JCAHO may develop compliance standards
How much hospital input?
Not getting enough heat from state and federal investigators? Make room for this on your overflowing plate: The Joint Commission on Accreditation of Healthcare Organizations in Oakbrook Terrace, IL, is about to enter the compliance fray. The agency is studying existing corporate compliance plans with an eye toward developing its own standards by early fall. What they want to find out is how much overlap exists between current Joint Commission standards and those in the hospital guidance issued by the Office of the Inspector General. Then they will decide which elements of those plans to adopt, says Al Buck, MD, executive vice president for standards, performance measures, and research at the Joint Commission.
If that happens, the agency will beef up enforcement of existing standards related to fraud and abuse. You can expect surveyors to pay special attention to the "accuracy and truthfulness" of the information you give them. Buck notes that the Joint Commission has already taken action against many hospitals on the grounds that they failed to disclose true and accurate information. In addition, if an accredited institution is prosecuted by state or federal investigators for fraud, the agency may "revisit" its accreditation decision.
"The closer health care entities get to a fraudulent activity," Buck adds, "they not only would be violating the basic requirements for accreditation, but more and more other regulatory and investigational capabilities would have to be brought to bear upon them."
"What the Joint Commission is concerned about, of course, is its own credibility and public trust in the whole accreditation process," says Fay A. Rozovsky, JD, MPH, president of The Rozovsky Group in Richmond, VA, and a member of Hospital Peer Review's editorial board.
Buck says the Joint Commission's purpose is simply to ensure that "the operating environment within the accredited health care entities [is] as constructive as it can be. And the accreditation process assumes that the input, the documentation, the interviews, all of the information gathering, however obtained, is in fact honest, pertinent, and comprehensive."
Some experts say the Joint Commission has been moving toward a tough position on fraud and abuse for some time. What remains to be seen is how comprehensive new standards will be and how much input hospitals will be allowed. Rozovsky points to the fact that the Baltimore-based Health Care Financing Administration (HCFA) has proposed revisions to its conditions of participation that would establish a link between the issue of quality of care and the submission of bills for services under Medicare and Medicaid. "Given that fact," says Rozovsky, "and the mandate of the Joint Commission as a deemed status surrogate for obtaining certification from Medicare, as well as the oversight HCFA can exert over the Joint Commission, I think one can see where the dots are being connected."
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