Minnesota Hospital Association

Policy & Advocacy

rules, regulations and comments

The Minnesota Hospital Association continually monitors state and federal rules and regulations to keep members informed and advocates on behalf of members regarding the impact of regulations on the state’s hospitals and health systems. MHA submits comment letters to share recommendations and feedback with the appropriate government organizations and health care stakeholders. Examples of rules and regulations that MHA addresses include those implementing federal or state health care reform efforts, changing payment methodologies, establishing community benefit or other standards for tax-exempt organizations, or modifying government oversight of health care activities.

July 08, 2013

Medicare & Medicaid programs; survey, certification & enforcement procedures; proposed rule

July 3, 2013


Marilyn Tavenner
Administrator
Centers for Medicare and Medicaid Services
Hubert H. Humphrey Building
200 Independence Avenue, S. W., Room 445-G
Washington, DC 20201

Submitted electronically

Re: CMS-3255-P, Medicare and Medicaid Programs; Survey, Certification and Enforcement Procedures; Proposed Rule

Dear Ms. Tavenner:

On behalf of our 144 member hospitals and their health systems, the Minnesota Hospital Association (MHA) appreciates the opportunity to comment on the Centers for Medicare and Medicaid Services’ (CMS) proposed rule to revise the survey, certification and enforcement procedures related to the agency’s relationship with national accrediting organizations (AOs).

As an initial matter, MHA strongly endorses the comments submitted by the American Hospital Association and agrees that this rule changes the nature of the relationship between CMS and AOs from a partnership model to a framework in which CMS is overly prescriptive. This, in turn, may negatively alter the positive relationship between AOs and hospitals.

MHA believes, based on input from hospitals throughout Minnesota, the proposed rule has the potential to significantly and negatively change the hospital survey process. The Joint Commission and the other AOs are working to establish a collaborative relationship with their accredited facilities and provide standards that are rooted in evidence-based practice, patient safety, and quality. It has been the experience of many hospital leaders that the standards used by AOs are often superior to the federal requirements in the conditions of participation (CoPs) in promoting quality and patient safety reforms within hospitals. Many hospitals, therefore, see AOs as partners in hospital-based efforts to promote quality and patient safety. This new rule may limit the ability of AOs to continue to innovate and partner with new and promising hospital initiatives.

This rule will inhibit continued innovation by increasing bureaucratic oversight and delay. In addition, the new structure could pass significant cost and burden on to accredited hospitals and other facilities. Health systems with hospitals in multiple states will likely see a different survey and compliance process, focused on burdensome regulations, with significant documentation requirements, and an inability to influence the determinations of new standards and requirements that impact health care providers.

In addition, MHA members have expressed the following concerns:

  • CMS proposes that all CMS-approved accreditation programs “would be approved in its entirety.” This requirement will allow CMS to assert authority over all AO standards and requirements, even those that do not correspond directly to a CoP, including the National Patient Safety Goals and emergency management standards.
  • CMS proposes that all standards that are revised or created by an AO would require approval by CMS, including those that are outside of the deeming relationship to the CoPs. CMS Survey and Certification staff may deny updates to standards and requirements that are based on the need for increased quality of care and patient safety when such standards and requirements are not explicitly included in CoPs. At the very least, this approval requirement could pose significant delays in updating requirements.
  • As a component of the approval process, AOs will need to demonstrate comparability with the survey process and guidance presented in the state operations manual (SOM). The SOM is not subject to review by either AOs or accredited facilities and often outdated. Through the regulations, CMS could require the accreditation surveys achieve complete comparability to the State Survey Agency (SA) contractors surveys, including having comparable size survey teams and survey duration, which will greatly increase the cost of the accreditation survey for both AOs as well as the organization they accredit. State Agencies typically maintain much larger survey teams.
  • The current regulation requires CMS to evaluate an AO’s accrediting program on the basis of “reasonable assurance” which requires CMS to review the accrediting program “taken as a whole.” The proposed regulation’s removal of the “taken as a whole” component of the current AO evaluation process, may lead to CMS comparing each individual AO standard to a corresponding Medicare requirements and the CoPs. This will likely require revision of every AO’s standards, a costly and disruptive result. For example, The Joint Commission standards do not match up one-to-one with each CoP, but the content of the CoP might relate to several of the Joint Commission standards. Removing the ability to look at the standards as a whole would force the Joint Commission to adopt the hospital CoPs.

Thank you again for the opportunity to comment. If you have any questions about our comments, please feel free to contact me at (651) 659-1405 or [email protected].

Sincerely,

Jennifer McNertney
Policy Analyst