Health Reform WK-EDGE CMS could improve patient survey oversight of ACOs, but otherwise does a good job
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Monday, October 12, 2020

CMS could improve patient survey oversight of ACOs, but otherwise does a good job

By Robert B. Barnett Jr., J.D.

OIG recommended that CMS tweak the Statement of Work provided to contractors to ensure that gaps in patient survey data collection and reporting are addressed.

Although CMS generally does a good job of ensuring that Medicare Accountable Care Organizations (ACOs) report complete and accurate data on quality measures for the purpose of qualifying for shared savings payments, CMS could tighten up oversight of patient surveys, an Office of Inspector General (OIG) report has concluded. The report recommended that CMS have its vendors (1) verify corrections of identified errors, (2) provide feedback reports more quickly to the ACOs, and (3) review survey instruments translated into languages other than English for accuracy. Under current vendor rules, CMS does not require that its vendors take any of those steps, and CMS has promised to make the appropriate changes (OIG Report, A-09-18-03033, September 22, 2020).

Background. Medicare providers may voluntarily participate in the Medicare Shared Savings Program (MSSP), which provides supplemental payments to qualifying providers. The providers participate in the program by joining an ACO, which seeks to qualify for the payments by satisfying MSSP quality performance standards. In 2017, of the 472 ACOs that exist, 159 received approximately $799 million in shared savings payments.

To qualify for the payments, ACOs are required to report 31 nationally recognized quality measures through three methods of submission: (1) a patient experience-of-care survey, (2) claims and administrative data, and (3) the CMS web portal. In a previous audit seeking to evaluate how accurately the ACOs were reporting their quality measures, the OIG concluded that they were generally doing a good job. This audit, on the other hand, sought to determine how well CMS was doing in its oversight responsibilities for monitoring the ACO reporting.

Survey results. The OIG concluded that CMS was generally doing a good job. The report’s criticisms were focused on only one of the three submission methods: the patient survey. The report concluded that lapses existed in what CMS was asking of its contractors in overseeing the survey results, which could lead to inaccurate reporting and ultimately affect the shared savings payments.

The OIG identified three survey-related gaps. First, when the CMS contractor monitored the survey vendors who supplied the survey results, the contractors were not required to request documentation from the survey vendors to verify corrections of errors. In the absence of that documentation, the OIG said, the survey vendors could keep making the same mistakes over and over again.

Second, the survey vendors are required to submit a Quality Assurance Plan. The CMS contractor reviews that QAP and provides feedback. OIG found, however, that the feedback loop was not fast enough to allow the survey vendors to incorporate the suggested changes into their QAPs for the next cycle. For example, a CMS contractor’s review of the 2017 reporting was not provided until late July 2018, which was after the due date for the 2018 QAP.

Third, the CMS contractors are required to monitor the use of survey translations into languages other than English. While the CMS contractors did a good job of updating the survey translations, they were not asked to ensure that the translations themselves were correct before updating them. Although the contractors reviewed the English language version for accuracy, they never reviewed the translated versions to ensure that they were consistent with the English version.

Recommendations. The OIG recommended that CMS update the Statement of Work provided to contractors to require that contractors (1) verify that survey vendors have corrected errors directly related to data collection and reporting, (2) confirm that all suggested changes are incorporated into QAPs before they are approved, and (3) review the translated survey templates to ensure that they are consistent with the English version.

Response. CMS concurred with the recommendations. It described actions either already taken (recommendation 3) or about to be taken (recommendations 1 and 2) to address the identified gaps.

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