A healthcare watchdog group late last week petitioned HCFA to review the authority of the Joint Commission on Accreditation of Healthcare Organizations to judge hospitals fit for Medicare and Medicaid participation.
The petition by Public Citizen's Health Research Group was prompted by its disclosure that one of every three hospitals failed to meet minimum quality standards for participation in 1992 during follow-up federal surveys to "validate" the JCAHO's results. Public Citizen obtained the results of validation surveys from 1987 to 1992 under the Freedom of Information Act.
The group's director, Sidney M. Wolfe, M.D., in a letter to HCFA Administrator Bruce C. Vladeck, further recommended that HCFA conduct routine surveys in all hospitals participating in the JCAHO accreditation program while the review is being done. He also said HCFA should not extend "deeming" authority to facilities other than hospitals. Accreditation earned under such authority doubles as Medicare certification.
The disclosures about the JCAHO's record on federal validation came as the commission responded to pressure from the American Medical Association to delay release of accreditation reports to the public. The JCAHO said it plans to adhere to its timetable for releasing the reports in late fall.
The Public Citizen petition cited new HCFA regulations effective Feb. 22, 1993, that said "a disparity rate of 20% or more" between findings of an accrediting body and determinations reached by state certification agencies "will trigger a review of deeming authority granted to an accrediting organization."
Public Citizen said the HCFA data it obtained showed at least 20% of accredited hospitals in the validation sample did not meet one or more Medicare/Medicaid conditions of participation for federal fiscal years 1987 to 1992.
The latest data available showed a failure rate of 34% in 1992. That was a sharp rise from 21% in 1991 and 20% in 1990. Other rates of failure were 28% in 1989, 32% in 1988 and 36% in 1987.
But William Jessee, M.D., the JCAHO's vice president for research and standards, said Public Citizen "took the raw numbers*.*.*.*and drew some conclusions that are quite erroneous."
He said the percentages do not represent a gap between quality problems uncovered by HCFA reviewers but missed by the JCAHO. Many of the problems cited on the follow-up validations also were cited in commission surveys and targeted for correction as part of its procedure of accrediting a hospital "with Type I" violations. Actual discrepancies between the two sets of findings is under 20%, Dr. Jessee said.
An HCFA spokeswoman said the agency was not prepared to comment late last week.
On the issue of accreditation-survey disclosure, the AMA's policymaking House of Delegates earlier this month went on record as opposing the release of organization-specific information on compliance with JCAHO standards until the AMA's delegates can "assess how the data are to be gathered, analyzed, validated and distributed."
The AMA's seven commissioners on the 28-member JCAHO board will press the issue at the next commission meeting, said Thomas Reardon, M.D., an AMA representative on the commission.
But that won't be until late September, and the JCAHO is refining the report's format for a late fall release, said JCAHO spokeswoman Cathy Barry-Ipema.
John Laing, the executive charged with overseeing the report's development, said the AMA's resolution "will be given very serious consideration" but added that the effort already had received substantial feedback from focus groups of hospital, employer and consumer representatives.
The JCAHO's board decided in May 1993 to issue organization-specific reports to the public, Mr. Laing said, and since then the commissioners "haven't really swerved on this."
Dr. Reardon said the AMA wasn't objecting to releasing the reports but wanted to make sure they were "not just raw data that hasn't been analyzed." He said even though the commission has 13 physicians on it, the report format should go back to the AMA's rank-and-file physicians for a hard look.
Mr. Laing said the reports do not get into clinicians' performance. "It's really important to realize that these are reports of organizations and not anyone within the organizations," he said.
But Dr. Reardon said the presentation of information about hospitals could affect the practices of physicians on staff.
Asked if the AMA's commissioners opposed the disclosure in May 1993, Dr. Reardon said they expressed concern back then that the information be accurate, reliable and not subject to misinterpretation by the public.
But Ms. Barry-Ipema said the measure had unanimous board support. Dr. Reardon did not join the commission until Jan. 1, she added.