Accreditation puts your facility on the cutting edge

Soon to be required for managed care, consumers

When the American Association of Retired Persons published an article on chronic pain in its newsletter and mentioned that pain programs could be accredited, CARF ... The Rehabilitation Accreditation Commission received 6,000 calls for a list of accredited pain programs in just one week.

Meanwhile, more than 300 large purchasers of managed care coverage have asked to receive lists of organizations accredited by CARF.

These are just two examples of why more subacute rehabilitation providers are seeking CARF accreditation, says Christine MacDonell, national director of the medical rehabilitation division of the Tucson, AZ, accrediting body.

Many managed care payers include CARF accreditation among their criteria, reports Linda Maher Williams, MN, RN, CRRN, CCM, director of rehabilitation services at Columbia Northlake Regional Medical Center in suburban Atlanta.

"Taking the extra step to meet national standards gives consumers and payers confidence and security. We know we do a good job, but CARF accreditation affirms it," explains Williams who is leading her three-year-old rehab unit toward its first CARF survey.

While it’s important to let consumers and payers know your subacute facility meets stringent standards, that shouldn’t be the only reason you apply for CARF accreditation, says Karen Clarke, RN, MSN, division manager of rehabilitation services at Memorial Hospital of Gulfport (MS). Clarke’s facility went through CARF accreditation last December, just six months into a new model of care.

"It was the best learning experience we could have gone through. It helped us focus on the delivery of health care that will take us into the 21st century," Clarke says.

But you must be committed to change to make the time, energy, and expense of a CARF survey worthwhile, Clarke advises. (See tips on preparing for a CARF survey, above.)

"It’s a strategic decision that you are committed to delivering care following state-of-the art standards. If you just want to be able to say your are CARF accredited but have no plans for giving something back to the community, it’s not worth it," she adds.

Seeking accreditation is a good housecleaning tool to make your facility look at new, creative ways of doing business, MacDonell says.

"Accreditation puts you in a mode that you will never be still. The changing health care arena demands that we learn new ways to get things done through creative problem-solving that utilized continuous quality tools," she adds.

In 1967, a year after CARF was established, there were four programs accredited by CARF.

From January 1994 to January 1996, the number of accredited comprehensive inpatient programs grew from 587 to 732.

Now there are 12,500 accredited programs in the United States, Canada, and Sweden. CARF is considering requests to set up accreditation standards for rehabilitation facilities in 14 other countries, MacDonell says. In addition to comprehensive inpatient rehabilitation in three categories acute rehab, subacute, and skilled nursing, the figure includes individual programs including spinal cord injury, brain injury, pain management, outpatient, home-and-community based programs, health enhancement programs, occupational rehab, employment services, community support services, early childhood, and family support services.

In January 1997, CARF began accrediting Veteran’s Administration rehabilitation programs under an agreement with the U.S. Department of Veteran’s Affairs. (See related story, above right.)

Your facility may seek accreditation for its comprehensive inpatient programs in any or all of the three categories, as well as individual programs.

However, if one of your programs gets a one-year accreditation, all programs will be accredited for only one year, even if the others meet the criteria for three-year accreditation. (For more information on accreditation type and duration, see the box, above.)

You must apply for accreditation by March 31, 1998, to use the 1997 standards manual. After that, you must meet the criteria in the 1998 manual. Your accreditation application is only good for six months. You must schedule your survey at least two months in advance.

If you are already accredited, allow six to eight months to prepare for a new survey. If you are a new facility, the standards must have been in use for six months.

The cost is $550 for the application fee and $950 per surveyor per day. About 98% of surveys involve a minimum of two surveyors for two days, MacDonell says. Only very small programs can be surveyed in a shorter time, she adds. There is a $700 fee if you need to reschedule after the surveyors have been assigned.

About six to eight weeks following a survey, you will receive a written report with your accreditation outcomes. However, the exit conference with surveyors mirrors the actual report and gives you a chance to produce proof if you feel you are in conformance with standards. You may videotape or tape record the exit conference.

After your survey, you’ll be required to submit a quality improvement plan within 90 days. You don’t have to complete the plan in 90 days, but surveyors will use it during the next survey.

Keep a copy of the plan and use it as a basis to keep you focused on where you are headed, MacDonell advises.