An advisory committee last week endorsed and sent to the Joint Commission on Accreditation of Healthcare Organizations board a proposal from the commission's staff to raise survey fees 2% for hospitals.
The proposal will be voted on during a meeting of the 28-member commission board next month.
Even though the JCAHO has not increased fees for three years, the prospect of higher fees in the current fixed-payment climate of healthcare business drew immediate criticism from the American Hospital Association and several state hospital associations.
"We definitely would be opposed to any increase whatsoever in Joint Commission fees," said Dorel Harms, vice president of professional services for the California Healthcare Association. "The hospitals in California are downsizing; they're getting less and less money every place we turn. For anyone to raise prices or even keep them at the same level now is difficult for hospitals."
JCAHO spokeswoman Alice Brown said the base fee for surveys would not change, and thus smaller hospitals wouldn't see a fee increase. The 2% increase would be worked into a formula used to determine additional costs of surveying larger hospitals.
The two-tier fee formula was implemented last year and included a cap on the maximum fee. Brown said the capped amount would be raised 2%.
Jonathan Lord, M.D., the AHA's liaison to the JCAHO, will be working with the Joint Commission board, of which the AHA controls seven seats, to focus on the problems this would create for hospitals, an AHA spokesman said.
"We think this is a step in the wrong direction, and we're glad it's not yet a done deal," the spokesman said. "We hope that the Joint Commission's board of commissioners will see the issue in a different light when they meet on Sept. 20-21."
The fee increase issue arises amid what some of the same associations say are significant gains in the JCAHO's standing and reputation as an accrediting organization.
For example, Wisconsin hospitals have reported "significant enhancement in services" and "a major change in the responsiveness" of the JCAHO, said Marvin Kolb, M.D., senior vice president for medical and professional affairs of the Wisconsin Health and Hospital Association.
"Hospitals are saying just lots of good things about the survey process," Kolb said. But he added that "the cost of the survey process is always an issue," and talk of a fee hike is capable of overshadowing other positive achievements. "I wonder if at this time it could impair the positive momentum," he said.
The timing makes it more than a budget issue, said Richard Hoeth, director of rural health and hospital affairs for the Texas Hospital Association. Hoeth predicted hospitals in the state would object to the fee hike.
The anti-fee mood is "definitely a philosophical view rather than the dollar amount involved," Hoeth said. "The 2% isn't that much. But it's another fee that can't be passed on" in the face of fiscal belt-tightening in response to the growth of managed care and payment cutbacks in Medicare and Medicaid.
Generally the JCAHO is more favorably perceived in the state now than a year ago, but hospitals still see survey fees as too high, Hoeth said. "They can see progress (in JCAHO performance), but most of them probably think the fee was too high to start with."