Republican leaders of the U.S. House Energy & Commerce committee wrote to the Centers for Medicare and Medicaid Services March 12 to say they were concerned about the agency’s ability to assure some hospitals were meeting standards.
The committee members, including the chairman, Rep. Greg Walden, R-Ore., focused on the agency’s oversight of accrediting organizations that certify whether hospitals in the Medicare program are meeting minimum requirements.
Hospitals reimbursed by the federal healthcare program can receive what are known as conditions of participation directly from the agency, known as CMS, or state authorities. However, 35,000 hospitals — or 89% in the program — chose a third path, accreditation by a nonprofit organization, said the letter, also signed by investigations subcommittee chairman Rep. Gregg Harper, R-Miss., and health subcommittee chairman Rep. Michael Burgess, R-Texas.
The letter cited a 2015 CMS report to Congress that accrediting organizations did not find 39% of "condition level" deficiencies — the most serious classification — that were later discovered by other authorities.
"Although CMS has worked to strengthen its oversight of [accrediting organizations], the committee is concerned about the adequacy of CMS’ oversight as well as the rigor of the AO survey process," the letter said.
For instance, a committee press release cited a Sept. 8, 2017, article in The Wall Street Journal, which found that CMS had threatened to cut off Cooley Dickinson Hospital in Northampton, Mass., from the Medicare program after the deaths of two babies and a pregnant woman. CMS had found the hospital's "failure to provide quality medical care" led to the deaths, the Journal reported.
Nevertheless, the newspaper reported an Oakbrook, Ill., accrediting group, the Joint Commission, continued to fully accredit the hospital.
The newspaper reported that the Joint Commission also accredited 350 hospitals that had been found to have violated Medicare standards, and in 2014, revoked the accreditation of less than 1% of the hospitals that were found out of Medicare compliance.
A Joint Commission spokeswoman said in an email that the group is still reviewing the letter. A CMS spokesman said it was looking into the issue and "patient care and safety are top priorities" for the agency.
