The Trump administration is looking for feedback on potential conflicts of interest for accrediting organizations that consult with providers that they also accredit.
The Centers for Medicare & Medicaid Services issued a request for information (PDF) on Tuesday, asking stakeholders to weigh in on the potential conflicts. The agency said in an announcement that it intends to use the comments to create future rules, building on an October reveal that it plans to boost oversight of these organizations.
Accrediting organizations that are approved by Medicare may also provide paid consulting services in several areas, including compliance, reviews of existing processes and educational services.
“We have concerns that this dual function may undermine, or appear to undermine, the integrity of the accreditation programs and could erode the public trust in the safety of CMS-accredited providers and suppliers,” CMS said in the RFI.
CMS’ efforts related to these organizations come about a year after The Wall Street Journal released an investigation into conflicts of interest for the country's largest accreditor of hospitals and health systems: The Joint Commission.
The newspaper found that the commission rarely revokes accreditation for hospitals that are not in compliance with Medicare, even in situations where there were significant safety lapses. The Joint Commission also operates a consulting subsidiary, so it can charge hospitals both for the accreditation and the consult to fix any issues.
Experts who have been critical of these potential conflicts praised CMS for diving into the issue, according to the WSJ.
“This is a game-changer,” Ashish Jha, M.D., director of the Harvard Global Health Institute, told the newspaper. “It could fundamentally alter the incentives for accreditors. We don’t need to be generating business for consulting arms.”
The issue also caught the eye of legislators, who expressed concern about the strength of CMS’ oversight of these organizations.
The Joint Commission and other accrediting organizations have also been criticized for not making inspection reports public. Sen. Chuck Grassley, R-Iowa, has pushed for increased transparency, and has proposed providing statutory authority to compel these groups to release their reports publicly.
CMS itself had proposed something similar in early 2017 but within drew the plan shortly thereafter as it was concerned it may “circumvent the law” in doing so.
CMS will accept comments on the issue for the next 60 days.