Medicare is lifting a page out of the Joint Commission's playbook.
Late last month, HHS released proposed regulations that completely revamp the conditions under which hospitals may participate in the Medicare program.
Process requirements, standards and conditions are out. Performance measurement, patient outcomes and quality improvement are in. And HHS is frank about where the new ideas are coming from: "The basic structure of all of the (conditions of participation) follows the Joint Commission on Accreditation of Healthcare Organizations' `Agenda for Change,' " the agency said.
"We're pleased about that," said Margaret Van Amringe, the JCAHO's vice president for external relations. "We firmly believe in performance-based measurement."
The changes in the regulations shouldn't affect the JCAHO's "deeming" authority, she said. Hospitals must meet HHS conditions of participation to qualify for reimbursement by Medicare or Medicaid. Accreditation by the Joint Commission has been deemed to constitute compliance with the conditions of participation.
In recent years the Joint Commission has been moving away from looking at processes and structures in the hospital and moving toward quality improvement and outcomes measurement. Its Oryx program, for example, will shortly require hospitals to start reporting clinical performance measures as a part of accreditation.
Medicare's conditions of participation were last revised in 1986. They're based on the types of services a hospital offers and include specific process requirements for each service or department. But these process-oriented requirements and enforcement of structures and procedures no longer reflect current thinking.
From now on, for example, HCFA won't specify that a hospital must make available to medical staff a written description of its laboratory services. Yet the hospital would still have to provide laboratory services to meet patients' needs, and its quality improvement program must include evaluation of its diagnostic services.
"The practical effect of this approach would be to stimulate the hospital to find its own performance problems, fix them, and continuously strive to improve patient outcomes and satisfaction," HCFA said.
"This sounds like the language changing peer-review organizations to quality-improvement organizations," said David Nash, M.D., associate dean for health policy, Jefferson Medical College in Philadelphia. That transformation over the past two years, he said, "also changed the focus of these organizations from groups that gave demerits to doctors to groups that are trying to help everyone improve the quality of care."
The deadline for public comment is Feb. 17. No date has been given for the final regulations to go into effect.