OIG investigating hospital supervision, JCAHO records
Expect tighter surveys this summer
If you have a survey scheduled this summer, it could be a humdinger if Joint Commission surveyors, spurred by a federal probe of their oversight process, strictly interpret standards.As part of a major inspection of the Oakbrook, Terrace, IL-based Joint Commission for Accreditation of Healthcare Organizations, investigators from the federal Office of the Inspector General (OIG) will actually go along on some surveys.
The OIG is probing how the Joint Commission operates and plans to send investigators along on a minimum of four surveys between July and October. That could mean tougher surveys, even if your hospital isn’t chosen by the OIG, some experts say.
There have always been variations in surveys because of the differing natures and experience of the surveyors, notes Judy Homa-Lowry, RN, MS, CPHQ, a quality consultant in Canton, MI. Nevertheless, "because of the fact that they’ll be monitored by an agency that has some questions as to the effectiveness of the survey process, it’s likely that surveyors would tend to ensure a tighter application of the standards," she suggests.
The OIG won’t say how many facilities it will visit. However, the federal inspectors plan a national review of Joint Commission documents, including "trend data on the most recent deficiencies and survey scores." Additionally, OIG inspectors will look at "information about recent significant adverse events in hospitals and responses to them."
The OIG outlined the scope of its probe in a memorandum sent June 20 to Dennis O’Leary, president of the Joint Commission. The OIG conducts and supervises audits, inspections, and investigations relating to government programs and supporting operations.
In the memorandum, the OIG says it is "seeking a deeper understanding of the current system of oversight for hospitals participating in Medicare [at a time when] patient harm in hospitals has become a frequent headline, calling into question the current system of oversight."
The investigation will focus on the accreditation of acute care hospitals participating in Medicare, but specialty hospitals, such as rehabilitation and psychiatric hospitals, will be excluded, the memorandum says. The inspection will include the American Osteopathic Association, which also accredits hospitals for Medicare participation, but it will focus primarily on the Joint Commission, says Ben St. John, public affairs officer at OIG.
St. John declines to comment on what the OIG will be looking for or whether the OIG’s presence will trigger inspection of records or procedures not normally examined by the Joint Commission. He also declined to discuss whether the Joint Commission could face possible penalties or an uncertain future.
Janet McIntyre, a spokeswoman for the Joint Commission, says the agency isn’t worried. While it is not unheard of for outside observers, such as journalists or representatives from state licensing bodies, to accompany Joint Commission inspectors on surveys, McIntyre admits "we don’t know exactly where the OIG is going to go with this."
McIntyre denies that the presence of OIG inspectors will make surveyors tougher on hospitals. She points out that surveyors use standardized information sheets "to help them make the same decisions at all hospitals they visit. The standards are what they are, and the surveyors are well aware of them."
Interest started from several sources
The OIG’s interest in the Joint Commission’s oversight may stem from a variety of sources. For example, a 1996 consumer survey showed that 52% of respondents thought the federal government should monitor health care providers to ensure a minimum standard of quality and make sure information about quality is available to the public.1 The same survey showed that 88% of Americans believe there is a role for government in the quality-of-care arena.Another issue prompting OIG’s involvement in accreditation surveys might be increasing concerns about Medicare fraud. Congress has greatly increased the resources and authorities of the OIG to combat fraud.
"The ultimate ramifications of this OIG investigation may be future changes in accreditation standards, the survey process itself, or more involvement by the Health Care Financing Administration to oversee health care quality issues affecting Medicare patients," suggests Patrice Spath, ART, BA, a consultant in health care quality and resource management in Forest Grove, OR.
The OIG expects its findings will yield "policy-level and operational recommendations aimed at an effective system of hospital quality oversight," says St. John.
Reference
1. Agency for Healthcare Policy Research, Center for Health Information Dissemination. AHCPR and Kaiser examine consumers’ use of quality information. Research Activities 1996 Dec.; 199:10-11.
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