When embraced, accreditation can drive beneficial operational reform. When treated as a box to check, accreditation loses its power. A recent review of patient-centered medical home literature illustrates this dichotomy and demonstrates why accreditation should include a focus on performance and collaboration between health system leaders and the accrediting body.
The review, titled “Nature And Nurture: What's Behind the Variation In Recent Medical Home Evaluations?” and published on the Health Affairs Blog on June 19, analyzed two recent studies of medical homes to suggest reasons why some medical homes had positive outcomes and others did not.
Among their many hypotheses, the authors found that, for one group of medical homes, supplemental payments were contingent on achieving patient medical home accreditation. According to the blog post, health systems focused operationally on meeting minimum accreditation standards, and did not implement practices widely accepted as foundational to reduce costs and improve outcomes.
This anecdote captures the challenges of creating an accreditation designation for a model that is still new in its implementation for much of our industry. Accreditation can create a baseline, but best practices for patient-centered medical homes may change more quickly than the standards that evaluate a medical home's validity.
The solution to this problem is most certainly not to eschew accreditation. For decades, forward-looking accreditation programs have shown the ability to raise the level of performance across entire professions. Accreditation can provide a framework for health systems looking to implement a medical home and provide counsel and inspiration for tracking performance and quality improvement in existing medical homes.
Accrediting bodies must create meaningful, adaptive accreditation programs for this emerging model. We can achieve this ideal by advocating for on-site visits and performance measurements as important components of patient centered medical home accreditations.
An expert, on-site accrediting surveyor gives accreditation a face and a name, and provides a personal point of contact for interpreting standards and supplying counsel. This reduces barriers to communication between the accrediting body and the organizations it accredits, benefits each party and builds a collaborative relationship.
The established medical home will benefit from the advanced-level quality and cost initiatives that an accreditation surveyor can inspire. A surveyor who visits medical homes nationwide has a wealth of knowledge in new and innovative quality improvement tactics to share with the organization seeking improvement beyond written standards.
For a nascent medical home, a personal relationship with an accreditation organization provides a trusted adviser to the health system's internal champions of the initiative. As the authors of the blog post note and as several medical home accreditation surveyors have observed, gaining buy-in from skeptical leadership is a significant obstacle for most medical homes. A seasoned medical home accreditor can provide the guidance and mentorship to those establishing the medical home when the initiative is still in its vulnerable early phases, and set it on a course that will deliver the cost and quality improvement numbers to ensure its viability.
High-quality, involved and accessible care should be the goal for every patient centered medical home, not a stamp of approval for the wall. Health system leaders who are sincere in their desire to reform their operations into a successful medical home should have a mindset that seeks continuous improvement in both their own organizations and in their accrediting bodies.
Stephen Martin Jr., Ph.D, is CEO of the Accreditation Association for Ambulatory Health Care.
