Private accreditors balk at CMS proposal to make reports public

A proposed CMS rule that would require private accreditation organizations to publicly release reports on healthcare facilities is garnering widespread backlash from stakeholders, but patient safety experts say it's high time to increase transparency.

The CMS in late April proposed that accreditors like the Joint Commission post survey reports and corrective action plans within 90 days of visiting a healthcare organization. The goal is to help healthcare consumers "make a more informed decision" about where they receive care and encourage "healthcare providers to improve the quality of care and services they provide," according to the CMS.

During the comment period, which closes June 13, private accreditation organizations have expressed their disdain, arguing that the rule will lead to greater confusion for consumers. The reports, they claim, don't tell the full story of what's happening. They also claim the rule will add yet another administrative burden.

"When we do a survey of a facility, it focuses on deficiencies that are found at a fixed point in time," said Barb Sylvester, director of regulatory affairs and quality at the Accreditation Commission for Health Care, a not-for-profit that accredits about 15,700 providers mostly in the hospice and home health arenas.

The ACHC accredits facilities once every three years and is on the lookout only for areas where the provider has failed to follow regulatory standards of care. The ACHC then works with the providers to help them outline and approve a corrective action plan.

The reports would only show consumers an organization's weaknesses, Sylvester said. The reports don't emphasize patient outcomes, which are more helpful metrics for those shopping for the best providers, she added.

"We are concerned that sharing a detailed report may not be the most useful or effective strategy for informing the public," Nancy Foster, vice president of quality and patient safety at the American Hospital Association, said in a statement. Foster suggested it might be more useful to require accreditors to provide a shortened summary of the reports with key takeaways.

Experts in favor of the rule reject claims that the information won't be helpful to consumers.

"The audits that are being done by these agencies are not revealing the level of problems that seem to exist," said Michael Abrams, co-founder of Numerof & Associates, a healthcare consulting firm. He points to the roughly 700,000 people who develop an infection at U.S. hospitals and the estimated 250,000 people that die each year attributable to medical errors.

The CMS and others have questioned how effective accreditation organizations are at finding problems. A 2014 study of 103 acute-care hospitals by state officials found accreditors missed 39 serious deficiencies after their reviews. These gaps raise "serious concerns" about private accreditors' ability to "appropriately identify and cite health and safety deficiencies during the survey process," the CMS noted.

In its comment letter, the Joint Commission, which accredits nearly 21,000 healthcare organizations across the nation, argued that the rule would be harmful to transparency, suggesting that clients are more comfortable sharing concerns and issues because they know the reports are confidential. This allows the Joint Commission to conduct a comprehensive assessment of the facility and help it improve.

The rule would "make providers less candid about their weaknesses on our surveys, (and) it would chill the open and confidential dialogue that is the foundation of our improvement efforts," according to the Joint Commission.

Both the Joint Commission and the ACHC are also concerned the rule would be an expensive and disruptive undertaking. Saying it would have to deploy new software and hire additional staff, the Joint Commission predicted startup costs for the rule would be $3.97 million in the first year, and $2.3 million in expenses for subsequent years.

Since the CMS audits only about 10% of providers, private accreditation organizations carry the lion's share of the load. Yet the relationship between private accreditors and providers has an "inherent potential for conflict of interest," said François de Brantes, director of the Center for Payment Innovation at the Altarum Institute.

Providers pay a fee for the services of the accreditors. "You don't want to embarrass your customer," de Brantes said.

But releasing the reports publicly would empower providers to maintain quality standards and improve care, he said. It would also enable providers who perform well to tout their achievements to consumers, fostering competition.

Concerns about the administrative burden and cost aren't an excuse to reject the rule, de Brantes said. "The sky won't fall, patients won't stop coming. But what might happen is that things improve."

Abrams said it's important for accreditors to invest in ways to make the reports easy to understand. If that means they have to charge providers more for services to swallow the cost, so be it, he said. "They can charge hospitals just a little bit more."

This proposed rule reflects a growing push from consumers for more information about where they receive care, Abrams said. As people continue to pay a larger share of their healthcare costs because of high-deductible plans, premiums and co-pays, they are starting to seek ways to shop for care.

"Consumers are beginning to see healthcare like the other things they purchase," he said. "They are thinking about healthcare differently."