JCAHO under fire again: JCR is the issue
Congressional critics allege conflict of interest
Senators Charles Grassley (R-IA) and Max Baucus (D-MT) and Representative Pete Stark (D-CA) are calling for JCAHO to answer questions about its relationship with Joint Commission Resources (JCR), its consulting subsidiary, and to account for the results of its new accreditation process.
A 2004 Government Accountability Office (GAO) report found that "JCAHO's pre-2004 hospital accreditation process did not identify most of the hospitals found by state survey agencies in CMS's annual validation survey sample to have deficiencies in Medicare requirements," according to a GAO summary. As a result, legislation was introduced to provide more federal oversight of the accreditation process, but it did not pass.
The 2004 legislation would have removed JCAHO's unique hospital accreditation deeming status — requiring JCAHO to apply for deeming status for hospitals just as it must for nursing homes and other facilities. "That sort of change is still a possibility," says Carol Guthrie, communications director in Sen. Baucus's office.
The GAO is in the process of conducting a second study relating to possible conflicts of interest and other concerns, and Grassley, Baucus, and Stark say that they will introduce revised legislation based on any new findings.
Since November 2005, the Joint Commission has been working with the GAO on a study addressing the relationship between JCAHO and JCR. JCAHO has responded to the scrutiny by underscoring that JCR is a not-for-profit organization. "The missions of these organizations are complementary in improving health care quality and safety in the United States and around the world," according a May 19 statement from JCAHO.
The Congressmen question JCAHO's ability to independently accredit hospitals while JCR sells products and services that aid hospitals in meeting accreditation standards.
"JCAHO claims to be a not-for-profit organization that maintains state-of-the-art standards. Nothing could be further from the truth," Stark said in a May 18 statement. "For years, JCAHO's close ties to industry have jeopardized the health of millions of Americans."
In addition, said Stark, JCAHO's ownership of JCR has created new conflicts of interest that warrant additional investigation. "If JCAHO has nothing to hide, it will provide us with an accurate, complete, and timely response. Anything less than full cooperation will be noted when Congress takes future action," he said.
"We're all aware that JCAHO's accrediting process has been under scrutiny off and on for years," says Kathleen Catalano, RN, JD, director of health care transformation support for Plano, TX-based Perotsystems. However, JCAHO has done a "major overhaul" of its accreditation process, which calls for continuous compliance because surveyors could walk in at any time, she says.
She points to unannounced surveys and the addition of a life safety code specialist who is present during surveys of organizations with 200 or more licensed beds.
"We know that organizations are being cited for more noncompliances, and that is why JCAHO has offered to increase the number of RFIs before a facility reaches preliminary denial of accreditation," says Catalano. "So I think we can say the accreditation process is working better than it was."
However, JCAHO's critics want hard evidence that the new process really is more effective. "It's very important to determine whether or not the new accreditation process is delivering results and overcoming the shortcomings of the old system," said Grassley, chairman of the Senate Committee on Finance, in the May 18 statement.
"Hopefully, the Commission's new accreditation process is improving the effectiveness of their work, which showed serious deficiencies just a couple of years ago. But if the business practices of the Joint Commission continue to compromise the safety and performance of America's hospitals, it's vital to know that now and take corrective steps," said Baucus, ranking member of the Senate Committee on Finance.
According to the Joint Commission, the 2004 GAO study was seriously flawed. "That study utilized grossly misleading metrics and omitted highly relevant and positive information about the Joint Commission's performance," according to the statement. "However, despite the biased findings contained within the report, the Joint Commission engaged in a constructive dialogue with the Congress on ways to strengthen federal oversight of all hospital accreditation activities. We welcome the opportunity to further that discussion."
From the perspective of dozens of quality professionals interviewed by Hospital Peer Review since unannounced surveys began in January 1, 2006, the new process is clearly more effective at finding problems.
"It brings the survey to the heart of patient care, which is where an organization should be measured as to their level of compliance with the standards," says Leisa Oglesby, assistant hospital administrator of quality at Louisiana State University Health Sciences Center in Shreveport.
However, some organizations are rethinking their accreditation by JCAHO and are moving to annual Medicare or osteopathic accreditations, Oglesby notes.
"Ongoing compliance with ever-changing standards is complicated and requires huge resources," she says. "Today's environment of declining resources, staffing shortages, shrinking budgets and revenues will mandate a closer look by all organizations as to their continued accreditation process."
[For more information, contact:
Kathleen Catalano, Perotsystems, Director Healthcare Transformation Support, 2300 W. Plano Parkway, Plano, TX 75075. E-mail: [email protected].
Leisa Oglesby, Assistant Hospital Administrator of Quality, 1541 Kings Highway, Shreveport, LA 71130. Telephone: (318) 675-5030. Fax: (318) 675-4646. E-mail: [email protected].]
Senators Charles Grassley (R-IA) and Max Baucus (D-MT) and Representative Pete Stark (D-CA) are calling for JCAHO to answer questions about its relationship with Joint Commission Resources (JCR), its consulting subsidiary, and to account for the results of its new accreditation process.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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