Skip to main content

CMS Seeking Public Comment on Accrediting Organizations and Conflicts of Interest

Analysis  |  By PSQH  
   December 27, 2018

CMS is seeking public comment on whether AOs should offer consulting services. 

By A.J. Plunkett

Have you ever questioned whether it appropriate to pay an accrediting organization for consulting services on how to comply with the same standards it sets and allows you to stay in business? CMS is wondering as well.

More to the point, CMS is seeking public opinion on this issue. On December 18, the federal agency pre-published a request for information on "Medicare Program: Accrediting Organizations Conflict of Interest and Consulting Services."

"This request for information seeks public comment regarding the appropriateness of the practices of some Medicare-approved Accrediting Organizations (AOs) to provide fee-based consultative services for Medicare-participating providers and suppliers as part of their business model," according to the notice published in the Federal Register.

"We wish to determine whether AO practices of consulting with the same facilities which they accredit under their CMS approval could create actual or perceived conflicts of interest between the accreditation and consultative entities. We intend to consider information received in response to this RFI to assist in future rulemaking," CMS says.

CMS: Public Trust an Issue

"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," said CMS Administrator Seema Verma, in a prepared statement announcing the initiative on December 19.

Noting that healthcare providers that seek reimbursement through Medicare or Medicaid must meet sometimes lengthy Conditions of Participation in Medicare or Conditions of Coverage, the agency also notes in its RFI that some providers go through AOs for what is referred to as "deemed status" to be able to bill CMS.

There are several AOs for various healthcare providers and suppliers, but one of the largest and oldest is The Joint Commission. (Some histories of the CoPs note that TJC's predecessors were accrediting hospitals for decades before Medicare existed and that some believe TJC standards were used as a model for the CoPs in the 1960s.)

TJC and other AOs came under fire over the past few years after CMS highlighted disparities between patient safety problems identified by AO surveyors and those found by CMS state surveyors in follow-up surveys several weeks later.

While compliance officers and consultants have noted that often problems found by CMS surveyors did not exist at the time an AO was on site, the disparity rates were reported to Congress as part of CMS' annual report on how it manages hospital and healthcare accreditation. That, combined with an article in September in the Wall Street Journal critical of TJC, spurred a House subcommittee to launch an investigation into the integrity of AO operations. [Editor's note: See correction at bottom.]

Investigation Spurs RFI

That investigation is, in part, behind CMS' request for comment on potential conflicts of interest AOs might have if they have associated interests in consulting services, according to the federal notice. CMS is also looking for ideas for potential solutions to prevent such conflicts of interest.

CMS notes that, as part of its responsibility for oversight and approval of AO accreditation programs, the federal agency reviews each AO's standards, "survey processes and procedures, surveyor training, and oversight and enforcement of provider entities. In addition, we also review the qualifications of the surveyors, staff, and the AO's financial status."

Also, "an AO submitting an application must include a copy of the AO's 'organization's policies and procedures to avoid conflicts of interest, including the appearance of conflicts of interest, involving individuals who conduct surveys or participate in accreditation decisions.' This provision is implemented by CMS's review of submitted documentation to determine that no conflicts of interest exist," according to the notice.

TJC is a non-profit organization headquartered in Oakbrook Terrace, Illinois. Any consulting services are provided through its not-for-profit arm, Joint Commission Resources Inc. On TJC's website, in a brochure with information for those who might want to work for the commission, the commission states:

"Joint Commission Resources, Inc. (JCR), a not-for-profit wholly-owned affiliate of The Joint Commission, provides innovative solutions designed to help health care organizations improve patient safety and quality. The Joint Commission and JCR maintain strict separation policies and have stablished a 'firewall' that prohibits The Joint Commission and the consulting services of JCR from sharing any organization-specific, confidential information about accredited organizations or certified programs, as well as certain accreditation process information."

TJC has released a statement on CMS' request for information:

"The Joint Commission is currently reviewing the Centers for Medicare & Medicaid Services (CMS) request for information seeking comment on accrediting organizations' potential conflict of interest and consulting services.

The Joint Commission recognizes the importance of assuring 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. 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 assure that this goal is achieved."

In its statement, CMS said the information received through the request for information "will assist in developing potential future rulemaking or guidance. As part of this process, CMS will determine whether revisions should be made to the AO application and renewal process to identify actual, potential, or perceived conflicts of interest."

How to Comment

Comments will be accepted for 60 days after official publication in the Federal Register, which is scheduled for December 20. Note that CMS may not respond to your comment, although you may be contacted for further information. In addition, comments may be made public and materials you submit will not be returned.

Comments should refer to file code CMS-3367-NC. CMS will not accept fax copies of comments. They can be submitted electronically by following the "submit a comment" instructions on, by regular mail or by overnight express mail.

To find out more about what information CMS hopes to learn, and specifics on how to comment, read the rule at here.


Correction: A previous version of this article incorrectly identified the Congressional committee behind an investigation into the performance of accrediting organizations. It was the Energy and Commerce committee in the House, not the Senate.

Patient Safety & Quality Healthcare’s mission is to provide news, science, research, and a forum for opinion for clinicians, healthcare professionals, and everyone interested in improving quality in healthcare. Learn more.

Get the latest on healthcare leadership in your inbox.