Who provides oversight and approval for the various health care organization accrediting agencies?

Preparing for accreditation can be a long, intensive process. It requires collaborating with administrators and leaders to update policies, procedures, and training materials.

But accreditation is a worthwhile investment. In the end, achieving accreditation in healthcare can have many important benefits for your organization:

Improved quality of care

Achieving accreditation requires holding staff to high standards for patient care. Studies have shown that accreditation improves the overall quality of care in healthcare facilities.

In certain specialty areas, accreditation programs even improve patient outcomes.

In a survey by the Public Health Accreditation Board, 98% of respondents agreed that accreditation prompted their organization to improve quality and performance.

Healthcare accreditation requires organizations to examine processes in every department and section of their facility. This also improves the quality of care by decreasing variations in the ways different staff members and departments care for patients.

The standards ensure that patients will receive consistent, excellent care throughout the facility.

Increased community confidence

In healthcare, patient trust is essential. Patients are putting their personal health – and often their lives – in the hands of healthcare staff.

Accreditation shows your patients that they can trust your organization to take care of them. It also demonstrates to the community that you are seeking to provide the highest quality service possible.

When community members see that your organization is accredited, they know that you have voluntarily undergone the process of meeting rigorous standards.

This increased confidence not only brings in more patients, it also can help your organization build partnerships within your community.

Better operational efficiency and processes

Healthcare organizations face unique challenges when it comes to management and business operations.

Organizations must make sure their operations comply with a complex series of federal and state laws. They also must continually improve processes while also cutting costs.

A survey conducted by the Harvard Business Review found that management issues were the biggest challenges facing healthcare providers.

They interviewed more than 150 healthcare executives at different types of organizations, and found that more than half of them said their operational model needed to change.

Accreditation in healthcare can help organizations make strategic shifts. Most accreditation standards provide a framework to help your organization set up better structures and achieve operational excellence.

In the Public Health Accreditation Board survey, 90% of respondents said accreditation improved the management processes of their leadership team.

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Who provides oversight and approval for the various health care organization accrediting agencies?

Reduced liability insurance

Healthcare is a high-risk and highly regulated industry. Federal healthcare regulations such as HIPAA, the False Claims Act, the Affordable Care Act, and more are complex and ever-changing.

Medical mistakes or compliance violations can cost your organization millions in lawsuits, or even put you out of business.

Preparing for accreditation requires doing a comprehensive review of how your organization functions. This lets you see the areas where you are most at risk.

You may spot a gap in compliance or find that you need to adjust the procedure to make a certain task safer. This proactive approach to risk management will result in safer processes, and therefore, fewer mistakes.

As a result, accreditation may provide you with better access to liability insurance.

Some insurance companies offer a reduced premium to facilities that are accredited. This can bring significant savings for your organization, and may even offset the cost of accreditation.

Gain competitive advantage

Accreditation gives you a leg up on your competition. Potential patients or partners are more likely to choose an accredited healthcare facility over one that is not accredited.

Since accreditation improves the quality of care, it also improves patient satisfaction. And satisfied patients spread the word and come back when they need additional medical help.

Receive shared policies, procedures, and best practices

When your organization gets accredited, you gain access to a whole new world of resources and partnerships.

Often the accreditation organization will offer ongoing tips and resources to help keep you up to date on new regulation, technology, and changes in the industry.

You can also share knowledge with other accredited organizations to improve your policies and procedures and keep up with current best practices.

Who provides oversight and approval for the various health care organization accrediting agencies?

Obtain insights and transparency through external review

When accreditation surveyors conduct their review of your organization, they do more than just check that your facility meets the standards.

Often, they will give you advice and insights on how to improve your organization above and beyond the standards.

The peer reviewers bring an objective, outside perspective that can help you identify the strengths and weaknesses of your organization. Often, they are leaders from other healthcare organizations, so they can provide concrete examples of strategies that have helped their organization improve.

