The latest spat between the American Hospital Association and the Joint Commission on Accreditation of Healthcare Organizations reveals just how little progress has been made in solving the communication problems that have tainted the groups' relationship for years.
In the 48 years the JCAHO has been in operation, it has yet to base accreditation solely on how well a hospital takes care of its patients.
It's the latest attempt by the Oakbrook Terrace, Ill.-based JCAHO to do that-through its "Oryx" program-that has led to the organization's latest confrontation with the AHA.
Earlier this month, the AHA and 17 state hospital associations put out the yellow flag on the JCAHO's Oryx program, saying it's making changes and moving too fast without adequate comment from participating hospitals (Jan. 11, p. 3).
In a three-page letter to JCAHO President Dennis O'Leary, M.D., dated Jan. 4, the associations identified their main areas of concern. The AHA's senior vice president for quality leadership, Don Nielsen, M.D., endorsed the complaints in a one-page cover letter.
The Joint Commission felt blindsided by the attack, accusing the AHA of releasing the letters to the media before presenting them to O'Leary.
"They're using the media" to sabotage the JCAHO's efforts, said one Joint Commission insider, who asked not to be named. "They're acting like they didn't know anything about (Oryx changes). This is no big secret."
Hospital groups have felt left out before. Last fall, for example, they expressed concern about losing the freedom to select their own clinical measures when the commission announced it had selected 12 acute-care focus areas for core performance measures.
This time, the JCAHO responded fast. In a Jan. 7 reply to Nielsen, which the JCAHO released to the press, O'Leary said, "I was surprised and disappointed to learn that these letters had been made available to the trade press before they were actually received by me."
And while hospitals wonder how the JCAHO can get so out of step with the industry, the JCAHO wonders how the AHA can claim to be uninformed about Oryx and other matters when it has seven representatives on the Joint Commission's 28-person board and sends staff members to JCAHO meetings. Nothing-including Oryx-is put forward or implemented without board discussion and approval, O'Leary said.
In their letter, the AHA and state associations questioned the JCAHO's plan to collect more quality data than it originally sought. They also complained that expanded reporting requirements were not adequately discussed by the Joint Commission board or key committees and that data transmission issues haven't been worked out.
They want the JCAHO to reconsider its approach and time line, which has not been set, and to hold more discussions.
Their views are not necessarily widely held, a quick spot survey reveals.
"There is not a big hue and cry in Arkansas" about Oryx changes, said a spokeswoman for St. Vincent Infirmary Medical Center in Little Rock. Likewise at the Missouri Hospital Association, a sponsor of the association letter. "We've not heard anything from the field on the core measurement initiative yet," said Becky Miller, director of performance measurement and quality at the MHA.
Catholic Health Initiatives, one of the country's largest Roman Catholic systems, with 62 hospitals nationwide, could not easily find someone with enough information to talk about the issue.
Even Gary Carter, president of the New Jersey Hospital Association, who signed the letter, said he's heard "nothing" on the matter from hospitals in his state. At O'Leary's request, Carter is organizing a meeting of all state hospital associations, to be held in Chicago in late February. The meeting will allow face-to-face communications about the future direction of Oryx, O'Leary said.
"I think it's mainly about communication," Carter said. The states want to make sure Oryx gets set up effectively and correctly. Misperceptions, he said, can arise from secondhand information.
Terry Townsend, president of the Texas Hospital Association, which signed the letter, said Texas hospitals are very concerned about any modification of Oryx policy.
"We've had these kinds of problems in the past. They keep coming out with things where our members wonder, `Did they talk to people in the field first?' " he said. "Our members want more input into the process. They want to look at cost benefits."
The THA has been a long-running critic of the JCAHO. And Townsend has a close relationship with the AHA.
* In 1994, O'Leary made a personal visit to Townsend and Texas hospital executives to discuss ongoing complaints about JCAHO.
* From 1995 to 1997 Townsend was chairman of the Committee of Allied State and Metropolitan Hospital Associations, the AHA's main link to the states.
* Last October, O'Leary attended a meeting of the AHA's regional policy board that represents hospitals in Arkansas, Louisiana, Oklahoma and Texas to hear concerns firsthand.
O'Leary is clearly exasperated by the argument that the JCAHO didn't allow enough field comment. Oryx development was discussed at length at the July and October meetings of the JCAHO board, he said. Nielsen himself, he said, was an AHA commissioner on the board until Dec. 31, 1998, during the whole period Oryx was discussed.
Nielsen said the board had raised questions about Oryx time lines.
"There needs to be ongoing discussion with JCAHO staff as this moves forward. That was the thrust of the board's comments at that last meeting in October," he said.