CMS to boost oversight of accreditation organizations through posting of performance data

The Centers for Medicare and Medicaid Services has announced new oversight efforts it said would increase transparency around the performance of Medicare Accreditation Organizations, or AOs.

This is to be done through the public posting of AO performance data, a redesigned process for AO validation surveys and the continued release of the Annual Report to Congress.

THE IMPACT/WHY IT MATTERS

The public relies on accreditation status as a way to gauge providers' and suppliers' quality of care. In posting more detail, such as accredited hospitals' complaint surveys, non-compliance information and AO performance data, the agency hopes to give the public more information and show greater transparency.

THE TREND

Currently, Medicare healthcare providers and suppliers complete a survey either by the state or an accrediting organization to ensure they are in compliance with CMS' quality and safety standards. AOs receive authority from CMS, which affirms that AOs' health and safety standards meet or exceed those of Medicare. Only facilities and suppliers deemed in compliance with CMS' standards by an AO or the state may receive payments from Medicare.

CMS will now post new performance information on the CMS.gov website, including 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 and the provider's AO; and overall performance data for AOs themselves.

The agency is not allowed to disclose the actual surveys done by AOs, except for home health agencies and the enforcement action survey.

CMS is also testing an alternative method for assessing AOs' ability to ensure compliance from facilities and suppliers with CMS requirements. Historically, CMS measured AO effectiveness through state-conducted assessment surveys within 60 days following AO surveys, and then compared results.

As part of a pilot, CMS will eliminate the second state-conducted validation survey and use direct observation during the original AO-run survey to evaluate the AOs' ability to assess compliance with CMS's conditions of participation.

"Direct observation will enable CMS not only to evaluate AO performance more effectively, but also to suggest improvements and address concerns with AOs immediately. This approach will relieve providers from having to undergo the burden of a state's follow up assessment. The approach is another example of the wide-ranging effort at CMS to eliminate duplication and relieve burden, reducing the amount of time that healthcare facilities must spend on compliance activities," CMS said.

The agency also plans to incorporate state complaint investigations of accredited facilities as part of an enhanced validation program, with an eye on identifying and monitoring accredited facilities that are out of compliance with Medicare requirements and using the information gathered as an additional indicator of AO performance.

ON THE RECORD

"Today we are taking action to improve our oversight of Accrediting Organizations, including by increasing transparency for patients on the organizations' performance," said CMS Administrator Seema Verma.  "The public trusts CMS to ensure the quality and safety of patient care, and we take this responsibility very seriously…Taken together, these efforts will provide important insights to the public and assist AOs, providers, and suppliers in ensuring patient health and safety."

Twitter: @BethJSanborn
Email the writer: beth.sanborn@himssmedia.com