Fear of a government takeover of hospital accreditation and remarks perceived as belittling industry concerns provoked this month's public attack on the Joint Commission on Accreditation of Healthcare Organizations.
The American Hospital Association and the American Medical Association stunned the normally chummy healthcare industry by independently bashing the JCAHO, the industry's leading accrediting body.
Both groups threatened to yank their support unless longstanding grievances are resolved.
The AHA acted because it was afraid some state hospital associations might orchestrate mass withdrawals of their members from the JCAHO, seriously damaging its credibility. The AHA feared that would prompt a federal takeover of the JCAHO's chief role as hospital inspector.
At a Dec. 8 news conference, AHA President Richard Davidson said 15 to 20 state associations are looking at alternatives to the JCAHO.
In fact, seven state hospital associations have formed an informal coalition to share information about alternatives, such as accreditation by other organizations or direct inspections by federal or state health officials. The associations are Arkansas, California, Florida, New York, Ohio, Texas and Wisconsin.
Representatives of the seven groups have been meeting once a month for the past three months, said Beth Ingram, associate vice president for education of the Arkansas Hospital Association.
Last year, the Arkansas association considered but postponed a mass withdrawal of its members from the JCAHO.
What pushed the associations over the edge was a summary of the Sept. 23 JCAHO board meeting, which said the board noted the dramatic changes taking place in healthcare markets across the country and the implications of the changes for the commission.
One implication was "increasing frustration among healthcare professionals, leading, in some cases, to agitation directed at the Joint Commission because it is a visible target."
Copies of the summary circulated among the associations, and many of them considered the comment to be a slap in the face that trivialized their concerns, a number of state executives told MODERN HEALTHCARE.
In addition, several state associations recently received letters from the JCAHO in response to formal requests for answers to their concerns.
Craig Becker, president of the Tennessee Hospital Association, said the JCAHO's response to his group's request was "less than satisfactory."
And, in a letter to JCAHO President Dennis O'Leary, M.D., the Metropolitan Hospital Council of New Orleans said, "Your response to our list of concerns was simply a set of promises that the JCAHO will do better in the future." It called the JCAHO's response unacceptable and insulting.
The associations' ire was conveyed to the AHA during a multistate conference call in mid-November and during the fall round of meetings of the AHA's nine regional policy boards.
The AHA's board of trustees issued a vote of no confidence in the JCAHO and called for a summit to discuss hospitals' concerns within 30 days. In a separate action, the AMA's House of Delegates instructed AMA staffers to study the implications of withdrawing from the JCAHO and pursuing alternatives to the commission (Dec. 12, p. 2).
"What the AHA did gives our criticisms more credibility," said Carolyn Scanlan, executive vice president of the Hospital Association of New York State. "But we're not going to change what we're doing. Our members are entitled to know about alternatives to the JCAHO."
Now, the AHA and the AMA, leading the charge against the JCAHO, are organizing their summit, to be held by mid-January 1995. Together, the AHA and AMA control 14 seats on the JCAHO's 28-member board of commissioners, but other JCAHO sponsors may not be on their side.
The JCAHO's critics may not have an ally in the American College of Surgeons, which contributes three members to the JCAHO board and has a historic tie to the accrediting body: It created and operated the predecessor to the JCAHO before it was spun off as the Joint Commission on Accreditation of Hospitals 43 years ago.
Spokeswoman Linn Meyer said the college would attend any summit, but it "doesn't necessarily agree with what the AHA had to say."
John Helfrick, the American Dental Association's lone JCAHO board member, affirmed his association's support of the commission's performance, saying "there have been a ton of positive things that have happened in the past year as a result of the past five or six years (of planning)."
The commission issued a two-page written statement after the attacks, saying it was "surprised and disappointed" that the AHA chose to raise its concerns in a news conference rather than discussing them directly with the JCAHO.
The JCAHO, based in Oakbrook Terrace, Ill., defended its service record and several new initiatives, including its provider network accreditation program. And it outlined efforts to improve both the JCAHO's core accreditation services and new products.
The JCAHO also questioned the motives of the AHA, noting that the association's representatives on the JCAHO board of commissioners approved the policies and programs now under fire.