One thing that the commission does have is brand-name recognition, said Pat Winstead, manager of accreditation services at 328-bed Owensboro (Ky.) Medical Health System. Hospitals typically are asked by insurers whether they are commission-accredited, so DNV will have to work to build its reputation and recognition in the industry. Theyre going to have to have some support from (insurers) to get reimbursement, she said. Still, that doesnt mean hospitals wont be interested in using DNV, she added.
DNV is a relative newcomer to the healthcare industry. Its parent companyDet Norske Veritas, a nongovernmental foundation based in a suburb of Oslo, Norwayfirst started in 1864 as a classification society to rate the seaworthiness of ships. In 2007, DNV Healthcare acquired TUV Healthcare Specialists, which saw its own bid for accreditation authority a year earlier fall short.
Hospital accreditation is voluntary, although its one way for them to qualify for the Medicare program. However, becoming accredited through one of the three authorized organizationsthe commission, DNV or the third choice, the American Osteopathic Associationlends cachet to hospitals hoping to demonstrate their high-quality performance. The Joint Commission reports that 91% of U.S. hospitals are accredited through its program.
As the largest accreditor, the Joint Commission has built a strong network of programs and partnerships among stakeholders in the industry. But it also has come under fire in recent years by federal officials who criticized the relationship between the commission and its consulting arm, Joint Commission Resources, and by hospitals that argued the commissions policies were becoming too rigid and cumbersome to follow.
Just last week the commission faced criticism from the CMS about its critical-access hospital accreditation program, which was put on probation. The federal agency said the section of the commission program regulating psychiatric or rehabilitation units that are a distinct part of a critical-access hospital is not in keeping with Medicare requirements.
The CMS last approved the commissions critical-access hospital program in 2002 but since then, Medicares conditions of participation have been revised, according to the CMS. Under the conditions, critical-access hospitals are allowed to provide inpatient psychiatric or rehabilitation services in a distinct-part unit as long as those services comply with hospital requirements in other sections of Medicares conditions of participation. The commission must revise its standards to comply with those requirements updated in the past six years. Once the commission has submitted its revised distinct-part unit standards, the CMS will conduct a survey to validate the changes.
The commission said in a written statement that it was pleased to gain approval for its critical-access hospital program and would work with the CMS to bridge the gaps in standards for distinct-part units.
The commission says it welcomes the competition from DNV. In our 50-plus years of experience we have been successful in a competitive environment for all of our programs. Our standards, National Patient Safety Goals and performance measurement requirements go well beyond the assessments of other external oversight bodies and represent an extremely high bar for hospitals to achieve in quality and safety, the organization said in an e-mailed statement.
The other national accrediting group, the AOA, declined to comment for this story.
The American Hospital Association, which has partnered with the Joint Commission in several quality initiativesincluding most recently the creation of a compendium to help reduce hospital-acquired infectionssaid voluntary accreditation is one way for hospitals to tackle quality issues. We recognize that having a choice of accrediting organizations could be good for patients and for hospitals. Both the Joint Commission and DNV Healthcare will work with hospitals to reach their goal of quality improvementtheyll just take different paths to get there, the AHA said in an e-mailed statement.
Hospitals might be attracted to those different paths, said Cynthia Alvey, director of nursing support services with Owensboro Medical. The hospital recently completed a Joint Commission survey and has no plans to switch accreditors. More competition is a good thing for facilities, said Alvey, who praised the commission for making progress on fixing areas for which it has been criticized.
The ISO process likely will be popular in regions with a large manufacturing base, Alvey said. It will be something that they recognize.
In addition to West Shore, other hospitals already have made the switch to DNV, which needed at least 24 hospitals to undergo its survey process as part of the companys application for deeming authority to the CMS. DNV has already accredited 27 hospitals in 22 states.
West Shore used to be certified by the Joint Commission, but the process didnt seem effective, according to Wilberg. The medical center has been ISO 9001-certified through DNV for the past seven years. West Shore worked with a state program to achieve Medicare qualification before becoming accredited through DNV.
It was very costly and we didnt seem to get much out of it, Wilberg said in reference to the Joint Commission. The biggest difference is in the attitude and behavior of the surveyors, Wilberg said. DNV surveyors look at us the same way we look at ourselves and staff feel comfortable indentifying problems and addressing issues, she said.
Unlike the Joint Commission, which focuses on segments within a hospitals operations, DNV takes a more holistic approach to implementing quality into a facilitys entire infrastructure, she said.
Hays Medical Center will be ending its more than 31 years of accreditation with the Joint Commission this year in favor of the DNV process. The hospital has already gone through DNVs survey process and found the different style appealing, Purdy said.
Hospitals will become certified in Medicares conditions of participation through DNVs accreditation process, dubbed the National Integrated Accreditation for Healthcare Organizations, or NIAHO. As they meet requirements through NIAHO, hospitals also will be complying with ISO 9001, one component within the family of ISO 9000 standards that form a quality-management system. While hospitals will be complying with the ISO 9001 standard by following DNVs process, actually receiving the ISO 9001 certificate is a voluntary option and will be a separate processing fee of between $2,000 and $3,000. Joint Commission annual fees are based on the size and the service complexity of individual hospitals and range from $1,780 to $36,845. DNV says its pricing is comparable to the commissions over a three-year period.
Yehuda Dror, president of DNV Healthcare, said he wants hospitals to view the accreditation process as a strategic tool. For them, it should be the way they do business.
The NIAHO uses hospitals own practices as the base of its written policies and procedures. Hospital leaders decide what to focus on and write their own plans of action, and DNV works with the facility to ensure it is following its written plan, Dror said. In addition, hospital staff members become trained as auditors so they can continuously monitor their quality operations, while DNV auditors conduct annual surveys. The goal is to have staff working on the same path and ensuring objectives are being met without restricting the methods used to achieve those objectives, he said. Its very difficult when you have a proscriptive system, he said.
Allowing for more flexibility in the survey process will give hospitals the opportunity to develop tailored quality systems that meet their needs, said Jim Levett, chief medical officer of Physicians Clinic of Iowa in Cedar Rapids, a practice with more than 40 doctors that is ISO 9001-certified. Levett is chairman of the standards and appeals board for DNV. Theres an opportunity for hospitals to continue to meet Medicare conditions of participation but develop programs that work for them.