The Joint Commission's program responsible for accrediting about 80% of the nation's hospitals was only granted two years of approval by CMS, with the agency citing issues with the survey process.
CMS grants accrediting organizations that survey healthcare facilities for participation in Medicare and Medicaid approval for up to six years. This week, CMS issued a notice to the Joint Commission that its hospital accreditation program was only approved for two years or until mid-July 2022. CMS was explicit that the shortened approval period was based on "concerns" related to Joint Commission surveyor performance and comparability of the Joint Commission's survey process to the agency's.
The agency also said in the notice that it will continuously review the Joint Commission's survey process for all its accreditation programs, which include home health agencies and ambulatory surgical centers. "In keeping with CMS' initiative to increase (accrediting organization) oversight and ensure that our requested revisions by the Joint Commission are complied with, CMS expects more frequent review of (The Joint Commission's) activities to avoid any continued inconsistencies," the agency said.
The Joint Commission had to make several changes to its survey process before it was approved by CMS for two years, according to the notice. The Joint Commission is now requiring additional training for its surveyors related to off-site location standards, reviews of medical records and the level of detail provided to facilities during briefings "to ensure it does not change the integrity of the survey process." Changes were also made to the Joint Commission's survey process related to "leading and probing questions during interviews," as well as more restrictions on interviewing frontline caregivers in the presence of supervisors.
In a statement, Dr. Mark Chassin, CEO of the Joint Commission, said he "appreciates" CMS' initiative to increase oversight of all hospital accrediting organizations.
"We will continue to demonstrate that Joint Commission accreditation provides the nation's most state-of-the-art and effective evaluation of hospitals. We look forward to our ongoing work with CMS to improve patient safety and quality of care," Chassin said.
The Joint Commission is the nation's largest hospital accreditor, estimated to survey about 80% of hospitals for Medicare participation. The Joint Commission's hospital program received the full six-year approval from CMS in 2014, although the agency also had new regulations for the accrediting organization to comply with. CMS only began to approve the Joint Commission's hospital accreditation program in 2010 after a provision in the Medicare Improvements for Patients and Providers Act of 2008 revoked the Joint Commission's recognition as a deeming authority for its own hospital program.
Tom Scully, former CMS administrator during the George W. Bush administration, said an official with CMS indicated the agency is attempting to send a message to the Joint Commission with its recent notice. "They are not happy with them," he said.
The stricter CMS oversight comes amid continued efforts by the Trump administration to crack down on accrediting organizations. CMS Administrator Seema Verma said during a speech in February the agency will enhance oversight of accreditors with standards that differ from the CMS' conditions of participation, calling it "simply not acceptable." The Joint Commission has previously touted that its standards go beyond CMS standards.
Verma also said the practice of acting as both an accreditor and consultant is "a glaring conflict of interest." Additionally, in 2018, CMS announced it will publicly post more information from accrediting organization surveys such as a list of providers out of compliance with CMS standards. CMS has also made changes to the audit process for accrediting organizations that involve state survey agencies accompanying them on surveys to directly observe them.
Joint Commission's competitors in the hospital accreditation space have also recently failed to receive the full six-year approval from CMS. Both DNV GL-Healthcare and the Healthcare Facilities Accreditation Program were granted four years of approval with CMS requiring them to revise standards.