A Tennessee hospital administrator says the Joint Commission on Accreditation of Healthcare Organizations must lower its survey fees to enable his hospital to comply with JCAHO's own accreditation standards.
In fact, the administrator is lobbying the Oakbrook Terrace, Ill.-based accrediting agency to rewrite its mission statement to reflect cost concerns.
The actions by the administrator and several of his Tennessee hospital peers are the latest examples of hospitals and hospital groups expressing their concerns with the current accreditation process and future direction of accreditation policies (May 9, p. 6).
Leading the dissenters in Tennessee is Phil Campbell, the administrator of 72-bed Woods Memorial Hospital District in Etowah, Tenn. He said JCAHO has forged ahead with new accreditation programs, accreditation standards, educational programs, consulting services and clinical indicator projects with little regard for the cost implications for accredited facilities.
"Although the Joint Commission has made some wonderful changes, it has not made changes that effectively serve healthcare organizations in today's environment," he said. "The Joint Commission is in the perfect position to enhance its value to healthcare organizations by standing up to the plate and taking on the quality vs. cost issue, which is the issue of the day."
Earlier this year, Mr. Campbell decided to use JCAHO's own accreditation standards to make his point.
Woods Memorial is accredited and has started to prepare for its next accreditation survey two years from now. The accreditation standards say hospitals should design their delivery systems to meet community needs.
After meetings with the hospital board, medical staff and local business leaders, Mr. Campbell said he concluded that the most important community need was controlling costs. And, one of the hospital's costlier items, in Mr. Campbell's opinion, was the expense of JCAHO accreditation.
In addition to its most recent survey fee of $24,700, the hospital estimated that it spends about $100,000 per year in personnel costs to comply with JCAHO's standards as well as prepare for upcoming accreditation surveys. The hospital also spends as much as $10,000 per year on related JCAHO services, such as educational programs.
In total, Woods Memorial estimated that it spends about $118,000 annually to be accredited by JCAHO.
"That's a lot of money for a 72-bed hospital," Mr. Campbell said.
The hospital and its 88-bed nursing home had an operating profit of about $800,000 on net operating revenues of $16 million in the fiscal year ended June 30, 1993, the hospital said.
After calculating Woods Memorial's accreditation costs, Mr. Campbell wrote each of JCAHO's 28 board members and asked them to rewrite the organization's mission statement to include a recognition for cost containment.
The current statement reads: "The mission of the Joint Commission on Accreditation of Healthcare Organizations is to improve the quality of care provided to the public."
Mr. Campbell also wants JCAHO to re-examine its fee schedule for small and rural hospitals because many "can barely afford the fees."
He's received responses from a number of JCAHO commissioners who said they shared his concern, and several said they would take up the issue with the board of commissioners.
Mr. Campbell also raised the issue at a March conference of small and rural hospital members of the Tennessee Hospital Association. Reacting to its members' concerns, THA invited a JCAHO representative to meet with hospital executives at a meeting to be held in June, a THA spokesman said.