Reacting to the pleas of hospitals that say they are drowning in irrelevant paperwork, the Joint Commission on Accreditation of Healthcare Organizations last week announced a relatively sudden decision to rework its outdated hospital standards.
But the work of a new 18-person standards review task force will be partially hamstrung because it is estimated that half of the commission's 488 hospital accreditation compliance standards would require federal government approval to change.
The JCAHO, which has survived through a stream of makeovers since launching its "Agenda for Change" in the late 1980s, has not revamped its hospital standards since 1994. As many as 85% of the standards that hospitals must meet to win accreditation have been unchanged for seven years.
The latest announced revamp of the Joint Commission's accreditation process also comes three months after a report by the Institute of Medicine called for an overhaul of the healthcare system to improve quality of care (March 5, p. 4) and one week after HHS announced plans to create a massive database on medical errors that would rival one operated by the Joint Commission (April 30, p. 4).
The decision to commit to a massive revision of its hospital standards was made only in the past month, according to Charles Mowll, the commission's executive vice president.
"I think it is fair to say that the environmental pressures that hospitals are experiencing today with both extraordinary levels of regulatory compliance burden and the looming staffing crises just really moved this up on our radar screen," Mowll said.
Making changes to the standards has been "an ongoing concern for our members," said Donald Nielsen, M.D., a senior vice president at the American Hospital Association. "It has been something that we have constantly been bringing up to the JCAHO."
The AHA appoints seven members to the commission's 28-member board of commissioners.
"I think we just heard mounting concern about the questionable relevancy of some of our standards," Mowll said.
Last week, the AHA released a study showing that every hour of patient care required an hour of paperwork in some hospital departments (See story, p. 12). The study focused primarily on the hassles of regulatory compliance, but Nielsen said accreditation preparation is a critical component in hospitals' ongoing battle with paperwork.
However, the capacity of the commission's task force of industry experts to lighten hospitals' credentialing burden may be bridled.
Spokeswoman Charlene Hill estimated that as many as 50% of the JCAHO's hospital standards were written to correspond with Medicare's conditions of participation, a comprehensive set of criteria that providers must meet to qualify for reimbursement. While the task force will review and recommend changes for these standards, the JCAHO is limited in how far it can stray from the conditions.
The JCAHO's adherence to the conditions stems from its "deemed" status with Medicare, which means that accredited hospitals are assumed to have met the participation standards.
Change to the Medicare conditions comes very slowly; the current rules have been largely unchanged since 1986. A major overhaul of the conditions was completed in 1997, but with few exceptions has not been implemented four years later.
Having to work within the constraints of Medicare's rules will stymie the JCAHO's ability to move forward, Mowll admitted.
Hospitals, which pay on average $20,000 for a JCAHO survey, are withholding judgment on the proposed standards overhaul.
"If the Joint Commission activity is aimed at streamlining and making the entire process more meaningful and less burdensome, then we are all for it," said Kenneth Raske, president of the Greater New York Hospital Association. "The proof is in the pudding."
The task force's review, in which the panel's members will complete a page-long assessment of each hospital standard, seeks to weed out standards not directly related to patient care and safety.
Mowll said the goal of the task force work is not to necessarily reduce the number of hospital standards or shorten the time needed for a hospital accreditation survey. Instead, success or failure will be measured using the commission's own quarterly survey of chief executive officers who have recently been through a survey, Mowll said.
The JCAHO declined to provide Modern Healthcare with the CEO survey results from the past year, saying a recent change in the survey's methodology would make comparisons misleading. Hill said the most recently available survey data from the first quarter of 2000 show that 92% of the 850 CEOs surveyed agreed that the JCAHO's hospital standards are relevant to providing quality patient care.
Ken Shull, president of the South Carolina Health Alliance, will serve as chairman of the new Standards and Standards Compliance Review Task Force. The JCAHO has asked state hospital associations to nominate various healthcare professionals to make up the rest of the 18-member task force.
JCAHO spokeswoman Cathy Barry-Ipema said the task force hopes to complete its work by December 2001. A HCFA spokesman said the latest overhaul of the Medicare conditions should be implemented by year-end. The JCAHO and HCFA said they have a communication process in place that allows the Joint Commission to provide advice on revisions of the conditions.
The only standards exempt from the JCAHO's review are those that have been adopted in the past year for pain management, patient safety, and patient restraint and seclusion.
Some JCAHO standards require hospitals to provide up to a dozen pieces of evidence to prove they are compliant. "We think there is an opportunity to make that much more sensible," Mowll said.