JCAHO may develop new compliance standards
As if there weren't enough heat on hospitals from state and federal health care investigators, a new and unlikely organization is set to enter the fray: The Joint Commission on Accreditation of Healthcare Organizations (JCAHO), based in Oakbrook Terrace, IL, is studying existing corporate compliance plans with an eye toward developing its own compliance standards by early fall.
The study is designed to find out how much overlap already exists between current Joint Commission standards and the points contained in the Health and Human Services Office of the Inspector General's hospital guidance and other plans. Once the study is over, JCAHO officials will decide which elements of these plans to adopt, says Al Buck, MD, executive vice president for standards, performance measures and research at JCAHO. When that happens, expect Joint Commission surveyors to pay even more attention to the "accuracy and truthfulness" of the information supplied to them.
Buck declined to say whether the Joint Commission's "heightened sensitivity" to compliance issues stems from last year's investigation of its accreditation practices by the OIG, or from criticism that it has inappropriately accredited hospitals suspected of serious health care fraud, such as Columbia Sunrise in Las Vegas.
In any case, some experts say they believe the Joint Commission has been moving toward a tougher position on fraud and abuse for some time. Fay A. Rozovsky, JD, MPH, DFASHRM, principal of the Rozovsky Group, Inc., in Richmond, VA, points to the fact that the Health Care Financing Administration's proposed revisions to its conditions of participation have established a definite link between the issue of quality of care and the submission of bills for services under Medicare and Medicaid. "Given that fact, 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," Rozovsky says.
According to Buck, 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."
"What the Joint Commission is concerned about, of course, is its own credibility and public trust in the whole accreditation process," Rozovsky adds.
Whatever its motivation for jumping on the compliance bandwagon, it seems clear that, in addition to creating new standards, the Joint Commission will beef up enforcement of existing standards related to fraud and abuse. Buck notes that JCAHO already has taken action against many hospitals on the grounds that they failed to disclose true and accurate information. And if an accredited institution is prosecuted by state or federal investigators for health care fraud, the Joint Commission may "revisit" its accreditation decision.
"The closer health care entities get to a fraudulent activity," Buck says, "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 with them."
Buck says the Joint Commission will reach a final decision about developing new standards for compliance by the end of the year, barring any unforeseen developments.
What remains to be seen is how comprehensive the new standards will be, and how much input hospitals will be allowed, Rozovsky says.
You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
- Award-winning Medical Content
- Latest Advances & Development in Medicine
- Unbiased Content