Two prominent sponsors of the Joint Commission on Accreditation of Healthcare Organizations last week threatened to yank their support of the troubled organization unless longstanding grievances are resolved.
The Dec. 7 bomb was dropped by the American Hospital Association and the American Medical Association. The groups coincidentally were conducting business meetings at which parallel groundswells against the JCAHO resulted in official complaints.
In addition to bringing provider complaints to a head, the actions could shake patient and payer confidence in the JCAHO and its seal of approval denoting high-quality patient care.
AHA President Richard Davidson acknowledged that the association's actions may spill over into the patient and payer worlds, but, he said, something dramatic had to be done.
"We've sent the same message the same way time and time again," Mr. Davidson said. "It was time to send it in a different way."
The AHA and AMA have been sponsors of the JCAHO for decades, controlling half the 28 seats on the JCAHO's board and contributing a combined $280,000 annually to its operations. The two groups contribute the majority of the commission's corporate funding.
Executives of both groups said they acted independently in issuing their warnings. AHA executives said, however, that they would be contacting the other JCAHO sponsors to discuss the situation.
The JCAHO released a brief written statement in reaction to the threats.
"We are surprised and disappointed that the American Hospital Association sought to address their concerns in a public forum rather than discussing them directly with us," the statement said. "In 1994, the Joint Commission began implementing the Agenda for Change to create a more meaningful accreditation process. We understand that change is difficult."
Specifically, the AHA's board of trustees issued a vote of no confidence in the JCAHO after a board meeting in Chicago last week. In a written statement, the board called for "immediate and substantive change." It called on the JCAHO's five sponsoring healthcare organizations to meet within 30 days with the executive committee of the JCAHO's board to take immediate steps to address several key provider concerns.
The concerns include the variability of accreditation surveys and surveyors; the value of JCAHO services and programs; and the role of the JCAHO as a peer review organization, accreditor and disseminator of quality data.
"The crisis that exists today is the result of the cumulative impact of chronic performance problems, marketing of too many add-on services and a fundamental lack of responsiveness to the needs of hospitals and their medical staffs," the board statement said.
Carolyn Roberts, who chairs the AHA board, said she expected action by the JCAHO by the end of March 1995. Neither Ms. Roberts nor Mr. Davidson, who held a post-board-meeting press conference, would elaborate on what steps may be taken if nothing is done. However, Ms. Roberts said the AHA board didn't consider withdrawing from the JCAHO during its deliberations.
AHA officials did not specify what actions they want the JCAHO to take.
Mr. Davidson said the AHA board issued its ultimatum after months of dialogue with the JCAHO failed to produce the desired results.
He also said action was needed quickly because several state hospital associations are considering alternatives to the JCAHO, and if they pull out en masse, the JCAHO could "collapse."
Meanwhile, 4,300 miles west in Honolulu, the AMA's House of Delegates approved in a voice vote a resolution that called for evaluating the implications of withdrawal from the JCAHO and the alternative of working with other organizations that certify or accredit healthcare organizations.
The resolution directs the AMA to report to its House of Delegates at the June 1995 annual meeting. The report also will include an evaluation of the JCAHO's activities, especially its implementation of AMA policy positions.
The AMA ultimatum was engineered by its hospital medical-staff section, the arm of the organization that deals closely with the JCAHO and acts as advocate for physicians who take issue with hospital accreditation policies.
The rank and file of that unit had been pushing for years to take a radical stance on the JCAHO because of mounting concerns that the accrediting body was unresponsive to complaints that it had become too burdensome and expensive for the benefits yielded, said Marie Kuffner, M.D., the unit's delegate in the AMA's House of Delegates.
In the past, the leadership of the medical staff section had advocated working out differences informally through JCAHO channels and had kept the anti-JCAHO sentiment from reaching the resolution stage.
But last week, the governing council decided that "enough is enough is enough," said Dr. Kuffner.
The resolution was floated Dec. 5 in an AMA committee fielding accreditation issues. The resolution was approved and sent to the delegates for a vote.
Most recently, the medical staff section was rankled by the JCAHO's handling of physician concerns about how to disclose for the first time the accreditation decisions reached for specific hospitals and other providers (Oct. 3, p. 6).
In a resolution introduced by the medical-staff unit and passed at a June policymaking session, the AMA opposed the release of organization-specific information until the association could assess how the data were to be gathered, analyzed and validated.
But the JCAHO was concerned with meeting an October 1995 deadline for unveiling the program rather than giving sufficient consideration to the AMA's concerns, Dr. Kuffner said.
To maintain industry support, the JCAHO has to bring the costs of accreditation in line with benefits, she said. "The burdens are just too great in exchange for the yield in quality improvement."
The JCAHO also has to take its lead from its constituent provider groups "and not be a staff-driven organization," she said.