CMS announces plans to ramp up oversight of hospital inspection agencies

CMS announced a new plan to strengthen oversight of Medicare’s accreditation organizations. (Getty/anyaberkut)

The Centers for Medicare and Medicaid Services is ramping up its oversight of the organizations that inspect hospitals, healthcare providers and suppliers for compliance with the Medicare program.

Announced Thursday, CMS officials said they are focusing on watchdog organizations that perform accreditation while also making it easier for patients to look at an organizations' performance online.

The changes come following a Wall Street Journal investigation last year which found that some facilities with ongoing problems kept their accreditation. In March, the House Energy and Commerce Committee launched its own investigation into hospital accreditation problems as a result. 

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“The public trusts CMS to ensure the quality and safety of patient care, and we take this responsibility very seriously," Verma said in a statement. "Today's changes will bolster the processes for overseeing how effective Accrediting Organizations, who work on CMS’ behalf, are in evaluating healthcare facilities.” 

What do the changes entail? 

All healthcare providers and suppliers that participate in Medicare are inspected by accrediting organizations (AOs) or state survey agencies to ensure they meet CMS quality and safety standards. And facilities and suppliers must be approved to receive payments from Medicare.  

Now, CMS will begin public posting of performance data from the watchdog organizations, will redesign the inspection process for those AOs and release an annual report to Congress about their findings. (The fiscal year 2017 findings are posted here.) 

That includes posting new information on its CMS.gov website such as the latest quality-of-care deficiency findings following complaint surveys at facilities accredited by AOs and a list of providers determined by CMS to be out of compliance with information included on the provider’s AO.

It will also include overall performance data for AOs themselves.

"By posting more detail—accredited hospitals’ complaint surveys, out-of-compliance information, and performance data for AOs themselves—CMS will offer the public more nuanced information than accreditation status alone provides," officials said in a release.

They are, however, still blocked by law from disclosing the actual surveys done by AOs, except for surveys of home health agencies and surveys related to enforcement action, officials said.

CMS is also pilot testing a new way of validating its AOs' ability to ensure that healthcare providers comply with CMS requirements through direct observation of an AO-run survey. Currently, CMS validates by choosing a sample of facilities, performing state-conducted assessment surveys within 60 days of an AO-run survey in order to compare results.

CMS also plans to analyze state complaint investigations of accredited facilities to identify and monitor accredited facilities that are out of compliance with Medicare health and safety requirements. CMS will use this information as an additional indicator of AO performance.

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