CMS Announces Plans to Strengthen Oversight of Medicare's Accreditation Organizations

PUBLISHED: Oct 5, 2018
Relevant to: All Healthcare Organizations

The U.S. Centers for Medicare & Medicaid has announced actions to improve oversight of Accrediting Organizations (AOs), including increasing transparency for patients on AO’s performance. Currently, Medicare-participating healthcare providers and suppliers are surveyed either by State survey agencies or by Accrediting Organizations to ensure that they meet CMS’ quality and safety standards. AOs receive deeming authority from CMS, which affirms that AOs’ health and safety standards meet or exceed those of Medicare. Only facilities and suppliers that have been deemed by state or AO surveyors to meet CMS’ standards may receive payments from Medicare. There are currently 10 CMS-approved AOs, each of which surveys one or more different type of facilities.

CMS will enhance and strengthen its oversight and quality transparency of AOs in three ways:

  • The public posting of AO performance data
  • A redesigned process for AO validation surveys and,
  • The release of the Annual Report to Congress.

According to CMS, taken together, these efforts will provide important insights to the public and assist AOs, providers, and suppliers in ensuring patient health and safety.

Posting AO Performance Data Online:

  • CMS will post new information on the CMS.Gov website, including:
    • The latest quality-of-care deficiency findings following complaint surveys at facilities accredited by AOs
    • A list of providers determined by CMS to be out of compliance, with information included on the provider’s AO
    • Overall performance data for AOs themselves. To view AO performance data, visit: https://qcor.cms.gov/hosp_cop/HospitalCOPs.html

Today, the public relies on accreditation status as a way to gauge providers’ and suppliers’ quality of care. 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. The agency is currently prohibited by law from disclosing the actual surveys done by AOs, except for surveys of home health agencies and surveys related to an enforcement action.

Pilot Testing Direct Observation for AO Validation Surveys:

Historically, CMS has measured the effectiveness of AOs by choosing a sample of facilities, performing state-conducted assessment surveys within 60 days following AO surveys, and comparing results of the state surveys with the AO surveys. CMS will conduct a pilot test that will eliminate the second state-conducted validation survey and instead use direct observation during the original AO-run survey to evaluate AOs’ ability to assess compliance with CMS’s Conditions of Participation. It is hoped that this approach will relieve providers from having to undergo the burden of a state’s follow up assessment.

CMS will also analyze and incorporate State complaint investigations of accredited facilities as part of the agency’s strengthened validation program. This work will focus on identifying and monitoring 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.

Posting the Most Recent Annual Report to Congress Regarding AO Performance:

CMS has also posted the most recent annual Report to Congress, the “Review of Medicare’s Program for Oversight of Accrediting Organizations and the Clinical Laboratory Improvement Validation Program Fiscal Year 2017,” on the CMS website. A link to that report is included in the references below.

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