In an announcement all too familiar to accredited hospitals, the Joint Commission last week said it will launch a new consulting service to help providers comply with a new set of accreditation standards. This time, it’s new medical staff standards.
And like past announcements, critics said the dual function of setting standards and selling consulting services creates a potential conflict of interest for the Joint Commission.
Consulting will be offered to help hospitals improve the credentialing and privileging process for physicians based on medical staff standards that were approved this year, according to a Joint Commission Resources news release. The standards include an ongoing practice evaluation for physicians and a review period when a doctor is given new privileges. Consulting fees vary on a case-by-case basis.
In August, JCR, an Oak Brook, Ill.-based not-for-profit arm of the Joint Commission, responded to the commission’s new infection standards by introducing consulting to assess facilities’ risks and capacity to address multidrug-resistant organisms; and to use evidence-based processes to help facilities implement changes (Aug. 27, p. 16).
JCR offers consulting services to help hospitals through several accreditation programs but considers itself a separate organization from the accrediting body, and the two organizations said they do not share information regarding facilities.
But that doesn’t change the perception of a conflict of interest, said Catherine Ballard, a partner with Cleveland-based Bricker & Eckler who covers medical staff and patient-care issues.
An actual conflict might not exist, but just the perception “has the potential to taint proceedings. That’s what makes it difficult,” Ballard said.
But there is a divide, according to JCR officials. In this case, the resources organization had developed its consulting program without being aware that changes were coming to the Joint Commission standard, said David Jaimovich, JCR chief medical officer. “We have a firewall; we really didn’t know what they were doing,” he said.
The credentialing standard is part of an overhaul of requirements under Medical Staff 1.20, the commission’s accrediting program for medical staff governance, including bylaws and procedures, which will be implemented in 2009.
Both the American Medical Association and American Hospital Association developed the changes to MS 1.20 with the commission. The AMA said in a written statement that it supports the revisions as another step toward improving patient safety and quality. The AHA in its newsletter also expressed concern over changes in the language of the proposed standard after a field review had already been conducted.
Ballard also has some concerns: The changes in MS 1.20 are too subjective as currently written and pose a problem for hospitals that are accustomed to governing their medical staff without the commission micromanaging, she said.
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