Both the Joint Commission on Accreditation of Healthcare Organizations and the Healthcare Facilities Accreditation Program of the American Osteopathic Association might need to make room for a new competitor in hospital accreditation.
The U.S. subsidiary of a German qualityimprovement consulting firm is asking the CMS for the authority-known as deeming authority-to accredit hospitals in the U.S.
The effort challenges the 40 years of hegemony in private-sector hospital accreditation enjoyed by the JCAHO and the AOA. And it comes just as the JCAHO is under fire from hospitals for selling its data to the Blue Cross and Blue Shield Association as part of a quality-monitoring program (Oct. 24, p. 8).
TUV Healthcare Specialists, Cincinnati, has applied for deeming authority. And TUV will offer a joint program of accreditation under Medicare conditions of performance rules and certification in the ISO 9000 quality-management program, said Darrel Scott, senior vice president for regulatory and legal affairs at TUV Healthcare Specialists. The company is a subsidiary of TUV America, which in turn is an arm of Munich-based TUV SUD Group, a global business services and consulting firm.
TUV America certifies companies as having met ISO standards for management and quality-improvement programs in the U.S. and elsewhere in the Americas.
"The model allows the hospital a minimum window to be ISO-certified, but they have to meet the goals of minimum conditions of participation," Scott said. "Then they have a two-year window to be ISO-certified. If at the end of the two years they meet conditions of participation, but don't make ISO certification, we can't accredit them," Scott said.
The company submitted its initial application in June but isn't likely to know for a while if its effort will gain deeming authority.
"It's an extremely long process," Scott said. "If everything goes as we hope it will go, we hope to have our approval sometime next year."
CMS spokesman Peter Ashkenaz would not hazard a guess as to how long the deeming authority process might take. While the agency is reviewing TUV's filings, Ashkenaz said the CMS is "only in the first phase" of its deliberations, which he called the pre-application process.
"We're making sure everything is right before we can even consider (TUV) has an application (pending)," Ashkenaz said. He also declined to comment on how long this preliminary phase might last, but "once it gets defined as an application, then the clock starts." The CMS is required by statute to act on a completed application within 210 days, according to Ashkenaz.
If its application is approved, the upstart TUV will face two entrenched rivals. The JCAHO, founded in 1951, took over in 1953 the accreditation program that was launched in 1918 by the American College of Surgeons. When Congress passed Medicare legislation in 1965, hospitals with JCAHO accreditation were automatically believed to have met conditions of compliance. Today, the Oak Brook Terrace, Ill.-based JCAHO accredits more than 4,650 acute-care and critical-access hospitals in the country. The HFAP, founded in 1945, also got in on the ground floor of the Medicare program, seeking deeming authority in 1965, according to AOA spokesman Michael Campea. Its Healthcare Facilities Accreditation Program accredits about 350 hospitals.
Paul Schyve, JCAHO senior vice president, said the organization is neither surprised nor threatened by the TUV challenge. "There has been talk for some time about a deemed-status application that involved the use of ISO 9000," Schyve said. "We have for a number of years now welcomed competition in the accreditation business. We feel it drives improvement."
"I think frankly both the (healthcare) organization and the public get a greater bang for the buck with JCAHO accreditation, but it also means that there are higher expectations for the organization and additional expectations for the organization," Schyve said.
For example, Schyve said, "With regard to the quality-management system, we do in fact require the organization to have a quality-management system and some of the parts of that we have shamelessly taken from other systems out there," including ISO 9000 and Baldrige quality-improvement methodologies.
There are concepts in it patterned after the Malcolm Baldrige National Quality Award, given by the National Institute of Standards and Technology, and concepts patterned after ISO 9000. Still, Scott said, TUV isn't shrinking from the competition. "It's a big world out there," Scott said. "We're not trying to supplant anybody other than present an alternative."
And the JCAHO, which recently unveiled a pilot quality-monitoring program that includes the selling of hospital data to the Blue Cross and Blue Shield Association, could be playing into its competitors' hands, according to the American Hospital Association's Richard Wade.
"From time to time, our members have longed for an alternative to the Joint Commission," Wade said. They haven't shifted to an alternative, he said, because, "for these many years, the gold standard has been the Joint Commission. Once you're in the process, that's locked in stone in so many institutions and the transition could be daunting."