The board of the Joint Commission on Accreditation of Healthcare Organizations shot down a proposal from its administrative staff to increase survey fees for larger hospitals by 2%.
In the process, the rejection scotched a staff proposal to expand the IMSystem-a commission-developed acute-care performance measurement program-to include evaluation of networks and health plans.
The issues rose and fell during final action on a $114 million budget for 1997 at the Sept. 20-21 board meeting of the JCAHO in Oakbrook Terrace, Ill.
It was the second successive year that a fee increase was proposed and rejected.
But this year the fee issue was just an element in a larger discussion about strategic priorities and provider concerns sparked by the budget talks, said Jonathan Lord, M.D., the American Hospital Association's liaison to the JCAHO.
He said several priorities were hashed out at the meeting:
Performance measurement was reaffirmed as a key priority critical to the future of accreditation in healthcare.
The JCAHO accreditation program for healthcare networks needs to be strengthened, but in collaboration with another accreditation agency, the National Committee for Quality Assurance, which has extensive inroads in the managed-care sector.
The process of accreditation must become more meaningful and less intimidating to the public. That calls for broadening the availability of provider-specific performance reports and improving the reporting methods.
The fee increase had been opposed by the AHA and state hospital associations as unnecessary and ill-timed considering payer pressures on providers to make do with less money in today's cost-conscious environment.
"In deference to current healthcare organization sensitivities about price changes, the board decided to forgo contemplated survey fee increases for the hospital, ambulatory-care, behavioral healthcare, home-care, long-term-care and laboratory accreditation programs," the commission said in a written statement.
The increase would have raised $1.3 million in additional revenues. "To accommodate the adjustment in the budget, the board moved to delay the incorporation of network and health plan indicators in the IMSystem and explore more immediate approaches to the inclusion of performance measurement requirements in the evaluation of networks and health plans," the commission statement said.
The IMSystem originally was envisioned as the sole performance-measurement instrument for accredited hospitals, but the commission decided early in 1995 to open up the process to other industry-developed measures deemed valid for evaluation purposes. A certification process for measurement systems is under way.
Dennis O'Leary, M.D., the JCAHO's president, said improvements in the survey process and internal operations have "eased the bottom line" for accredited organizations during the past few years. "The Joint Commission continues to respond aggressively to calls for cost containment from healthcare organizations which are facing the challenges of adapting to a rapidly changing marketplace," he said.
Commission streamlining and cost savings also will be directed at the public within the next year as the JCAHO mobilizes to transfer reporting of organization-specific performance reports to the Internet.
With those reports slated to appear on the JCAHO's World Wide Web site no later than January 1998, the agency will stop charging $30 per report to those who request the information, said spokeswoman Janet McIntyre.
The JCAHO also will discontinue its practice of telling accredited organizations the name and address of the requesting party, she said.