October 9, 2018

Inside CMS' new pilot to evaluate hospital accrediting organizations

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    CMS on Thursday announced a new pilot program intended to increase the agency's oversight of organizations involved in accrediting and inspecting most U.S. hospitals.

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    Investigation flags concerns with hospital accreditors

    CMS historically has used a validation survey process to evaluate whether an accrediting organization, such as the Joint Commission, can accurately assess whether providers and suppliers are complying with federal requirements for health and safety.

    Currently, the agency relies on states to inspect a sample of medical facilities within 60 days of an accrediting organization's visit and compares the results of the state-level inspections with the accrediting organization's assessment.

    However, a Wall Street Journal investigation in 2017 found potential issues with how CMS evaluates the effectiveness of accrediting organizations. The Journal found the Joint Commission, which accredits nearly 80% of U.S. hospitals, did not take actions to modify or revoke hospital accreditations when state inspectors found safety violations at the hospitals. Hospitals in some cases maintained their full accreditation despite being barred from participating in Medicaid, the Journal found.

    CMS Administrator Seema Verma said, "Because of that article, we've taken a lot of action, and we're just getting started on the issue." She added, "We're trying to bolster our efforts to have oversight and to also have our reviews of [accreditors] transparent."

    CMS to pilot new program for evaluating AOs

    CMS said it will pilot a new approach for assessing accrediting organizations that "will streamline and strengthen" its evaluation process.

    The pilot will take place in Georgia, Ohio, and Texas. Under the program, state inspectors will directly observe facilities during the accrediting organizations' self-assessment period, instead of within 60 days after the assessment is completed. CMS said, "Direct observation will enable CMS not only to evaluate [accrediting organization's] performance more effectively, but also to suggest improvements and address concerns with [accrediting organizations] immediately. This approach will relieve providers from having to undergo the burden of a state’s follow up assessment."

    CMS under the new program also will "analyze and incorporate state complaint investigations of accredited facilities," with a "focus on identifying and monitoring accredited facilities that are out of compliance with Medicare health and safety requirements." The agency will use the data it collects from those assessments as another indicator of accrediting organizations' performance, CMS said.

    In addition, CMS said it will begin to publicly publish accrediting organization performance data, such as information related to potentially missed safety issues. CMS will publish a list of hospitals and health organizations that are not in compliance with safety requirements, as well as the accrediting organization that accredited them.

    Verma said the federal government intends to take further action in the fall, but those steps would require new federal regulations, which will take time to implement (Armour, Wall Street Journal, 10/4; CMS release, 10/4).

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