The American Hospital Association is leading a grass-roots review of hospitals' accreditation needs, MODERN HEALTHCARE has learned.
The review raises the stakes in the ongoing rift between many hospitals and the Joint Commission on Accreditation of Healthcare Organizations, signaling that hospitals want more control over the future direction of accreditation.
The review follows the resignations of two top executives charged with improving accreditation and threats by some hospitals to drop the JCAHO.
"*`Will the Joint Commission listen?' is the key," said Steven Summer, president of the West Virginia Hospital Association. "Will we see the ship change direction or stay on the same heading?"
Mr. Summer said the accreditation review also will be a test for the AHA. He said the trade group will be held accountable for how well the JCAHO responds to hospitals' concerns.
The AHA controls seven seats on the JCAHO's 28-member governing board.
AHA executives confirmed last week that the six-member executive committee of the AHA's board of trustees and the AHA's nine regional policy boards are debating the future role of accreditation. The debate began at the spring round of regional policy board meetings in March and will continue during the summer round of meetings starting on July 11.
The regional boards are made up of leading executives from several hospitals in each state as well as representatives from state and local hospital associations. The regional boards serve as the AHA's grass-roots policymaking mechanism.
The AHA has asked the regional boards to consider several accreditation issues, including the extent to which private accrediting bodies should be involved in releasing provider performance data to the public (See graphic, p. 12).
Some hospitals and state associations have questioned the cost and usefulness of the JCAHO's clinical indicator program, the soundness of the JCAHO's public disclosure policies and the quality of the Oakbrook Terrace, Ill.-based agency's accreditation services (March 14, p. 30).
The AHA is asking the regional policy boards how accreditation should work in a new healthcare environment shaped by reform, said Carolyn Roberts, president of Copley Hospital in Morrisville, Vt., and chairwoman of the AHA's board.
The goal of the exercise, Ms. Roberts said, is the development of a set of accreditation principles the AHA would use to support its reform agenda. For example, the principles could be used to judge the work of individual accrediting bodies such as the JCAHO, or they could be used to evaluate the quality-oversight provisions in reform bills.
Ms. Roberts said the accreditation principles should be drafted before the August meeting of the AHA board.
"We're well aware of what the AHA is doing, and we think it's great," said Cathy Barry-Ipema, the JCAHO's communications director. "We always encourage open dialogue to figure out what's the best way of doing things."
The AHA's review will continue and be completed without two top executives highly involved with JCAHO activities.
William Jessee, M.D., said on March 18 that he was resigning as the JCAHO's vice president for performance measures and research (March 28, p. 4). He's leaving on June 30. A week later, George Belsey submitted his resignation as the AHA's executive vice president of professional affairs (April 4, p. 2). He was the liaison between the AHA and the JCAHO.
In a previous interview with MODERN HEALTHCARE, Dennis O'Leary, M.D., JCAHO's president, boasted of the support he's gotten from the AHA and Mr. Belsey.
In an April 5 memo to AHA staffers, AHA President Richard Davidson said Mr. Belsey would be leaving "sometime in the next few months," and he named Fredric Entin, the AHA's senior vice president and general counsel, as acting executive vice president.
Mr. Davidson also said a top priority for the association will be "building stronger relationships with physician, nurse, and other professional groups, coupled with a clear vision of where we want to be on accreditation and other public accountability issues."
Meanwhile, some hospital organizations aren't waiting for the AHA.
On March 14, the 38-member professional services committee of the Hospital Council of Southern California decided to hold off on becoming a "quality partner" in the JCAHO's clinical indicator program, known as the IMSystem. The committee consists of representatives from the council's 240 hospital members.
The JCAHO has solicited associations to become quality partners in the IMSystem. As partners, associations agree to market the IMSystem to members in exchange for member discounts on JCAHO consulting and educational services.
Last November, the same committee endorsed the clinical indicator program being operated by the Maryland Hospital Association. Julie Hopkins, senior vice president of Performance Connection, a council subsidiary, said 20 hospitals have signed up for the Maryland project.
Ms. Hopkins said financial issues related to becoming a JCAHO quality partner were among the reasons for the decision. She said the committee will reconsider its decision in June.
The Arkansas Hospital Association, meanwhile, last year considered a mass withdrawal of its members from the accreditation program.
"The idea of walking away from the JCAHO was unthinkable," said James Teeter, executive vice president of the Arkansas Hospital Association. "But there have been so many problems the unthinkable has become thinkable."
Last May, the association, responding to its members' dissatisfaction with the JCAHO, threatened the exodus. About two-thirds of the association's 100 hospitals are accredited.
An accreditation pullout by hospitals from President Clinton's home state at a time when the JCAHO was lobbying for a role in federal reform legislation could have been embarrassing for the JCAHO. But Dr. O'Leary persuaded the association to remain with the program, Mr. Teeter said.
"We have seen no dramatic change since Dr. O'Leary's visit," Mr. Teeter said, adding that "he wouldn't be surprised" if individual hospitals starting dropping out.