Is JCAHO just a way to make money?

[Cheyenne RN,BSHS]

I have some thoughts about the JCAHO accreditation that hospitals work so hard to achieve and pay for.

I am concerned about the high cost of medical care and the people who come to the hospital too late because they could not afford the care, or they could not afford the medications to keep them healthy. I have been saddened to see two such people end up in ICU within the past week because of just these reasons. I wondered if there was a way that money is being spent that could be placed elsewhere to directly benefit patients more.

I have been in nursing for over twenty years and have worked in critical care, long term care, and home health. I have even worked at the juvenile correcton facility in our state and I have practiced out of state as well as in my state of licensure.

Some of the facilities that I have worked at were JCAHO accredited and others were not, some facilities were private pay, others state funded, but all were visited and monitored by state licensing boards whether they were JCAHO or not.

In reviewing the areas that I have worked, I have seen quality care presented in highly professional ways in each place. All sought ways to improve patient care and dealt with staffing and budget issues. In thinking about all of this, I am wondering if the public has been falsely convinced that ONLY facilities that are JCAHO accredited can provide safe, high quality patient care?

I wonder if some where along the way JCAOH is padding someone's (?) pocket while taking monies away from more practical and realistic needs in staff and patient care areas?

I do not know how much a hospital has to pay to be surveyed by JCAHO, but I do know that there is money exchanged. I do know that hospitals with the JCAHO accreditation advertise their accreditation and overall tend to charge higher fees for health care, medical procedures, room rates, ER visits,etc. I have heard it said that there is a need to charge more because they provide such a high level of professional quality care as evidenced by JCAHO.

The facilities that I have worked in that were only state licensed and reviewed were just as high in quality performance. At times the hospitals seemed to work even harder to pass state reviews because the state is the one with the authority to close a facility. I know there are bad facilities that offer substandard care out there, but in my experience I have not yet seen much difference.

I learned first hand that the state has expectations that are just as detailed and aggressive in patient care areas as JCAHO, but do not cost the facilities the money the JCAHO "title" does.

It just seems to me that money is often being wasted (?) and spent to have the title "JCAHO Accreditied" after the name of the hospital and that the same money could be put to much better use. Specially when you view the cost of healthcare overall and patient care needs and staffing shortages.

Is JCAHO the same type of gimic to make money and appear "better" as an item one would buy with a designer label on it? Where does the money that JCAHO obtains used? I know it is an in depth review, but is there really a difference? And couldn't that money be used more efficiently toward direct patient care areas?

[jsteine1]

I have some thoughts about the JCAHO accreditation that hospitals work so hard to achieve and pay for.

I am concerned about the high cost of medical care and the people who come to the hospital too late because they could not afford the care, or they could not afford the medications to keep them healthy. I have been saddened to see two such people end up in ICU within the past week because of just these reasons. I wondered if there was a way that money is being spent that could be placed elsewhere to directly benefit patients more.

JCAHO makes upwards of $10,000 per accreditation. Early on, everybody went nuts to get JCAHO acred for marketing/economic reasons. A lot of insurers, managed care companies required it of their providers, so if you wanted a census and a certain patient mix, you had to go that way. It also made for nice advertising on brochures etc. I think in the not too distant future, there will be less emphasis on JCAHO. There has been a lot of negative press about their fees and stamp of approval decisions lately. It has lost some of it's luster. I agree with you- that kind of $$ could be put to much better use. The federal survey processes have tightened up so much, quality issues are enforced with potentially severe penalties and the facility doesnt have to pay for the pleasure!

[sweetcheekers]

I have some thoughts about the JCAHO accreditation that hospitals work so hard to achieve and pay for.

I am concerned about the high cost of medical care and the people who come to the hospital too late because they could not afford the care, or they could not afford the medications to keep them healthy. I have been saddened to see two such people end up in ICU within the past week because of just these reasons. I wondered if there was a way that money is being spent that could be placed elsewhere to directly benefit patients more.

I have been in nursing for over twenty years and have worked in critical care, long term care, and home health. I have even worked at the juvenile correcton facility in our state and I have practiced out of state as well as in my state of licensure.

Some of the facilities that I have worked at were JCAHO accredited and others were not, some facilities were private pay, others state funded, but all were visited and monitored by state licensing boards whether they were JCAHO or not.

In reviewing the areas that I have worked, I have seen quality care presented in highly professional ways in each place. All sought ways to improve patient care and dealt with staffing and budget issues. In thinking about all of this, I am wondering if the public has been falsely convinced that ONLY facilities that are JCAHO accredited can provide safe, high quality patient care?

I wonder if some where along the way JCAOH is padding someone's (?) pocket while taking monies away from more practical and realistic needs in staff and patient care areas?

I do not know how much a hospital has to pay to be surveyed by JCAHO, but I do know that there is money exchanged. I do know that hospitals with the JCAHO accreditation advertise their accreditation and overall tend to charge higher fees for health care, medical procedures, room rates, ER visits,etc. I have heard it said that there is a need to charge more because they provide such a high level of professional quality care as evidenced by JCAHO.

