lizz is correct. hospitals do not have to have jcaho accreditation to qualify for medicare conditions of participation (title 42). hospitals can also ask medicare to do a survey of their facility to qualify them. however, most facilities opt to go with jcaho or aoa. i am currently studying health information management and this is one of the major subjects that we study.
to get to shiggles! post. . .medicare and medicaid are about as close as the u.s. has come to a national health insurance. granted, it is by no means fairly distributed, but that is for a different discussion. however, since the u.s. government is paying for the services provided to medicare beneficiaries, they are making sure that they are able to account for every penny that is being spent. in the early days of medicare, they recognized that a lot of the money being paid out for medicare services was money being thrown to the wind. as the years have gone on, medicare has tightened the purse strings more and more and demanded quality for the money they paid out. in doing so, they have put a lot of rules and regulations on providers of medicare services. one way of standardizing and improving the services was to require conditions of participation. it became too overwhelming for medicare to administrate this so jcaho and aoa (as well as ncqa for hmo hospitals) accreditation were seen as feasible ways to assist in this. i think it is reasonable to assume that without title 42 and jcaho standards, many which merely repeat part 482 (conditions of participation for hospitals) of title 42, that there were would be a lot of substandard care given to people and we would be hearing about a lot of really bad care and advantage being taken of people. because healthcare wasn't policing it's own practices well enough, the government, by way of medicare, stepped up and did it. now, we're stuck with it. the insurance companies merely ride the coattails of medicare. medicare, they recognize, has demanded quality of healthcare providers. beside the money issue, medicare has brought about some importance quality improvement things that have been a great benefit to us all. one that i can think of off the top of my head has been physician peer review.
i think what you are seeing may be poor management by the hospital you are working in. many of the hospitals i've worked in had jcaho committees where everyone on the management staff participated and was responsible for making sure that standards were being met. compliance is meant to be an ongoing activity, not something that is only done a month before the surveyors are coming in to inspect. anyway, jcaho has changed its inspection methods and they no longer give notice of when they are coming like they used to. is it possible that this has revealed a primary weakness in your hospital's system of dealing with compliance?
if you've followed the national news recently, king medical center here in l.a. lost its jcaho accreditation with it's recent survey and was going to have to close its doors. the entire healthcare community has been trying desperately to do what it can to keep the facility open since it primarily services medicaid and medicare patients. the impact of it closing due to losing its jcaho accreditation would cripple the other surrounding hospitals due to the influx of patients they would have to take in. loss of jcaho accreditation = inability to bill medicare and medicaid for services to medicare and medicaid patients. there are only very few circumstances where a hospital can legally collect the money from these patients if medicare or medicaid denies payment.
this is just one of the trends you are going to see in the u.s. if healthcare facilities do not stay current with trends and fail, or refuse, to strategize and practice good accounting and budgeting, there are going to be more closures. i wish we would just go to a national health insurance like canada, britain and germany have done and get it over with. however, too many people in this country feel this would be the wrong direction to go, so i don't think we're going to see this in my lifetime. therefore, we're stuck with what we currently have: medicare/medicaid, private medical insurance coverage, and self-payment for medical services.