The CMS plans to enhance oversight of accrediting organizations in light of conflict of interest concerns and publicized safety issues at provider organizations, according to CMS Administrator Seema Verma.
During a speech at the agency's Quality Conference in Baltimore, Verma told the audience accreditors are failing to protect patients from harm and the CMS will be doing more on the issue "in the near future."
The Office of Management and Budget is currently reviewing a proposed rule from the CMS in response to its request for information in December 2018 asking for feedback from accreditors like the Joint Commission regarding how they establish and disclose relationships with providers they both sell consulting services to and accredit for participation in Medicare. The proposed rule is also recommending new requirements for accrediting organizations to conduct surveys.
Verma said the business practice of acting as both an accreditor and consultant is "a glaring conflict of interest." She added it's "simply not acceptable" some accrediting organizations use standards that differ from the CMS' conditions of participation. The Joint Commission, which is the leading accreditor of hospitals, issues requirements that go beyond CMS standards.
"Receiving CMS' authorization to inspect and deem healthcare providers compliant with Medicare's quality standards is nothing short of assuming a sacred public trust responsibility," Verma said. "But an increasing amount of evidence indicates that accrediting organizations are not living up to that high bar."
Dr. Mark Chassin, CEO of the Joint Commission, has defended the business framework of acting as both an accreditor and consultant. The accreditation arm is a separate legal entity from its consultancy arm, called Joint Commission Resources.
Verma also said in her speech the CMS plans to unveil soon the launch of Meaningful Measurement 2.0, which is a successor to the Meaningful Measures initiative the agency launched in 2017.
Meaningful Measures has focused on removing measures from CMS programs that don't offer value to patient and providers. It also added measures focused on patient outcomes. The initiative has led to elimination of 18% of the agency's quality measures and saved $128 million through reductions in administrative work.
Meaningful Measurement 2.0 will focus on quality measurement done electronically, according to Verma.
"Imagine a world in which clinicians don't have to lift a finger, where quality measures can be seamlessly transmitted from their EHRs," she said. "In this world, we would be able to identify quality problems before patients are harmed and intervene accordingly."
Verma pointed to the adoption of the Fast Healthcare Interoperability Resources standards as a way to achieve this vision. FHIR is an EHR standard the Office of the National Coordinator for Health Information Technology is requiring providers adopt in its still-pending interoperability rule. FHIR will allow healthcare organizations to share information with each other no matter the EHR vendor they use. Quality experts claim it will lead to better quality measures and easier reporting.
"This will pave the way for stakeholders to submit data to a centralized submission system," Verma said. "The receiving system can then perform the measure calculations and exchange data and results with several applicable quality programs, removing the burden from the submitter to submit data multiple times."
Verma said the CMS will be announcing more details about its Meaningful Measurement 2.0 framework in the next several months.
