a representative on the Joint Commission board, defends the arrangement, the Federation of American Hospitals appears to be open to changes. In response to the RFI, the investor-owned hospital association said, “Anything that may undermine the integrity of accreditation programs or the public trust in CMS-accredited providers and suppliers must be considered and addressed.”
The Center for Improvement in Healthcare Quality, which accredits roughly 100 hospitals in the U.S. and offers consultancy services to hospitals it doesn’t accredit, is mainly concerned that the CMS’ proposed rule may no longer allow them to offer customers educational tools and support to help them meet Medicare’s conditions of participation.
CIHQ, along with many other accreditors, helps explain to provider organizations how to interpret standards and offers strategies about how to appropriately meet them. Accreditors argue this is different from consultancy because it’s a more hands-off approach that doesn’t involve an individual working with a hospital to fix specific issues at that facility or to help implement programs.
“The concern I have, and many of my colleagues share, is that if the CMS takes an overly broad interpretation of what consulting means then we are going to be prohibited from doing things that are educational in nature, supportive in nature, that really help hospitals better comply with the standards,” said Richard Curtis, CEO of CIHQ.
Consumer advocates have a different view. Leah Binder, CEO of the Leapfrog Group, said the relationships accreditors have with customers do appear to have a conflict of interest.
“We are really relying on accreditors to be tough and accurate, often that is the only surveillance that a hospital gets in a given year,” she said. “If there is anything that is going to compromise that, or appear to compromise that, we do have a problem.”