Congressional watchdog asked to jump on JCAHO
Plans to allow self-inspections criticized
Continuing to face withering criticism from diverse corners, the Joint Commission on Accreditation of Healthcare Organizations has now drawn the ire of a powerful member of Congress.
Rep. Pete Stark, (D-CA) ranking Democrat on the House Ways and Means Health Subcommittee, has formally requested the Office of the Inspector General of the Department of Health and Human Services to take a hard look at some of the Joint Commission’s planned accreditation changes.
"JCAHO recently announced that in 2004 they would be converting to a self-assessment-oriented hospital survey protocol," Stark stated in a letter requesting the action. "This protocol appears even more collegial and less regulatory in nature than the current survey. In addition, its reliance on extensive self-assessment activities is particular cause for concern."
The action comes on the heels of several controversial developments, including strong criticism by ICPs of the Joint Commission’s recent request for reports of fatal or life-impairing nosocomial infections.
Scalded by criticisms in the press that it is lax on infection control, the Joint Commission had warned that it was going to become more aggressive in the area. Stark’s pointed attack also falls under the general umbrella of quality, particularly the Joint Commission’s plan to allow 18-month institutional "self-assessments" as part of its Shared Vision/New Pathways accreditation program.
In the most recent Centers for Medicare & Medicaid Services report to Congress, validation studies indicated that JCAHO was least reliable in assessing Medicare Conditions of Participation (CoPs) when self-assessment activities were a primary component of the monitoring process, Stark emphasized. "Now, it will be the predominant component of the entire survey," he stated. "I am requesting that you investigate whether the proposed new procedure can effectively assess compliance with the Medicare CoPs and assure quality and safety in Medicare participating hospitals."
In addition, JCAHO business practices appear fraught with potential for conflict of interest because it has been aggressively pursuing and obtaining consulting contracts with the very institutions it is surveying, Stark charged. "There is a specter of undue influence eroding the impartiality of the surveying process," he warned. In response, the Joint Commission said it welcomed an evaluation by the Office of the Inspector General at any time.
"The self-assessment is an additional accreditation requirement and does not in any fashion substitute for the on-site evaluation by the survey team; neither the survey length nor the size of the survey team are to be reduced," the Joint Commission responded in a statement posted on its web site.
"The principal purposes of the self-assessment are to increase organization awareness of the importance of continuous standards compliance and to promote organization ownership of the self-assessment findings and the improvements that it should expect of itself. Self-assessment methods have long been used successfully by other accrediting bodies and evaluators, including government agencies."
Concerning the conflict of interest charges, the Joint Commission said a "firewall" exists between its consulting and accrediting entities and all activities meet U.S. Securities and Exchange Commission separation criteria.
Continuing to face withering criticism from diverse corners, the Joint Commission on Accreditation of Healthcare Organizations has now drawn the ire of a powerful member of Congress.
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