In your editorial criticizing the Joint Commission on Accreditation of Healthcare Organizations (March 21, p. 36), I found it curious that you assail it for the process it followed and the expense it's incurred in developing its indicator monitoring project.
Then, you used the National Committee for Quality Assurance as an exemplary model of how payers and managed-care organizations have "ventured out" to develop their own system. You implied that NCQA has a better process and funding mechanism than JCAHO. In reality, it appears that NCQA is modeling its process-with funding based on very high accreditation survey fees and use of their proscriptive "Data Information Set"-after the JCAHO's process.
My organization for 15 years has accredited HMOs and other ambulatory-care organizations and certified the quality of HMOs on behalf of every state that mandates these reviews. Our survey fees are one-third of those charged by NCQA. We use and evaluate all available quality processes along with proven national standards in our accreditation process.
I believe NCQA, like JCAHO, has developed and is selling an expensive computer program, the Health Plan Employer Data and Information Set (HEDIS) that has been funded on the backs of payers in the same way JCAHO indicators were funded. Thus, NCQA is a poor example of how to enhance the quality performance of providers in a cost-effective manner.
We share your sentiment that the most valuable role the JCAHO and NCQA could play would be "to provide a stamp of approval for whatever quality process each hospital or system chooses." Our organization's accreditation process does exactly that.
SAM J.W. ROMEO, M.D.
Accreditation Association for
Ambulatory Health Care