The House and Energy Commerce Committee has sent letters to CMS and four hospital accreditation organizations (AOs), including the Joint Commission, asking for more information on how the entities conduct surveys and why there’s been a disconnect between their results and what state survey agencies find.

The questions from Congress stem from a 2017 Wall Street Journal story about the disconnect on identifying patient safety problems. The article found that of the 350 Joint Commission-accredited hospitals found to be in violation of Medicare requirements in 2014, less than 1 percent had their accreditation violation.

At least one, Cooley Dickinson Hospital in Northampton, Massachusetts, was given the commission’s “Gold Seal of Approval” even after CMS threatened to cut it off after three patients died related to safety issues—including a pregnant women who died after the hospital failed to ensure she was treated for high blood pressure caused by pre-eclampsia.

“Although CMS has worked to strengthen its oversight of AOs, the committee is concerned about the adequacy of CMS’s oversight as well as the rigor of the AO survey process,” wrote committee members Reps. Greg Walden, R-Oregon, Gregg Harper, R-Mississippi, and Michael Burgess, MD, R-Texas. “For example, according to CMS’ most recent annual report to Congress, in (fiscal year) 2015, AOs conducting hospital surveys did not report 39 percent of ‘condition level’ deficiencies that were subsequently reported following validation surveys conducted by State Survey Agencies no later than 60 days following the AO survey.”

The letters asked the Joint Commission, as well as other AOs like Bureau of Healthcare Facilities Accreditation, the Center for Improvement in Healthcare Quality and DNV GL Healthcare, for copies of any Medicare hospital accreditation program application submitted by the AOs to CMS, as well as performance reviews, corrective action plans, validation survey feedback and any correspondence addressing the disparity rates for hospital surveys performed by the AOs.

A spokesperson for the Joint Commission told HealthExec that it’s reviewing the request and intends to respond, seeing it “as an opportunity to share on the work we do to improve healthcare quality and patient safety by facilitating high reliability.”

The Joint Commission and other AOs have been under closer scrutiny over the past year about their survey data. It seemed to begin in April 2017, when CMS proposed in its inpatient payment rule that these private organizations would have to publicly release the results of these inspections—a change which didn’t make it into the final rule after the AOs strongly opposed it on the grounds it would expose proprietary information and create a culture of adversity between the inspectors and healthcare organizations.

Sen. Chuck Grassley, R-Iowa, took it a step further by asking CMS later in 2017 what legal barriers were standing in the way of making the results public. He particularly singled out the Joint Commission in this request, saying it “appears to be unable to aggressively enforce the necessary standards on all facilities.”

The Joint Commission responded to that request by saying it shares the goal of “healthcare system that consistently delivers the highest quality of care to all patients and enables healthcare providers to continually improve their performance.” To achieve that, however, it argued there needed to be a balance between “disclosure and confidentiality.”