A personal visit from Dennis O'Leary, M.D., president of the Joint Commission on Accreditation of Healthcare Organizations, doesn't appear to have quieted the saber-rattling by rural Tennessee hospital administrators.
In fact, the Tennessee Hospital Association is moving ahead with plans to educate its membership about methods of achieving Medicare and Medicaid certification other than JCAHO accreditation.
Cathy Barry-Ipema, a JCAHO spokeswoman, described Dr. O'Leary's June 23 meeting with the THA's small and rural hospital constituency group as "very productive." She said it was another example of the organization's effort to "reach out to the field" to address hospitals' concerns.
"We appreciate the opportunity to meet with them, and we'll use the feedback to make improvements in the accreditation process," she said.
The meeting resulted from a growing chorus of complaints from administrators of small and rural hospitals in Tennessee who say their accreditation costs are exceeding benefits received (June 6, p. 17).
For example, executives at 36 of the 38 Tennessee hospitals that responded to an internal JCAHO opinion poll conducted by the Tennessee Hospital Association said they felt that the JCAHO's accreditation fees were either "too high" or "excessive." MODERN HEALTHCARE obtained a copy of the survey results last week.
Another 22 of the 38 respondents questioned the relevance or usefulness of the JCAHO's new clinical indicator system, which will be mandatory for accredited hospitals as early as 1996. The survey didn't report on how many of the hospitals had tested the system.
"Only Dr. O'Leary knows whether the meeting was productive," said William Walter, administrator of 275-bed Maury Regional Hospital in Columbia, Tenn. "He said he listened to our concerns, but all the listening in the world won't mean anything unless there's a reaction."
Mr. Walter said his primary concern is the cost of compliance with JCAHO standards that may not have any relevance to the daily quality-improvement activities at his hospital.
Mr. Walter also is chairman-elect of the THA's board of trustees. He said that after he becomes chairman in October, he'll appoint a special THA task force to draft a "white paper" on hospitals' concerns about the JCAHO to share with other state hospital associations.
"I'm not for leading a charge against accreditation. It's an individual decision, but almost everyone here is asking whether it's worth it," Mr. Walter said.
He said many hospitals are considering dropping accreditation to automatically qualify for Medicare and Medicaid in favor of permitting state and federal certification inspections.
"The JCAHO's big threat is, `If we don't do it, the government will,'*" Mr. Walter said. "I think the JCAHO is more worried about the government taking them over."
To help hospitals make a choice, the THA intends to talk to state and federal regulators to determine what is involved in direct certification inspections, said THA President Craig Becker. The THA will make that information available to its members, he said.
He also said the THA intends to forward a list of hospital concerns to the JCAHO as a follow-up to the meeting.
"The fact that Dr. O'Leary showed up was a plus. What will change I'm not sure," Mr. Becker said.
At the conclusion of the meeting, with Dr. O'Leary in attendance, the group of about 100 executives passed a motion giving the JCAHO a "Type I" recommendation for relevance and cost, and placed it on probation for one-year with a follow-up survey scheduled for June 1995. Type I recommendations are the most serious deviations from the JCAHO's accreditation standards.