The Centers for Medicare and Medicaid Services proposed Thursday to crack down on accrediting organizations following concerns of biased, inconsistent survey results and conflicts of interest.
The proposed rule would strengthen CMS’ oversight of accrediting bodies and mandate the organizations reduce conflicts of interest with healthcare facilities, including by limiting fee-based consulting services. The proposal also would standardize accrediting organizations' survey processes.
The proposals stem from several years of evidence showing inefficiencies and deficits in accrediting organization performance, CMS said in a news release. In some instances, providers and suppliers have retained their accreditation status despite being terminated from the Medicare or Medicaid programs for serious quality and safety issues.
The agency also said the results from surveys conducted by accrediting organizations tend to differ from those conducted by state survey agencies, often due to accrediting organizations notifying facilities ahead of the dates of their onsite surveys.
Under the proposed rule, accrediting organizations would be required to:
- Align their standards, survey activity requirements and staff training sessions more closely with state survey agency practices.
- Match the standards set under Medicare and Medicaid Conditions of Participation and Conditions for Coverage in their application process.
- Limit the fee-based consulting services provided to healthcare facilities the organizations accredit, and report how they will monitor, prevent and deal with conflicts of interest related to these services.
- Prohibit owners, surveyors or other employees with ties to a healthcare facility accredited by the organization from participating in surveys or related activities.
- Submit a public correction plan to CMS if the organization is performing poorly.
As part of the proposed rule, CMS is also asking for feedback on whether to limit the number of times an accrediting organization can submit an incomplete application for a new accreditation program by failing to include key information such as their financial viability and survey processes.
The proposed rule said that if a court were to strike down part of the final regulation, the agency intends to keep the rest of it in place.
CMS’ proposed rule would affect the nine accrediting organizations approved to survey and accredit Medicare-certified facilities, including The Joint Commission, Center for Improvement in Healthcare Quality and Community Health Accreditation Partner. The rule excludes organizations that accredit clinical laboratories and non-certified suppliers.
URAC, an independent quality and safety accrediting organization, has thrown its support behind the proposed rule.
“URAC prides itself on not offering consulting services, which can be a conflict of interest because it’s like giving an organization seeking accreditation the answers to the ‘test,’ defeating the purpose of accreditation being a rigorous test of quality,” said Dr. Shawn Griffin, president and CEO of the nonprofit, which accredits healthcare organizations like Amwell, Optum and Johns Hopkins Medicine.
“We believe this new rule will improve the quality of healthcare by ensuring organizations are implementing best practices and quality standards on their own accord, before receiving the ‘gold star’ of accreditation," he said.