The facilities that I have worked in that were only state licensed and reviewed were just as high in quality performance. At times the hospitals seemed to work even harder to pass state reviews because the state is the one with the authority to close a facility. I know there are bad facilities that offer substandard care out there, but in my experience I have not yet seen much difference.

I learned first hand that the state has expectations that are just as detailed and aggressive in patient care areas as JCAHO, but do not cost the facilities the money the JCAHO "title" does.

It just seems to me that money is often being wasted (?) and spent to have the title "JCAHO Accreditied" after the name of the hospital and that the same money could be put to much better use. Specially when you view the cost of healthcare overall and patient care needs and staffing shortages.

Is JCAHO the same type of gimic to make money and appear "better" as an item one would buy with a designer label on it? Where does the money that JCAHO obtains used? I know it is an in depth review, but is there really a difference? And couldn't that money be used more efficiently toward direct patient care areas?

what about critical access? I know many of our smaller hospitals are going to this to make ends meet. I wonder about how that works (other than the facility gets government money to keep their facilities open). What's in it for the government? They aren't handing out $ for this and not getting something in return. The whole idea of it makes me feel weird. Its like the hospital is on welfare and then they take this $$$$ and start redecorating and I'll bet the rates patients pay never goes down. I just wonder how many of them are really going to sink without it. I can't judge fairly, though, because I am not nearly informed enough.

[William_SRNA]

It just seems to me that money is often being wasted (?) and spent to have the title "JCAHO Accreditied" after the name of the hospital and that the same money could be put to much better use. Specially when you view the cost of healthcare overall and patient care needs and staffing shortages.

Is JCAHO the same type of gimic to make money and appear "better" as an item one would buy with a designer label on it? Where does the money that JCAHO obtains used? I know it is an in depth review, but is there really a difference? And couldn't that money be used more efficiently toward direct patient care areas?

I agree would you give the people in the ICU half of your paycheck please?

[CseMgr1, ASN, RN]

Last week I began working in an acute care facility doing abstracts for QI reports which have to be turned in to various agencies, including JACHO and CMS...and there is a VERY fine line as what can be considered "compliant" and "noncompliant" regarding medical care for a specific diagnosis. The auditing process itself is very time-consuming, and I can't help but wonder how the smaller hospitals, hit by declining reimbursement and revenues, manage to survive this process and pay JACHO the blood money they demand.

[justavolunteer]

JCAHO may or may not be a moneymaker for their top people. What I can tell you for sure is that JCAHO is a MAJOR pain in the butt! Every time they have inspected our facility, their major contribution to the nurses has been another pile of forms that need to be filled out for each pt. Lately, some "genius" at JCAHO decided that IV bags of saline are now "medication". Since I'm a volunteer, I can't handle "medication". I used to be able to wheel pts to ultrasound with an IV bag (some pts apparently have IV fluid used to fill their bladders before the US). Now the nurse has to take them instead of me. I have read comments here from people that have worked for CMS or state inspection agencies. Most agencies apparently don't do idiotic things like this. It seems to be a particular domain of JCAHO.

I just remembered another bit of JCAHO nonsense from our recent inspection. JCAHO apparently has 7 or 8 "national patient safety goals". Not a bad idea to keep pts safe. The stupid part that I heard about was that JCAHO could come up to a nurse & say "what's NPSG #7?" and the nurse was supposed to have to recite it verbatim. I guess it was a violation if she couldn't.

Things that would really help pt safety, like not drowning nurses in paperwork or just having ENOUGH nurses on a unit, JCAHO doesn't say squat about.

[JustMe]

I can understand the purpose behind JCAHO--pt safety and all that. But why can't they hit the facilities where something is wrong? Why do all of us have to suffer for the few? We've never had problems with things like restraints, careplans, social service referrals, etc. Why are we being penalized with mountains of paperwork because somebody across the country isn't doing their job? :angryfire

[kitty=^..^=cat]

what about critical access? I know many of our smaller hospitals are going to this to make ends meet. I wonder about how that works (other than the facility gets government money to keep their facilities open). What's in it for the government? They aren't handing out $ for this and not getting something in return. The whole idea of it makes me feel weird. Its like the hospital is on welfare and then they take this $$$$ and start redecorating and I'll bet the rates patients pay never goes down. I just wonder how many of them are really going to sink without it. I can't judge fairly, though, because I am not nearly informed enough.

JCAHO has a separate set of standards for Critical Access Hospitals and the survey fees are scaled back considerably.

[justavolunteer]

I can understand the purpose behind JCAHO--pt safety and all that. But why can't they hit the facilities where something is wrong? Why do all of us have to suffer for the few? We've never had problems with things like restraints, careplans, social service referrals, etc. Why are we being penalized with mountains of paperwork because somebody across the country isn't doing their job? :angryfire

It can probably be argued that SOME things from JCAHO may be related to pt safety. But such things as: screaming bloody murder if a nurse is seen taking a drink of water in the work area, making the idiotic rule that saline is "medication", cooking up ever more paperwork for nurses or having nurses memorize NPSG's and parrot them like 2nd-graders, do not contribute ANYTHING to pt safety. In fact, the time a nurse has to spend on JCAHO-inspired paperwork has led to LESS time with pts. and MORE job dissatisfaction among nurses!

