CMS to scrutinize conflicts of interest among accrediting organizations

CMS wants to take a closer look at the financial relationships of accrediting organizations (AOs) that survey Medicare-certified healthcare providers. Specifically, CMS is seeking comment on potential conflicts of interest, as AOs charge consulting services fees to facilities they monitor, the agency announced Dec. 18.

“Today’s [request for information] RFI asks for public input on whether these consulting fees create conflicts of interest, as the same entity is both consulting for a given facility and monitoring whether that facility is accredited to participate in Medicare,” the announcement reads.

The move could be seen as part of a larger crackdown on AOs. The agency previously announced it would implement more oversight and quality transparency around AOs in October. The push for more transparency around AOs has been ongoing; CMS proposed making hospital inspections by AOs public in 2017.

The proposal was strongly opposed by hospitals and, ultimately, not included in the final rule.

“We are concerned that the practice of offering both accrediting and consulting services––and the financial relationships involved in this work––may undermine the integrity of accrediting organizations and erode the public’s trust,” CMS Administrator Seema Verma said in a statement. “Our data shows that state-level audits of healthcare facilities are uncovering serious issues that AOs have missed, leading to high ‘disparity rates’ between the two reviews.”

CMS stated it will consider public input to assist in future rulemaking, including reviews of whether CMS should revise its application and renewal process for all AOs.  The agency stated the RFI was prompted by rising concerns about potential conflicts of interest created by the AOs and the consulting services they perform.

Typical consultation services can include:

  • Compliance assistance for clinical and non-clinical leaders
  • Mock survey simulation to review facility standards and promise early intervention and action
  • Review of a facility’s processes, policies and functions
  • Identification and improvement assistance for areas in need of improvement
  • Educational consultative services

AOs have provided these fee-based services to Medicare-participating healthcare facilities “for some time,” according to CMS.

"The Joint Commission recognizes the importance of ensuring the integrity of the accreditation process, which we accomplish by prohibiting any sharing of information about consulting services for individual organizations with anyone involved in accreditation," Katie Looze Bronk, manager of communications and media relations with the Joint Commission, told HealthExec in an emailed statement. "The Joint Commission as an accrediting organization and Joint Commission Resources, Inc. as a provider of education and consulting services are two separate organizations. The Joint Commission enterprise has long-standing firewall policies, practices and procedures in place that ensure that this goal is achieved."

Find the RFI on the Federal Register here.