Is the Joint Commission enough for accrediting

the health care organizations?

Agila Elsaid

 Professor: Cynthia Conrad

Health Care Delivery

PA 642

What is the accreditation of the health care?

“a process whereby a professional association or nongovernmental agency grants recognition to a school or health care institution for demonstrated ability to meet predetermined criteria for established standards”

• the health care organizations to become accredited, it should meet specific

quality standards. These standards are broad and cover different aspects of the

care services. Not only the clinical services which provided, but also the

managerial process, the outcomes of services, the qualification of providers and

the patient’s satisfaction.

What is the Joint Commission?

the Joint Commission on Accreditation of Healthcare Organizations is a private not-for- profit USA organization. The JCAHO operates accreditation programs for a fee to subscriber hospitals and healthcare organizations

• accredits more than 17,000 organization and healthcare programs around the USA

• majority of state governments recognize Joint Commission accreditation as a

condition of licensure and the receipt of Medicaid reimbursement except in

states of Oklahoma, Pennsylvania, and Wisconsin.

How JCAHO works:

• The main part of the Joint Commission accreditation process is the surprising full survey which conducted in 2006. It means the organization does not receive an advance notice of its survey date. The survey occurs between 18 to 39 months after the organization’s previous unannounced survey

• the hospital should also comply with applicable standards during the entire period of accreditation

Why hospitals seek accreditation:

• Most of the private and insurers the federal government require accreditation as a prerequisite for reimbursement

• the hospitals think that the JCAHO survey will help establish safety and quality

standards and thereby distinguishes hospitals to purchasers, payers, and the

public.

The cost of accreditation:

• the costs of accreditation for the United States hospitals include the annual fee to keep the accreditation status and the on-site survey fee.

• Annual fees are depending on the size and the service complexity of individual hospitals and range from $1,780 to $36,845.

• For 2010, the on-site survey fees for hospitals are: $2,500 per surveyor for the first day and $1,030 per surveyor for the second and subsequent days.

• The big challenge for the organization is the cost of consultation and the preparation for the survey. These services will cost the organization roughly $140,000 per year.

• The cost of the international accreditation includes the cost of surveyors travel, food, local transportation and the hotel in addition to the survey costs. The current average fee for a hospital full survey is $46,000.00 USD.

Literature Review:

• One of the research by (Chen, Rathore, Radford & Krumholz, 2003) about the

JCAHO Accreditation And Quality Of Care For Acute Myocardial Infarction, “ they

examined the association between JCAHO accreditation of hospitals, those hospitals’

quality of care, and survival among Medicare patients hospitalized for acute

myocardial infarction. Hospitals not surveyed by JCAHO had, on average, lower

quality and higher thirty-day mortality rates than did surveyed hospitals. However,

there was considerable variation within accreditation categories in quality of care and

mortality among surveyed hospitals, which indicates that JCAHO accreditation levels

have limited usefulness in distinguishing individual performance among accredited

hospitals”.

Some of Criticism to the Joint Commission:

1. Lenient:

critics have attacked them for being too lenient. According to the Washington Post, the Joint Commission certifies nearly all hospitals that it inspects -- about 99 percent.

2. Controlled by one who regulate:

Three-fourths of the seats on the board are occupied by corporate members from the health care industry.

3. Increase the health care cost:

the Joint Commission takes in about $113 million in revenue each year, most

of it deriving from the fees it charges hospitals. This cost ultimately gets

passed on to patients in the form of higher fees, making health care less

affordable.

The Joint Commission Response:

• the Joint Commission began the unannounced survey at January 2006. This change increases the accuracy of the survey. The average number of deficiencies per hospital has jumped to seven from three, and the percentage of hospitals with conditional accreditation has risen to 2.8 percent from 1 percent.

• the Joint Commission began to provide information about the accredited and certified organization to the public on the quality check website which lunched in 1996.

• in 2004, the commission changed its inspections so that surveyors now spend most of their time following and observing care given to patients, rather than interviewing executives.

