George L. Mee Memorial Hospital's acute-care operation is accreditation-worthy, and its long-term-care unit tops the charts with surveyors.
But the 42-bed hospital in rural King City, Calif., is still fighting to keep from being denied a seal of approval from the Joint Commission on Accreditation of Healthcare Organizations.
That's because Mee Memorial also has a home healthcare agency that failed inspection in a September 1993 survey of all three healthcare components.
Officially, the home-care operation is a part of the hospital organization. And under the JCAHO's rules, a failing grade by any of the components means accreditation is denied to the others as well. "It's not like it's three separate decisions," said JCAHO spokeswoman Alice Brown. "It's one decision for the organization."
The case illustrates a problem that could plague the industry as hospitals form systems offering multiple services.
The Mee decision was among the results of the JCAHO accreditation committee's actions taken in July and reported late last month. Four hospitals also were given conditional accreditation, a probationary status.
The facts of the Mee Memorial case involve nursing documentation practices during a period of executive turnover that left the agency short on ability to do the paperwork, said Linda Stireman, Mee Memorial's chief executive officer.
But the larger issue involves whether the whole healthcare organization should be dragged into the so-called "adverse accreditation decision" by reporting it as a single result. "They would not separate our home healthcare, even though it's licensed separately (by the state)," Ms. Stireman said.
But hospitals increasingly are integrating nonhospital operations into their organizations in response to managed-care and reform pressures. When such hospitals apply for accreditation as a single organization, the JCAHO conducts what it calls a "tailored survey" of all the services it accredits, said Ms. Brown. Those accreditations normally would be handled separately by different units of the JCAHO accrediting apparatus.
The JCAHO was not able to say whether other accreditation denials of hospitals have resulted from surveys of component services.
Mee Memorial's problems started in 1990, when a director of home healthcare left. The small hospital had trouble keeping the job filled, resulting in a lack of administrative cohesion and no one to document the care that nurses were providing, Ms. Stireman said.
When a five-person survey team came to the hospital last year, it found the acute-care side of things passable, while the skilled-nursing unit ended up with the highest possible marks across the board, Ms. Stireman said.
But when surveyors saw the poorly documented home care, they flunked the operation. A new director had been hired four months earlier and was shaping up the reporting, but that wasn't enough, she said.
The accreditation denial came after a year's worth of back-and-forth contact, and Mee Memorial isn't planning to appeal it. Instead, it's trying to get the process started fresh with a new survey. But the hospital's leaders "want to see if they will just do home health," Ms. Stireman said. The reasons are financial as well as practical.
To prepare for another three-pronged survey would be "a tremendous amount of work for a small hospital," she said. And the original survey cost $20,000 just in fees. "Is the Joint Commission not being flexible? What difference does it make to just separate them?" Ms. Stireman asked.
Besides the Mee Memorial decision, the JCAHO gave conditional accreditation to 427-bed MacNeal Hospital, Berwyn, Ill.; 41-bed Rye (N.Y.) Hospital Center; 356-bed Hospital Damas, Ponce, Puerto Rico; and 44-bed Methodist Hospital Levelland (Texas).
In a separate action last week, a JCAHO appeals board upgraded Goshen (Ind.) General Hospital to conditional, a year after issuing an "adverse decision" after a surprise survey found safety problems related to a construction project (Oct. 18, 1993, p. 3). A follow-up visit is set for later this month.
Conditionally accredited organizations must correct violations of accreditation standards by a certain date, usually in six months, after which they either receive full accreditation or are denied it.