Is the Joint Commission enough for accrediting the health care organizations? Agila Elsaid Professor: Cynthia Conrad Health Care Delivery PA 642
What is the accreditation of the health care? “ a process whereby a professional association or nongovernmental agency grants recognition to a school or health care institution for demonstrated ability to meet predetermined criteria for established standards” <ul><li>the health care organizations to become accredited, it should meet specific quality standards. These standards are broad and cover different aspects of the care services. Not only the clinical services which provided, but also the managerial process, the outcomes of services, the qualification of providers and the patient’s satisfaction. </li></ul>
What is the Joint Commission? the Joint Commission on Accreditation of Healthcare Organizations is a private not-for- profit USA organization. The JCAHO operates accreditation programs for a fee to subscriber hospitals and healthcare organizations <ul><li>accredits more than 17,000 organization and healthcare programs around the USA </li></ul><ul><li>majority of state governments recognize Joint Commission accreditation as a condition of licensure and the receipt of Medicaid reimbursement except in states of Oklahoma, Pennsylvania, and Wisconsin. </li></ul>
How JCAHO works: <ul><li>The main part of the Joint Commission accreditation process is the surprising full survey which conducted in 2006. It means the organization does not receive an advance notice of its survey date. The survey occurs between 18 to 39 months after the organization’s previous unannounced survey </li></ul><ul><li>the hospital should also comply with applicable standards during the entire period of accreditation </li></ul>Why hospitals seek accreditation : <ul><li>Most of the private and insurers the federal government require accreditation as a prerequisite for reimbursement </li></ul><ul><li>the hospitals think that the JCAHO survey will help establish safety and quality standards and thereby distinguishes hospitals to purchasers, payers, and the public. </li></ul>
The cost of accreditation: <ul><li>the costs of accreditation for the United States hospitals include the annual fee to keep the accreditation status and the on-site survey fee. </li></ul><ul><li>Annual fees are depending on the size and the service complexity of individual hospitals and range from $1,780 to $36,845. </li></ul><ul><li>For 2010, the on-site survey fees for hospitals are: $2,500 per surveyor for the first day and $1,030 per surveyor for the second and subsequent days. </li></ul><ul><li>The big challenge for the organization is the cost of consultation and the preparation for the survey. These services will cost the organization roughly $140,000 per year. </li></ul><ul><li>The cost of the international accreditation includes the cost of surveyors travel, food, local transportation and the hotel in addition to the survey costs. The current average fee for a hospital full survey is $46,000.00 USD. </li></ul>
Literature Review: <ul><li>One of the research by (Chen, Rathore, Radford & Krumholz, 2003) about the JCAHO Accreditation And Quality Of Care For Acute Myocardial Infarction, “ they examined the association between JCAHO accreditation of hospitals, those hospitals’ quality of care, and survival among Medicare patients hospitalized for acute myocardial infarction. Hospitals not surveyed by JCAHO had, on average, lower quality and higher thirty-day mortality rates than did surveyed hospitals. However, there was considerable variation within accreditation categories in quality of care and mortality among surveyed hospitals, which indicates that JCAHO accreditation levels have limited usefulness in distinguishing individual performance among accredited hospitals”. </li></ul>
Some of Criticism to the Joint Commission: <ul><li>Lenient: </li></ul>critics have attacked them for being too lenient. According to the Washington Post, the Joint Commission certifies nearly all hospitals that it inspects -- about 99 percent. 2. Controlled by one who regulate: Three-fourths of the seats on the board are occupied by corporate members from the health care industry. 3. Increase the health care cost: the Joint Commission takes in about $113 million in revenue each year, most of it deriving from the fees it charges hospitals. This cost ultimately gets passed on to patients in the form of higher fees, making health care less affordable.
The Joint Commission Response: <ul><li>the Joint Commission began the unannounced survey at January 2006. This change increases the accuracy of the survey. The average number of deficiencies per hospital has jumped to seven from three, and the percentage of hospitals with conditional accreditation has risen to 2.8 percent from 1 percent. </li></ul><ul><li>the Joint Commission began to provide information about the accredited and certified organization to the public on the quality check website which lunched in 1996. </li></ul><ul><li>in 2004, the commission changed its inspections so that surveyors now spend most of their time following and observing care given to patients, rather than interviewing executives. </li></ul>
Are these changes actually improved the quality of the health services? <ul><li>According to Liz Kowalczyk (2007) the Inspectors found numerous qualities of care problems at Massachusetts General Hospital during a surprise inspection late last year, noting concerns about medication safety, inconsistent hand washing by caregivers, and incomplete medical records. . Despite these issues, hospital executives said that they had been told yesterday that Mass. General would receive full accreditation from the Joint Commission”. </li></ul><ul><li>the Joint Commission sentinel data point out there are a lot of sentinel event occurs in the accredited hospital, and reporting of the sentinel events will not effect on the accreditation status of the organization. </li></ul>
Table shows the number and the type of the reported sentinel events from 1995 to 2009
Some stories which raise the question about the Joint Commission Accreditation: Gilbert M. Gaul Washington Post writer (July 25, 2005) wrote that “Norwalk Hospital in Connecticut won accreditation from the joint commission in May 2004. Less than a month later, state regulators reported numerous violations at the hospital. One patient received 10 times the prescribed dosage of a painkiller, according to state records. Another had his left testicle mistakenly removed. Still another, experiencing suicidal thoughts, was given a taxi token and told to find a treatment center. He hanged himself hours later, according to a November 2004 consent agreement between the hospital and state. Norwalk officials agreed to pay the state a $50,000 fine without admitting wrongdoing”.
Conclusion: the Joint Commission is doing a very good job specially in making a national and international health care standard, and it plays an important role in improving the quality of the health care. However, as everything in the world, it needs to reevaluate the whole system. In my opinion, the Joint Commission must take some of the responsibility in pre-decided quality event that occur in the accredited organization such as paying part of the fine required due to this event. Furthermore, it should take more serious decision against the sentinel events. And the federal government should take an action toward the Joint Commission in case of serious quality problem in any accredited organization.
References: Joint commission , March 15, 2010. Facts about the Joint Commission . Retrieved from http://www.jointcommission.org/facts_about_the_joint_commission/ Allan Tobias , MD JD. (n.d). Need JCAHO , Retrieved from http://www.medicalaw.net/new_page_11.htm Kate Jackson , May 31, 2004, Beyond JCAHO: There’s More Than One Path to Accreditation, For the Record, Retrieved from http://www.fortherecordmag.com/archives/ftr_053104p30.shtml Joint Commission International , (n.d), Costs of Accreditation. Retrieved from http://www.jointcommissioninternational.org/Cost-of-Accreditation/ Michael Wolfe , September 3, 2010, Benefits & Disadvantages of the Joint Commission, eHow, Retrieved from http://www.ehow.com/list_6900079_benefits-disadvantages-joint-commission.html Liz Kowalczyk , March 17, 2007 , Surprise check faults MGH quality of care, Boston Globe, Retrieved from http://www.allbusiness.com/health-care/health-care-facilities-nursing/11897140-1.html Quality Check (2010) Facts about Quality Check and Quality Reports, Retrieved from www.qualitycheck.org/help_qc_facts.aspx Health care quality news (2009) The Joint Commission updates sentinel event statistics, Retrieved from http://www.hcqualitynews.com/home/2009/10/25/the-joint-commission-updates-sentinel-event-statistics.html The Washington Post (2005) Accreditors Blamed for Overlooking Problems, Retrieved from http://www.washingtonpost.com/wp-dyn/content/article/2005/07/24/AR2005072401023.html Top of Form