In comments submitted to CMS on Accreditation Organizations (AOs) Conflict of Interest, JKTG Foundation stressed the inherent conflicts of interest that result from AO consulting relationships with providers, objectivity challenges when providers are part of AO board of directors, particularly those who receive payment for their board participation and gave recommendations on how these conflicts (both actual and implied) could be addressed.

1.  Assuring that the AO provision of consulting service does not have a negative effect.

  • Prohibit all approved AOs from the provision of consulting services of any type related to the subject matters of quality reviews.
  • Require that any approved AO not offer consulting services to the providers it reviews and if the AO inadvertently finds such services were performed, the AO should resign from that provider’s review.
  • Stipulate that any AO that is CMS approved is explicitly prohibited from performing any AO review of a provider entity represented on that AO’s Board of Directors.
  • In the AO application to CMS for deemed status require that the AO provide their review results when they have reviewed a provider that utilized their own AO consulting division as well as the review of other AO consulting division no less often than quarterly.
  • CMS should calculate a “disparity rate(s)” of items cited and items missed by consultants and require such be reported publicly
  • At least require that the AO establish a Chinese Wall between its review and consulting arms including appropriate policies and procedures that CMS could review.

2. Improving the Credibility of AO Leadership and Garnering of Input.

  • AOs should use Advisory Councils in lieu of Board of Directors memberships.
  • Require beneficiary representation on the AO Board of Directors and require that such representation be current Medicare beneficiaries and such representation must not be from an organization that merely represents beneficiaries since these entities tend to have self-interests rather than the interests of individual beneficiaries.
 

3.  Addressing Actual and Implied and Real And Perceived Conflicts.

  • Require an external review of the AO’s COI policies and practices as well as any interactions with the AO’s Board of Directors related entities.
  • Require the public reporting or reporting to CMS of any and all errors found by any AO consulting division either for their own reviewed providers or others and make those errors or findings public both on the AO’s and provider’s website.
  • Require consulting AO divisions to report when they believe that other AO consulting divisions are predatorily finding errors in their reviews.
  • Inform Medicare beneficiaries of these issues and their importance and impact on quality.

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Jayne Koskinas Ted Giovanis
Foundation for Health and Policy

PO Box 130
Highland, Maryland 20777

Media contact: 202.548.0133