September 17, 2019
Around the world accreditation is used to assure a high baseline level of healthcare quality. In the United States, accreditation is a multi-million-dollar industry without any sign of slowing down because it's compulsory for federal payments and a marketing necessity in an increasingly competitive landscape.
It's no secret that healthcare organizations in the United States depend on revenue. Funding is complex and comes from various plans including the major federal contributors of Medicare and Medicaid. In order to receive federal payments from Medicare or Medicaid programs, a health care organization must meet the government requirements for program participation, including a certification of compliance with the health and safety requirements called Conditions of Participation (CoPs). Options exist for meeting CoPs: 1) A survey may be conducted by a state agency on behalf of the federal government or 2) a survey by a national accrediting organization such as the Joint Commission that has been recognized by the Centers for Medicare & Medicaid Services (CMS).
There are other eligible national accrediting organizations that conduct surveys to determine whether an organization meets or exceeds Medicare and Medicaid requirements, but the Joint Commission is the oldest accrediting body and accredits or certifies over 21,000 health care organizations in the United States today. In 1951 a joint agreement among the American College of Physicians, the American Hospital Association, the American Medical Association, the Canadian Medical Association and the American College of Surgeons created the Joint Commission on Accreditation of Hospitals (JCAH). The mission statement of the Joint Commission began explicitly referencing patient safety during the 1990's and later programs like Speak Up™ were launched to help patients and their advocates become active in their care.
New standards for Joint Commission are developed and added only if they relate to patient safety or quality of care, have a positive impact on health outcomes, meet or surpass law and regulation, and can be accurately and readily measured. Those with input include health care professionals, providers, subject matter experts, consumers, and government agencies (including CMS). The accreditation process is lengthy and incorporates performance-improvement strategies, provides education, and includes advice and counsel from surveyors during the on-site survey. Surveys by the Joint Commission are designed to be organization-specific and consistent. Resources and consultants are available to help prepare with mock surveys.
Marketing is part of the drive to achieve accreditation or certification status. Accreditation is a means of proving quality to the community and the competition. After earning accreditation or certification, health care organizations receive The Joint Commission's Gold Seal of Approval®. Sometimes the terms accreditation and certification are mistakenly used interchangeably. Both accreditation and certification require an evaluation by The Joint Commission, but they apply to different types of entities. The evaluation covers compliance with the standards and other requirements and verifies improvement activities.
Joint Commission accreditation can be earned by many types of health care organizations, including hospitals, doctor's offices, nursing homes, office-based surgery centers, behavioral health treatment facilities, and providers of home care services. Certification is earned by programs or services that may be based within or associated with a health care organization. For example, a Joint Commission accredited medical center can have Joint Commission certified programs or services with neurological or orthopedics. These programs could be within the medical center or in the community. Other certifications include health care staffing services, integrated care, medication compounding, memory care, and primary care medical home.
Studies regarding the impact of accreditation on patient outcomes lead to questions about the value of accreditation in healthcare. These are important questions because physician depression and burnout rates are at an all-time high and this process increases the burden for physicians and administrators. Whether working toward accreditation or certification with Joint Commission or another accrediting body, an organization will heavily invest time and resources. Achieving many of the standards proves challenging especially for ambulatory care centers and smaller organizations. Understandably, stakeholders with different roles have disparate opinions about the value of accreditation regarding quality improvements and financial incentives. Skeptics and pragmatic minds view accreditation as a means to improve the bottom line through marketing and revenue from federal programs without a definite correlation to better patient outcomes. Others opine that patient outcomes measurably improve with accreditation. Still others view investment of time and resources in accreditation as worthy due to a correlation of process improvement, patient care and the financial outcome.
It's fortunate that Joint Commission standards align with a robust healthcare compliance program. For instance, there's even an OSHA alliance that aims to provide information, guidance, and access to resources that will help protect the health and safety of workers, and understand the rights of workers and the responsibilities of employers in healthcare.
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