[JustMe]

it cam probably be argued that SOME things from JCAHO may be related to pt safety. But such things as: screaming bloody murder if a nurse is seen taking a drink of water in the work area, making the idiotic rule that saline is "medication", cooking up ever more paperwork for nurses or having nurses memorize NPSG's and parrot them like 2nd-graders, do not contribute ANYTHING to pt safety. In fact, the time a nurse has to spend on JCAHO-inspired paperwork has led to LESS time with pts. and MORE job dissatisfaction among nurses!

You're absolutely right. Another irritating thing about JCAHO--it might not even be a clinical nurse telling us what to do!!

[Daytonite, BSN, RN]

I have some thoughts about the JCAHO accreditation that hospitals work so hard to achieve and pay for.

I am wondering if the public has been falsely convinced that ONLY facilities that are JCAHO accredited can provide safe, high quality patient care?

I wonder if some where along the way JCAOH is padding someone's (?) pocket while taking monies away from more practical and realistic needs in staff and patient care areas?

The reason all the hospitals get JCAHO accreditation is because it is a requirement by Medicare. Medicare will not recognize a hospital as a Medicare provider without JCAHO accreditation. Unless a hospital has this accreditation Medicare will not reimburse (pay) the hospital for Medicare services provided to a Medicare patient. A good many of a hospital's users of care are Medicare beneficiaries. Unless someone is very wealthy or willing to pay for their hospitalization out of their own pocket, they are going to go to a hospital that Medicare, Medicaid, or their health insurance company is going to pay for.

It doesn't stop there. Medicaid services are administrated by Medicare, so guess what Medicaid requires of facilities? JCAHO accreditation. Whenever Medicare makes a rule, the insurance companies fall in line also. So, a lot of insurance companies require JCAHO accreditation of the hospitals their policy holders use as well. Otherwise, their policy holders would have to pay their hospital bill out of their pockets as the insurance company would deny payment.

So, to answer your question of why hospitals work so hard to get JCAHO accreditation, the bottom line is so that they can get patients into their hospitals. It's a business decision. In actuality there is one other hospital accrediting body that Medicare will recognize, but very few hospitals use it. Doctor's groups started all these accreditation practices years and years ago and look at what it has grown into! Fact is, many patients probably don't know what JCAHO accreditation means. However, healthcare is becoming more and more regulated. Part of it grew out of unfairness in the way patients were treated a century ago. Some of it is coming from over abuses and cost overruns in providing healthcare services. Today, with the introduction of computers the geeks (I think geeks are terrific!) have shown healthcare just how they can turn all kinds of data into usable information that will improve and streamline not only the business end of it, but also the clinical area as well. It's a very helpless feeling to realize that we are part of a huge profession that is being driven by more and more bureaucracy. We can't deny, however, that things were not that good 100 years ago. Still, quality doesn't come cheap, does it? Maybe with the help of the computer geeks they can get costs down and quality up with liberty and justice for all.

[ClaudiaBMCCSN]

The reason all the hospitals get JCAHO accreditation is because it is a requirement by Medicare. Medicare will not recognize a hospital as a Medicare provider without JCAHO accreditation. Unless a hospital has this accreditation Medicare will not reimburse (pay) the hospital for Medicare services provided to a Medicare patient. A good many of a hospital's users of care are Medicare beneficiaries. Unless someone is very wealthy or willing to pay for their hospitalization out of their own pocket, they are going to go to a hospital that Medicare, Medicaid, or their health insurance company is going to pay for.

It doesn't stop there. Medicaid services are administrated by Medicare, so guess what Medicaid requires of facilities? JCAHO accreditation. Whenever Medicare makes a rule, the insurance companies fall in line also. So, a lot of insurance companies require JCAHO accreditation of the hospitals their policy holders use as well. Otherwise, their policy holders would have to pay their hospital bill out of their pockets as the insurance company would deny payment.

So, to answer your question of why hospitals work so hard to get JCAHO accreditation, the bottom line is so that they can get patients into their hospitals. It's a business decision. In actuality there is one other hospital accrediting body that Medicare will recognize, but very few hospitals use it. Doctor's groups started all these accreditation practices years and years ago and look at what it has grown into! Fact is, many patients probably don't know what JCAHO accreditation means. However, healthcare is becoming more and more regulated. Part of it grew out of unfairness in the way patients were treated a century ago. Some of it is coming from over abuses and cost overruns in providing healthcare services. Today, with the introduction of computers the geeks (I think geeks are terrific!) have shown healthcare just how they can turn all kinds of data into usable information that will improve and streamline not only the business end of it, but also the clinical area as well. It's a very helpless feeling to realize that we are part of a huge profession that is being driven by more and more bureaucracy. We can't deny, however, that things were not that good 100 years ago. Still, quality doesn't come cheap, does it? Maybe with the help of the computer geeks they can get costs down and quality up with liberty and justice for all.

I agree with Daytonite. I am still a student but I lost track of how many times nurses have told me that patient care has improved because of JCAHO. Particularly in long term care facilities.