CMS hints at accreditation organization crackdown after airing concerns over consulting arms, survey accuracy

Seema Verma
Centers for Medicare & Medicaid Services Administrator Seema Verma voiced concerns over accreditation organizations, prompting questions as to whether new regulations are coming. (HIMSS)

BALTIMORE—The head of Medicare put accrediting organizations that inspect hospitals on notice that they could expect more scrutiny over their surveys and consulting arms.

Centers for Medicare & Medicaid Services (CMS) Administrator Seema Verma blasted accrediting organizations for greenlighting hospitals that later went on to make safety violations. She also slammed organizations that set up fee-based consulting services, which she called a conflict of interest.

“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,” she said during the CMS Quality Conference in Baltimore on Tuesday. “But an increasing amount of evidence indicates that accrediting organizations are not living up to that high bar.”

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Chief among those concerns are the consulting arms of accreditation organizations that help a facility pass the organization’s survey.

“We think philosophically that it is important that whoever is doing an accreditation review does not have any type of financial relationship with who they are reviewing,” Verma told reporters after her speech. “That is the standard we have in Medicaid and quality improvement organizations. We think that standard should be applied across the agencies.”

The Wall Street Journal reported back in 2017 that The Joint Commission, the largest hospital accrediting body, rarely withdraws its approval for hospitals even after serious safety lapses. The report also details a subsidiary of The Joint Commission that charges hospitals to help them get and retain accreditation from the body.

The Joint Commission said in a statement to FierceHealthcare on Wednesday that it submitted detailed comments to CMS on its consulting services that outline the value they provide and "how intensively we have built and enforced robust firewall policies and procedures to assure the integrity of the accreditation process."

Another concern is whether accrediting organizations are inspecting hospitals per CMS standards. CMS can review the surveys of accreditation organizations and go out with the organization’s inspector on a survey to compare their results to the results of the agency.

“The accreditation organizations when they review an entity is coming out with different results than we would have,” Verma told reporters.

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Verma did not name a specific accreditation organization whose results differed from the agency.

CMS put out a request for information back in December 2018 to solicit feedback on regulation of accreditation organizations. But, since that request, the agency has not issued any new regulations on the organizations. Verma hinted that “you’ll see more from us on this issue in the near future.”

The Healthcare Facilities Accreditation Program (HFAP) told FierceHealthcare that it supports better coordination with state agencies to validate their surveys. But HFAP added that most accreditation organizations add standards beyond the minimum Medicare requirements.

“We don’t believe that responsibility ends with an ‘inspection.’” The group said in a statement.

Other accrediting organizations tasked with inspecting hospitals—DNV GL Healthcare and Accreditation Commission for Health Care—did not have a comment on Verma’s remarks as of press time.