The juxtaposition of two events late last month couldn't have been more revealing. While the Government Accountability Office was nailing the Joint Commission for failing to find serious safety violations at hospitals, the commission-under pressure from its hospital overseers-was busy retreating from its new requirements for safer administration of drugs and reducing the risk of surgical fires.
The GAO report calls for new government oversight of the commission, and Joint Commission on Accreditation of Healthcare Organizations President Dennis O'Leary says that's fine with him. "We're flying by the seat of our pants, and nobody is in the barrel with us, particularly CMS."
O'Leary's inadvertently apt quote only confirms what we've been observing for years. The commission's MO has always been to wing it. One set of accreditation standards or performance measures is triumphantly rolled out, then revised and soon abandoned for another approach. In the latest incarnation, the triennial survey-previously interrupted only when a headline-grabbing sentinel event occurred-has been augmented by a sort of self-policing by hospitals at the midpoint of the accreditation cycle. Bet that catches a lot of safety violations.
Years behind private-sector initiatives, the commission has finally moved to a system of reporting hospital quality data to the public, but as usual, there's a catch. At first hospitals reported on two sets of measures from among four disease conditions, so that payers and the public would be kept in maximum confusion. Now hospitals are reporting three sets of measures out of five. Three out of five beats two out of four, I guess.
How hospital performance data are presented is utterly and purposefully confusing. After first proposing a five-star rating system, the JCAHO has turned to a grid of overall and separate scores. After further tweaking, some stars have returned, though what they stand for now is anyone's guess. What payers, let alone hapless consumers, are supposed to do with this jumble is unknown but probably irrelevant.
For one thing, John Griffith, a health policy professor at the University of Michigan, concluded in a 2002 research project that there was no correlation between a hospital's outcomes measures and the score it receives from the JCAHO.
For another, the GAO found that state agencies that checked up on a sample of 500 JCAHO-accredited hospitals determined that the commission missed 69% of serious safety violations ranging from fire prevention to failure to properly prepare and administer drugs. Good thing the commission backed off from those new medication rules and that its worthy plan to stop informing hospitals in advance of surveyor visits won't start until 2006.
Of course, the commission says the GAO study was based on a flawed methodology, and that hospitals are among the safest healthcare environments thanks to the JCAHO's efforts. Never mind that a comprehensive study out last week estimated there are 195,000 preventable patient deaths each year at hospitals.
It's time to stop the bleeding at the JCAHO. Start by getting rid of a board dominated by the hospital and physician community. The board should include public and private payers, consumers and independent quality gurus.
A public-private financing scheme should be found so that the JCAHO isn't dependent on the very institutions it accredits.
Accreditation should be based on a new set of quality data that can easily be reported to and understood by the public.
Finally, as we have argued before on this page, get rid of O'Leary, who has done little but blow smoke about improving healthcare quality.
Let him fly something else by the seat of his pants.