For IV: An alternative to the Joint Commission
ACHC provides infusion-specific surveys
Gaining accreditation has many advantages, ranging from increasing marketability to maintaining quality in an organization. Some find that payer sources are requiring accreditation. While most home infusion professionals first think of the Oakbrook Terrace, IL-based Joint Commission on the Accreditation of Health Care Organizations (JCAHO), this month, Home Infusion Therapy Management speaks with a pair of home infusion companies. One elected to go with the Raleigh, NC-based Accreditation Commission for Home Care (ACHC), and the other elected to receive accreditation through the ACHC and plans to let it’s JCAHO accreditation with commendation expire.
The bottom line, according to these agencies, is that the clarity of the ACHC’s standards is far superior to JCAHO’s, while a reduced cost and a more orderly survey process for the ACHC were the nails in the JCAHO coffin for their companies.
Where to begin
When it came time for Frank Brunson, RPh, president of Infusion Care of South Carolina, a home infusion provider in Columbia, SC, to choose between JCAHO and the ACHC, a handful of areas were of prime importance.
"There were several factors," says Brunson. "Cost was important, the ease and simplicity of following the standards they require you to practice by, the time in which they could get to me and do the surveys, and the predictability of when we had to have everything done."
Infusion Care had started down the path toward Joint Commission accreditation but soon turned back.
"We had received some of their brochures and bought some of their manuals, which they change on a yearly basis," he says. "It was not so much we were dissatisfied with what we were going to get from JCAHO; it was that every time we jumped through a hoop they would set the hoop on fire and want us to jump back through it."
Brunson attributes much of that to the lack of clarity in Joint Commission standards. (See related story for Joint Commission’s response, p. 7.)
"To identify exactly what was required of a Joint Commission regulation or standard became a little bit complicated," he says. "Not that the standards were any easier for ACHC; it was just easier to identify what they were looking for and how you would actually prove you had everything in place. It’s very important to note that the quality and consistency of the standards are the same. It’s not easier for you to meet ACHC standards, it’s simply easier to see what you need to prove that you’re doing these things."
Brunson also notes that the total cost of the survey would likely be more expensive for JCAHO by a couple thousand dollars. The total expenses for his ACHC survey came in at less than $5,000, money Brunson says he had no choice but to spend.
"It’s industry driven, and some of the insurance companies were requiring credentialing of some sort," he says. "In particular, Blue Cross/Blue Shield of South Carolina was requiring us to have accreditation to be a part of their network, and of the five companies they listed, the ACHC was one of the five."
Even with the numerous accrediting bodies available, Infusion Care was limited to two choices.
"Many of the larger infusion companies have both pharmacy and nursing, but in the standards it becomes difficult to dissect what was a pharmacy responsibility and what was a nursing responsibility," he says. "When it came to infusion-specific standards, Joint Commission and ACHC are the only ones I’m aware of."
For Rod Okamoto, RPh, president of Nutri-share, the choice was not as simple as starting from scratch. Nutrishare, an Elk Grove, CA-based agency with a satellite office in Louisville, KY, that provides total parenteral nutrition (TPN) to patients nationwide already had and still holds accreditation with commendation through the Joint Commission. But he found switching to the ACHC would be easier, although the realization was a gradual one. The final straw may have been a comment by his pharmacist.
"Our pharmacist actually recommended we hire another pharmacist to work on being compliant with JCAHO, and I found that ironic in this day and age when home care is being asked to do more with less," says Okamoto.
ACHC sounding better
As he began to weigh his options, the ACHC became more and more appealing.
"Our perceptions are that ACHC standards are easier to read and understand, and ACHC’s pre-survey desk review process was much simpler," notes Okamoto.
As an example, Okamoto notes the section of ACHC’s standards as related to client care coordination. The standards read as follows:
Section 5. Client Care coordination.
A client bill of rights should be distributed to clients receiving services.
A) Organization must have a written client bill of rights.
B) Review of the client bill of rights is accomplished in conjunction with needs assessment or development of plan of care.
C) The organization must have written policies and procedures addressing client questions and complaints and procedures for investigating and resolving complaints.
Submit these items with your application:
• copy of client bill of rights;
• policy and procedure relating to investigations of complaints;
• copy of written information given to clients showing the telephone number and complaint procedure.
"That was it for that standard, so you can see it’s pretty straightforward," notes Okamoto. "You locate those three things, copy them from your policies and procedures, and send them in, and that standard is done before the surveyor comes out."
Okamoto’s company currently is accredited with commendation from both JCAHO and the ACHC, although he plans to allow his JCAHO accreditation to expire. After going through both processes, Okamoto’s experience leads him to believe that it is harder to qualify for accreditation with commendation from the ACHC than JCAHO. The numbers seem to agree with him. Nearly a quarter of home care organizations surveyed by JCAHO are accredited with commendation, as compared with less than 15% for the ACHC.
Cynthia Layton, the vice president of accreditation services for the ACHC, notes that the organization has been in existence since 1986, yet it may be a new name to many because it only recently began expanding its focus.
"We initially started with community-based programs, and now we have been approached by horizontal networks and national private-owned organizations," she says. "We’re going to appeal to a lot of different kinds of organizations because our 11 years of experience have been in home care, as opposed to other accrediting bodies, which might have started out in other areas."
Deemed status may be on the way’
In fact, some home infusion providers are likely to find ACHC’s view toward the accreditation process downright refreshing.
"We are a provider-based organization, and our standards were established by providers across the private and governmental sections of the industry," notes Layton, who adds that input was received from hospitals, home health organizations, home health aide service programs, the Department of Aging and pharmacies, as well as legal professionals.
"Our committees that make up the standards and review process are all volunteers and people in the field," she adds.
In addition to home infusion, the ACHC provides surveys specific to community-based home care, in-home aide service programs for states that provide grants to provide such services to the elderly, and multi-service surveys for home health agencies that offer a wide variety of services to patients.
"We’re in the business of accrediting services rather than institutions," says Layton.
She notes that the ACHC may soon become more appealing to certain home infusion agencies.
"We’re in the process of preparing an application for the Health Care Financing Administration for home health deemed status, which would allow organizations to receive reimbursement through Medicare and Medicaid," she 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