The Centers for Medicare & Medicaid Services (CMS) has published a fact sheet centered on the obligations of accrediting organizations (AOs) that survey Medicare and Medicaid providers and suppliers.
The June 12 fact sheet emphasized that AOs’ accreditation standards “must meet or exceed the requirements and conditions under the Medicare or Medicaid programs to ensure patients receive quality and safe care.”
CMS added that its approved AOs survey more than 9,000 healthcare providers annually to check on health and safety requirements.
“When CMS approves an AO program, the AO can perform surveys in lieu of state survey agencies (SAs),” the fact sheet said. “By taking on this role, AOs accept a ‘public trust’ responsibility in their oversight of the nation’s healthcare providers.”
CMS lists concerns over AO surveys
The agency noted “several concerns about AOs’ survey performance”:
— Providers and suppliers retaining their accreditation after they are terminated from Medicare or Medicaid programs for quality and safety concerns.
— Conflicts of interest arising from AOs providing fee-based consulting services to the providers and suppliers they accredit (often just before an accreditation survey), potentially compromising the integrity of the process.
— Inconsistent survey results due to AO standards or practices that differ from those of SAs (e.g., AOs notifying facilities before the date of their onsite surveys, which is against CMS policy).
CMS said it “is committed to correcting deficient AO survey performance, strengthening oversight of AOs, reducing conflicts of interest, and establishing greater consistency in survey processes and standards to improve patient care and ensure safety in participating facilities.”
Final rule to ensure AO standards meet or exceed Medicare’s standards
The fact sheet was published alongside the “Strengthening Oversight of AO and Preventing AO Conflicts of Interest” final rule, which CMS said in a June 12 announcement “ensures that the organizations responsible for the oversight of more than 9,000 healthcare providers and suppliers use Medicare standards, and creates greater consistency between state survey agencies and AOs in their respective survey processes. These changes will reduce provider burden, strengthen survey policies, and increase transparency.”
“The work accrediting organizations do is vital, but it also raises an age-old question: Who watches the watchmen?” said CMS Administrator Mehmet Oz, M.D. “The answer is, we do. With this new rule, CMS is advancing its commitment to upholding rigorous standards for accrediting organizations and ensuring the health and safety of American patients.”
The announcement added that the final rule “creates a brand-new process for monitoring AO performance; establishes consistent standards, processes, and definitions; updates validation and performance systems; requires AO surveyors to take the same CMS training as SA surveyors; and reduces burden on SAs, AOs and providers by streamlining the CMS AO validation process.”
The rule also prohibits AOs “from conducting mock surveys for providers they accredit before initial surveys and within 12 months of re-accreditation” to ensure those consulting activities don’t compromise the objectivity and integrity of the accreditation process.
“This rule establishes clear, uniform requirements to eliminate ambiguity,” CMS said. “By applying Medicare conditions and requirements as the baseline standards, CMS ensures the application of consistent safety requirements across facilities.”
