Maria Castellucci February
25, 2020
The CMS plans to enhance oversight
of accrediting organizations in light of conflict of interest concerns and
publicized safety issues at provider organizations, according to CMS
Administrator Seema Verma.
During a speech at the agency's
Quality Conference in Baltimore, Verma told the audience accreditors are
failing to protect patients from harm and the CMS will be doing more on the
issue "in the near future."
The Office of Management and Budget
is currently reviewing a proposed
rule from the CMS in response to its request for information
in December 2018 asking for feedback from accreditors like the Joint Commission
regarding how they establish and disclose relationships with providers they
both sell consulting services to and accredit for participation in Medicare.
The proposed rule is also recommending new requirements for accrediting
organizations to conduct surveys.
Verma said the business practice of
acting as both an accreditor and consultant is "a glaring conflict of
interest." She added it's "simply not acceptable" some
accrediting organizations use standards that differ from the CMS' conditions of
participation. The Joint Commission, which is the leading accreditor of
hospitals, issues requirements that go beyond CMS standards.
"Receiving CMS' authorization
to inspect and deem healthcare providers compliant with Medicare's quality
standards is nothing short of assuming a sacred public trust
responsibility," Verma said. "But an increasing amount of evidence
indicates that accrediting organizations are not living up to that high
bar."
Dr. Mark Chassin, CEO of the Joint
Commission, has defended the business
framework of acting as both an accreditor and consultant. The accreditation arm
is separate legal entity from its consultancy arm, called Joint Commission
Resources.
Verma also said in her speech the
CMS plans to unveil soon the launch of Meaningful Measurement 2.0, which is a
successor to the Meaningful Measures initiative the agency launched in 2017.
Meaningful Measures has focused on
removing measures from CMS programs that don't offer value to patient and
providers. It also added measures focused on patient outcomes. The initiative
has led to elimination of 18% of the agency's quality measures and saved $128
million through reductions in administrative work.
Meaningful Measurement 2.0 will
focus on quality measurement done electronically, according to Verma.
"Imagine a world in which
clinicians don't have to lift a finger, where quality measures can be
seamlessly transmitted from their EHRs," she said. "In this world, we
would be able to identify quality problems before patients are harmed and
intervene accordingly."
Verma pointed to the adoption of
the Fast Healthcare Interoperability Resources standards as a way to achieve
this vision. FHIR is an EHR standard the Office of the National Coordinator for
Health Information Technology is requiring providers adopt in its still-pending interoperability rule.
FHIR will allow healthcare organizations to share information with each other
no matter the EHR vendor they use. Quality experts claim it will lead to
better quality measures and easier reporting.
"This will pave the way for
stakeholders to submit data to a centralized submission system," Verma said.
"The receiving system can then perform the measure calculations and
exchange data and results with several applicable quality programs, removing
the burden from the submitter to submit data multiple times."
Verma said the CMS will be
announcing more details about its Meaningful Measurement 2.0 framework in the
next several months.
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