The format for reporting accreditation results to the public is all ironed out, but the Joint Commission on Accreditation of Healthcare Organizations still must reach agreement with the American Medical Association on the text of an accompanying explanation of the survey process.
A time line for that agreement will cut it close to the scheduled Oct. 27 unveiling of the disclosure program and an anticipated mid-November start.
The commission's board unanimously approved a format that uses numerical scores to rate performance in 28 areas, along with an overall score, said JCAHO spokeswoman Alice Brown. The numerical version was the only format presented for a vote on Sept. 24, she said.
A format using ratings of one to five stars was unanimously endorsed two months ago by a task force on confidentiality and disclosure. But state associations and the American Hospital Association opposed the format as reminiscent of ratings for restaurants and as too simplified to be of any use (Sept. 26, p. 10).
The approved format eliminates the correlation of performance levels to a certain number of stars. Instead, readers will get a narrative telling them about the relative significance of numerical comparisons (See chart).
But the board referred back to the task force a second component of the reporting process: a stock explanation of the accreditation process intended to help the public understand the report's content. The document summarizes each of the main areas of accreditation and identifies the most important things surveyors look for in each area, Ms. Brown said.
AMA representatives to the commission board objected to some of the explanations in that document, said William Jacott, M.D., who chairs the AMA delegation to the JCAHO.
"To make it readable to the public, the wording was such that it suggested more than we can accomplish," said Dr. Jacott, a family practitioner at the University of Minnesota in Minneapolis.
He said some explanations did not correspond to an actual standard, and the AMA wanted the document shelved until a working group of hospital clinicians-the JCAHO Hospital Accreditation Program/Professional and Technical Advisory Committee-could review it and make recommendations to the commission task force.
The working group isn't scheduled to meet until Oct. 12, two weeks before the disclosure program is to be launched at a news conference during the JCAHO's annual National Forum on Health Care Quality in Chicago.
Dr. Jacott said the disclosure program can't go ahead until the physicians agree with the way it's presented to the public. That was the main concern behind an AMA House of Delegates vote in June to oppose the release of organization-specific results until the policymaking body of the AMA could "assess how the data are to be gathered, analyzed, validated and distributed."
But although the commission board didn't approve the explanatory document, it "has given authority to the task force to do the final sign-off, so it's not going back to the board," said Cathy Barry-Ipema, the JCAHO's communications director.
"The comments were minimal on the accompanying document," she said, adding that the JCAHO sees no possibility of delaying the program's Oct. 27 launch.
Pressure to accommodate a growing consumer movement is behind the JCAHO's determination to keep its date with the public, said Marie G. Kuffner, M.D., a delegate to the AMA House of Delegates from the hospital medical staff section of the association, which introduced the resolution on the disclosure issue.
Dr. Kuffner said the JCAHO's president, Dennis O'Leary, M.D., "feels if he's going to stay in the proper light and maintain his power with government, he's going to have to listen to the consumer."
In the bargain, though, the press and public may seize on problems that don't equate with poor-quality care, she said. "Many of the violations of standards come down to what the public would consider to be not important," Dr. Kuffner said.
Yet, newspapers will play up the scores and misinterpret their significance, she argued.