Since your organization has to go through peer review every few years to maintain accreditation, the process will keep your organization moving forward and constantly improving.

These are just a few of the benefits of accreditation in healthcare. Healthcare accreditation can help your organization improve the quality of care, streamline operations, reduce liability risks, and more.

Achieving and maintaining accreditation gives you a clear picture of how to constantly improve your organization for years to come.

CMS to Strengthen Oversight of Medicare’s Accreditation Organizations
Agency’s website will increase transparency into Accrediting Organization performance, and CMS will streamline and strengthen the validation of Accrediting Organization surveys

Today, the Centers for Medicare & Medicaid Services (CMS) took action to improve quality and safety in healthcare facilities and empower patients with information to make decisions about where to receive care.

“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.  Today's changes will bolster the processes for overseeing how effective Accrediting Organizations, who work on CMS’ behalf, are in evaluating healthcare facilities.”

Currently, Medicare-participating healthcare providers and suppliers are surveyed either by State survey agencies or by Accrediting Organizations (AOs) to ensure that they meet CMS’ quality and safety standards. AOs receive deeming authority from CMS, which affirms that AOs’ health and safety standards meet or exceed those of Medicare. Only facilities and suppliers that have been deemed by state or AO surveyors to meet CMS’ standards may receive payments from Medicare. There are currently 10 CMS-approved AOs, each of which surveys one or more different types of facilities.

CMS will enhance and strengthen its oversight and quality transparency of AOs in three ways:  1) the public posting of AO performance data; 2) a redesigned process for AO validation surveys and 3) the release of the Annual Report to Congress. Taken together, these efforts will provide important insights to the public and assist AOs, providers, and suppliers in ensuring patient health and safety. 

Posting AO Performance Data Online

To increase transparency for consumers, CMS will post new information on the CMS.Gov website, including:  The latest 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, with information included on the provider’s AO; and overall performance data for AOs themselves. To view AO performance data, visit: https://qcor.cms.gov/hosp_cop/HospitalCOPs.html

Today, the public relies on accreditation status as a way to gauge providers’ and suppliers’ quality of care. By posting more detail—accredited hospitals’ complaint surveys, out-of-compliance information, and performance data for AOs themselves—CMS will offer the public more nuanced information than accreditation status alone provides.  The agency is currently prohibited by law from disclosing the actual surveys done by AOs, except for surveys of home health agencies and surveys related to an enforcement action.

Pilot Testing Direct Observation for AO Validation Surveys

CMS is testing a more streamlined, efficient way to assess AOs’ ability to ensure that facilities and suppliers comply with CMS requirements.

CMS evaluates the ability of AOs to accurately assess providers’ and suppliers’ compliance with health and safety standards through a validation survey process. Historically, CMS has measured the effectiveness of AOs by choosing a sample of facilities, performing state-conducted assessment surveys within 60 days following AO surveys, and comparing results of the state surveys with the AO surveys. In a pilot test, CMS will eliminate the second state-conducted validation survey and instead use direct observation during the original AO-run survey to evaluate 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 will also analyze and incorporate State complaint investigations of accredited facilities as part of the agency’s strengthened validation program. This work will focus on identifying and monitoring accredited facilities that are out of compliance with Medicare health and safety requirements. CMS will use this information as an additional indicator of AO performance.

Posting the Most Recent Annual Report to Congress Regarding AO Performance

CMS has also posted the most recent annual Report to Congress, the “Review of Medicare’s Program for Oversight of Accrediting Organizations and the Clinical Laboratory Improvement Validation Program Fiscal Year 2017,” on the CMS website.  As the changes announced today inform and bolster our oversight of AOs, CMS will continue to publish this report online annually to demonstrate the impact of these changes on the oversight of AOs and to provide greater transparency for the public. The FY 2017 Report to Congress is posted online: https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/Policy-and-Memos-to-States-and-Regions.html

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