Opposition from hospital interests sent the Joint Commission on Accreditation of Healthcare Organizations looking for an alternative to a controversial accreditation disclosure format just two months after a task force unanimously endorsed it.
Going into the Sept. 23-24 meeting of the JCAHO board, the commission staffwas prepared to propose an alternative to a plan to convert hospital-specific scores in 28 performance areas to a rating of one to five stars (See related story, p. 8).
Details of the alternative were not disclosed by the JCAHO prior to the meeting, but the American Hospital Association circulated an alert to its members on Sept. 16 saying "it now appears likely that actual numerical scores will be used instead" of the star system.
The apparent reversal followed weeks of talks among staffers of the AHA and the JCAHO in the wake of hospital-industry opposition to the format, said Richard Wade, AHA senior vice president for communications.
The AHA, which controls seven seats on the JCAHO's 28-member board of commissioners, signaled its opposition to the star system during the association's annual convention last month in Dallas. AHA executives revealed they had formed a special task force to examine the star system, and late last month they said they supported the test marketing of various formats before implementing one nationally (Aug. 29, p. 40).
As the board meeting neared, "the Joint Commission indicated that there would be another proposal" and that the JCAHO "could foresee a scenario in which the star system could be replaced," Mr. Wade said.
That shift apparently was abrupt enough that the AHA rewrote an earlier draft of its "early warning" to member hospitals on the probable impact of the JCAHO's scheduled Sept. 24 vote on the public-disclosure plan.
In a draft dated just a day earlier, the star rating option was prominently discussed throughout and billed as "the result of all the Joint Commission's deliberations so far." But in the Sept. 16 version, three specific references to the star system were deleted.
The AHA did not advertise its influence on the proposal's fate, answering questions on the action behind the scenes only when pressed. "We didn't want to make the Joint Commission feel like we were using the star system as a weapon against them," Mr. Wade said. "Why raise the level of anxiety any more than we have to?"
The AHA's new liaison to the JCAHO, Jonathan Lord, M.D., said the two organizations worked for common ground. "The Joint Commission is very committed to the process of public release and wants to have as much support as possible going into that release," Dr. Lord said.
"There had been some general consensus about the numerical system, and I think people were becoming comfortable with that system," he said.
The star system was the only format that wasn't subjected to focus-group comment, Mr. Wade said. "It was a way to get around the complexity of numerical scores," he said.
But many hospital executives and state hospital association officials said the system oversimplified complex accreditation data to the point of being useless. And, they felt it trivialized quality data by using a rating system often applied to restaurants and movies.