The American Hospital Association is going back to square one on the issue of provider accountability for quality of care, including an examination of the role of private accrediting agencies.
In a background policy document being circulated to its nine regional policy boards, the AHA identified what it believes are the four major dimensions of accountability. And it asks key hospital industry leaders to identify the public or private organizations that should be responsible for each dimension.
With healthcare reform on the horizon, the AHA feels the need to take a proactive approach to accountability, an issue on which it has allowed other organizations to take the policy lead.
The AHA's regional policy boards will discuss the document and accountability issues at their summer round of meetings across the country starting this week. The AHA's board of trustees will use the feedback from the meetings to draft a formal policy on provider accountability at the trustees' annual meeting next month in Dallas.
MODERN HEALTHCARE obtained a copy of the accountability document last week.
The debate comes at a time of growing hospital dissatisfaction with a key player in the accountability arena, the Joint Commission on Accreditation of Healthcare Organizations. Using its quality-assurance standards, the JCAHO accredits about 5,300 facilities nationwide. Accredited hospitals automatically qualify for the Medicare program as well as Medicaid programs in many states.
During the past six months, several hospitals and state hospital associations have become vocal about their dissatisfaction with the JCAHO, alleging that the value they receive from the accreditation process isn't worth the cost or effort. Many hospitals are considering voluntarily dropping accreditation (July 4, p. 4).
Still other hospitals are questioning the value of the JCAHO's clinical indicator program, which will become mandatory for accredited hospitals as early as 1996 (March 14, p. 30).
"We're looking at the whole broad issue of accountability," said Richard Wade, the AHA's senior vice president for communication. "Accreditation is a part of this."
The AHA has seven representatives on the JCAHO's 28-member board. In addition, the association recently appointed a new liaison, Jonathan Lord, M.D., to the Joint Commission (June 20, p. 26).
In its five-page policy paper, the AHA didn't identify any public or private organization by name. That continues a key tenet of the policy development process, which began in March. The AHA wants its policy board members to consider the accountability issue objectively, setting aside any personal feelings they may have about the JCAHO or any other private accrediting agency (April 18, p. 3).
In the paper, called "Accountability for Quality in a Reformed Health Care System," the AHA listed four dimensions of accountability. They are eligibility to deliver services; performance improvement by healthcare organizations; consumer and purchaser choice; and community health status improvement.
The AHA wants its policy board members to identify the public or private organizations that should play the major role in each category.
For example, who should be responsible for determining which providers are eligible to deliver care? Should it be the federal government, state governments or private accrediting agencies through "deemed status" arrangements with state and federal officials?
Also, the AHA wants its policy board members to decide who should be responsible for releasing quality-of-care information to the public. Should it be private accrediting agencies, federal or state governments, or purchasers?
In addition to helping the association reach those conclusions, the exercise will identify duplicate activities among the public and private organizations, Mr. Wade said. That may help the AHA in its effort to reduce redundant quality reporting requirements facing many hospitals, he said.
Mr. Wade said the policy could contain criteria by which to judge the ability of organizations, including private accrediting agencies like the JCAHO, to fulfill key accountability roles.