Accrediting organizations may have to reduce their fee-based consultation services and prohibit survey participation for employees with ties to health facilities or face penalties for violating conflict-of-interest provisions if the Centers for Medicare and Medicaid Services sticks with recent oversight proposals.
CMS proposed a rule to hike oversight of those organizations Feb. 8 in response to concerns about the integrity of accrediting bodies and the quality of the facilities they survey.
Related: CMS proposes to increase accrediting organization oversight
CMS' regulation is intended to make sure there is greater consistency, as well as a lack of bias, in accrediting organizations’ survey processes and that accredited facilities meet or exceed the agency’s health and safety standards.
Here’s what to know about the proposed rule and how it could impact accrediting organizations and health systems.
What are accrediting organizations responsible for?
Accrediting organizations set standards for the delivery of high quality patient care and assess healthcare companies based on those standards. The organizations grant accreditation to those that meet certain criteria.
“Accreditation is meant to be an additional quality check to make sure that an organization is doing things right and they are worthy of your trust,” said Dr. Shawn Griffin, president and CEO of URAC, an independent quality and safety accrediting organization. “Understanding the interests of the accreditors and the role that they play in complementing regulation is important.”
Organizations with a CMS-approved program survey more than 9,000 accredited healthcare providers and suppliers each year to guarantee they meet or exceed Medicare health and safety requirements. The accrediting bodies perform initial certifications, re-accreditations, follow-ups and complaint surveys.
Who would the proposed rule affect?
CMS’ proposed rule would alter the operations of organizations approved to survey and accredit Medicare-certified facilities: the Accreditation Association for Ambulatory Health Care, Accreditation Commission for Health Care, American Association for Accreditation of Ambulatory Surgery Facilities, Center for Improvement in Healthcare Quality, Community Health Accreditation Partner, DNV Healthcare, National Association of Boards of Pharmacy, National Dialysis Accreditation Commission, The Compliance Team, The Joint Commission and the Utilization Review Accreditation Commission.
The Joint Commission said in an email statement it is still reviewing the rule, but supports CMS’ efforts to improve patient care safety and quality.
The proposed rule excludes organizations that accredit clinical laboratories and non-certified suppliers, and it doesn’t affect healthcare providers and suppliers certified by a state survey agency.
What led CMS to push for stronger oversight?
Over the past few years, CMS has looked into numerous lapses in accrediting bodies’ performance and found merit in various concerns about the organizations’ conflicts of interest and inaccurate survey findings.
A main problem is accrediting organizations offering fee-based consulting services to the providers it accredits, the agency said. This is a conflict of interest that leads facilities to expect favorable survey results if they pay an accrediting body for its services, according to CMS.
Another issue is the discrepancies between surveys conducted by accrediting bodies and those conducted by state survey agencies. In a 2020 report, CMS stated that accrediting organizations missed care quality problems found by state survey agencies in 42% of their hospital surveys.
Accrediting organizations have also allowed hospitals to keep their accreditation despite being terminated from the Medicare program over serious safety violations, according to media reports. CMS said those reports have played a factor in its crackdown on accrediting bodies.
Where can conflicts of interest arise for accrediting organizations?
Aside from offering fee-based consulting services to entities seeking accreditation, organizations can also face conflicts of interest if they:
- Accept fees for personal, contract, referral or supply services given to accredited facilities. CMS said the firewalls some accrediting bodies have between the various arms of their businesses may not be enough, as the organizations could still have an incentive to provide a positive survey report to "demonstrate the efficacy" of their services and "keep paying customers happy."
- Have a financial investment or business interest in an accredited facility. These kinds of ties could lead to an accrediting organization surveyor minimizing or ignoring problem areas and determining they are not representative of the facility, according to CMS.
- Have employees or board members that work for accredited facilities. Health system employees involved in accreditation processes for facilities they work for might cause biased results if they also act as a surveyor. Such personnel could advocate on behalf of a facility they work for and explain its policies and procedures to the survey team, skewing results.
- Have employees that also work for state survey agencies. State survey agencies and accrediting organizations are meant to perform surveys and assessments independent of each other as a system of checks and balances.
To avoid potential conflicts of interest, URAC ensures all its accreditation applications are de-identified before being judged and its accreditation committee is an independent body from its board. URAC also offers free materials to educate healthcare entities on best practices as they undergo the accreditation process, Griffin said.
"Our primary focus is to measure and reward quality, not to bill hours," he said.
What fee-based services do accrediting bodies provide?
Accrediting organizations often offer services like classes on Medicare conditions of participation, technical assistance with changing clinical or administrative areas in need of improvement, and mock surveys with written reports reviewing facilities' processes, policies and operations.
How would CMS’ proposed rule tackle accrediting organization performance issues?
Under the proposed rule, accrediting bodies would be required to make number of changes to prevent conflicts of interest and discourage biased survey results.
While facilities would still be able to hire third-party fee-based consulting services, accrediting organizations would be penalized for providing such services prior to an initial accreditation survey or in response to a complaint about a specific facility.
Additionally, accrediting organizations would need to tell CMS on a biannual basis the services they provide, along with their policies and procedures for separating fee-based consulting services from accreditation services.
To ensure the integrity of the survey process, CMS would require accrediting organizations to share all survey reports and corrective action plans with the agency, and give their employees the same basic training as state survey agency surveyors.
The rule would also mandate accrediting bodies revoke their certification of a provider involuntarily terminated from Medicare.