The Joint Commission on Accreditation of Healthcare Organizations is at odds with the hospital industry over the JCAHO's role in a proposed federal database to track medical errors.
The body that accredits about 80% of U.S. hospitals says it wants access to voluntary reports collected in such a database so that it can help hospitals fix their problems, but the Joint Commission won't rule out using what it discovers to make its own accreditation decisions.
The American Hospital Association, which sent a letter to Sen. Edward Kennedy (D-Mass.) last week supporting his draft bill to create the database, says the role that the Joint Commission wants to carve out for itself would violate an earlier agreement among the groups that such a reporting resource would be nonpunitive.
"If they would rather preserve the right to use it in a quasi-regulatory role, then we would have some concerns," said Anne Berdahl, the AHA's senior associate director of health policy development.
Despite the fact that the AHA appoints seven members to the Joint Commission's 28-member board of commissioners, the AHA and the JCAHO often are at odds on major policy issues.
Individual hospitals also object to allowing the Joint Commission to access organizational-specific details of a government database of provider errors. Such a role would make hospitals less likely to report adverse events for fear that it will be held against them, hospital executives argue, and also assumes that the Joint Commission has the expertise to provide valued assistance to hospitals struggling with quality problems.
"I don't think that the Joint Commission has proven itself as an effective tool for process improvement," said a corporate vice president of quality issues for a multihospital system who requested anonymity.
The AHA said organizations other than the Joint Commission should be tapped to work with government agencies to provide quality-improvement resources to hospitals.
"We think that the entities that have expertise to work with providers are probably not the same organizations that have an oversight function," Berdahl said.
Sens. Kennedy, William Frist (R-Tenn.) and James Jeffords (I-Vt.) plan to introduce their Patient Safety Improvement Act in September, said a Kennedy spokesman. A draft of the bill obtained by Modern Healthcare indicates the legislation would establish a national database of information that a newly established Center for Quality Improvement and Patient Safety will use to research and promote methods for improving healthcare.
Providers would be called upon to voluntarily report a range of patient safety data, including the events that occurred when an injury or death, or even a potential injury or death, is directly associated with the medical care a patient received. Included in the draft, and critical to the success of any national medical-error reporting system, is language that protects reported data from subpoena or legal discovery.
The Joint Commission has opposed the bill during stages of its development because it stripped the accreditor of the right to access database records.
"There is a role here for accreditors to get the information to work with healthcare organizations on the local level," said Margaret VanAmringe, the JCAHO's vice president for external relations. In fact, accreditation itself risks being "sort of destroyed" if bodies like the Joint Commission aren't allowed access, VanAmringe said. She added that the Joint Commission wants to bring its expertise gained in dealing with medical errors to healthcare providers that report mistakes. The purpose is to offer help in quality improvement and risk reduction, not to rip away accreditation, VanAmringe said.
But VanAmringe doesn't deny that information the Joint Commission discovers through the database may find its way into an accreditation decision for the organization.
The Joint Commission has had limited success with its sentinel event program, which calls on hospitals to voluntarily report to a database unanticipated patient deaths or severe injuries. As of late June, the program has reviewed 1,294 events in more than six years. Last year, JCAHO President Dennis O'Leary, M.D., said that fear of litigation is a significant reason organizations don't report more frequently.