Are these changes actually improved the quality of the health services?

• According to Liz Kowalczyk (2007) the Inspectors found numerous qualities of care

problems at Massachusetts General Hospital during a surprise inspection late last

year, noting concerns about medication safety, inconsistent hand washing by

caregivers, and incomplete medical records. . Despite these issues, hospital executives

said that they had been told yesterday that Mass. General would receive full accreditation from

the Joint Commission”.

• the Joint Commission sentinel data point out there are a lot of sentinel event occurs

in the accredited hospital, and reporting of the sentinel events will not effect on the

accreditation status of the organization.

Table shows the number and the type of the reported sentinel events from 1995 to 2009

Type 1/1/95-9/30/09 1/1/95-12/31/08 1/1/09-9/30/09

Wrong-site surgery 867 741 126

Suicide 770 698 72

Operative/post-operative complication 710 631 79

Delay in treatment 536 442 94

Medication error 526 492 34

Patient fall 406 341 65

Unintended retention of foreign body 309 212 97

Assault, rape or homicide 245 218 27

Perinatal death or loss of function 201 175 26

Patient death or injury in restraints 198 189 9

Some stories which raise the question about the Joint Commission Accreditation:

Gilbert M. Gaul Washington Post writer (July 25, 2005) wrote that “Norwalk Hospital

in Connecticut won accreditation from the joint commission in May 2004. Less than a

month later, state regulators reported numerous violations at the hospital. One patient

received 10 times the prescribed dosage of a painkiller, according to state records.

Another had his left testicle mistakenly removed. Still another, experiencing suicidal

thoughts, was given a taxi token and told to find a treatment center. He hanged himself

hours later, according to a November 2004 consent agreement between the hospital and

state. Norwalk officials agreed to pay the state a $50,000 fine without admitting

wrongdoing”.

Conclusion:

the Joint Commission is doing a very good job specially in making a national

and international health care standard, and it plays an important role in

improving the quality of the health care. However, as everything in the world, it

needs to reevaluate the whole system. In my opinion, the Joint Commission

must take some of the responsibility in pre-decided quality event that occur in

the accredited organization such as paying part of the fine required due to this

event.

Furthermore, it should take more serious decision against the sentinel events.

And the federal government should take an action toward the Joint Commission

in case of serious quality problem in any accredited organization.

References:

Joint commission, March 15, 2010. Facts about the Joint Commission. Retrieved from

http://www.jointcommission.org/facts_about_the_joint_commission/ Allan Tobias, MD JD. (n.d). Need JCAHO, Retrieved from http://www.medicalaw.net/new_page_11.htm

Kate Jackson, May 31, 2004, Beyond JCAHO: There’s More Than One Path to Accreditation, For the Record, Retrieved from http://www.fortherecordmag.com/archives/ftr_053104p30.shtml

Joint Commission International, (n.d), Costs of Accreditation. Retrieved from http://www.jointcommissioninternational.org/Cost-of-Accreditation/

Michael Wolfe, September 3, 2010, Benefits & Disadvantages of the Joint Commission, eHow, Retrieved from http://www.ehow.com/list_6900079_benefits-disadvantages-joint-commission.html

Liz Kowalczyk, March 17, 2007, Surprise check faults MGH quality of care, Boston Globe, Retrieved from http://www.allbusiness.com/health-care/health-care-facilities-nursing/11897140-1.html

Quality Check (2010) Facts about Quality Check and Quality Reports, Retrieved from www.qualitycheck.org/help_qc_facts.aspx

Health care quality news (2009) The Joint Commission updates sentinel event statistics, Retrieved from http://www.hcqualitynews.com/home/2009/10/25/the-joint-commission-updates-sentinel-event-statistics.html

The Washington Post (2005) Accreditors Blamed for Overlooking Problems, Retrieved from http://www.washingtonpost.com/wp-dyn/content/article/2005/07/24/AR2005072401023.html

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