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?

[justavolunteer]

Someone mentioned the "other" accreditation program for hospitals. It's called the "Healthcare Facilities Accreditation Program" and it's under the American Osteopath Association. I found it on a website (I wondered about a hospital in my area that didn't show up under JCAHO). I have also seen posts on this board by nurses who said they worked for CMS directly. (CMS = "Center for Medicare & Medicaid Services". It's a Federal agency.)

As far as JCAHO improving pt. care, like I've said before, some things they do likely help pt. care. However way too many of their rules seem more geared to driving nurses crazy and don't do a doggone thing to help pts. If JCAHO considers it a major violation to see a nurse take a drink of water in the work area, someone please explain how that improves pt. care. If JCAHO decides that nurses need 6 new forms to fill out, that helps pts how??? NPSG's themselves are a good idea. If there is an actual procedure in place to keep the wrong pt from going to surgery, great! If a nurse simply has to memorize the NPSG & recite it back like a 2nd-grader, that's dumb, dumb, DUMB!

[kitty=^..^=cat]

As far as JCAHO improving pt. care, like I've said before, some things they do likely help pt. care. However way too many of their rules seem more geared to driving nurses crazy and don't do a doggone thing to help pts. If JCAHO considers it a major violation to see a nurse take a drink of water in the work area, someone please explain how that improves pt. care. If JCAHO decides that nurses need 6 new forms to fill out, that helps pts how??? NPSG's themselves are a good idea. If there is an actual procedure in place to keep the wrong pt from going to surgery, great! If a nurse simply has to memorize the NPSG & recite it back like a 2nd-grader, that's dumb, dumb, DUMB!

As someone who has worked closely with the JCAHO accreditation process at both the hospital and system level, I can tell you it isn't JCAHO's intent for nursing staff to have to memorize a list of prohibited abbreviations repeat them like a parrot when asked or document the same information in six different places.

When you read the JCAHO standards and the intent of those standards, there isn't a lot of prescriptive language - the JCAHO standards are mostly concerned with the existence of processes that ensure that the intent is met.

JCAHO isn't the "bad guys". The bad guys are the free-lance consultants and out-of-touch administrators that fail to balance the realities of the individual patient care setting with the meaningful expectations of the JCAHO survey/accreditation process. They're the ones that complicate process development and put JCAHO "behind the 8 ball"...

A JCAHO surveyor isn't interested in hearing a nurse rattle off an inclusive list of NPSGs -- he's interested in finding out "What's your process for assuring that patients at risk for falls are identified?" and "How do you know that process works?"

=^..^=

[canoehead, BSN, RN]

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..

This is incorrect. Our hospital did away with JCAHO they only require state certification to be reimbursed but the state will come more often to ensure compliance with standards for the Medicare/Medicaid programs.

[kitty=^..^=cat]

This is incorrect. Our hospital did away with JCAHO they only require state certification to be reimbursed but the state will come more often to ensure compliance with standards for the Medicare/Medicaid programs.

True, but having JCAHO accreditation makes it possible for a facility to negotiate for higher reimbursement rates with private/commercial insurance companies.

Also, having JCAHO accreditation is also taken into consideration if a facility applies for a Certificate of Need for additional beds or certain services.

[directcare4me]

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 have heard this said before, but I know that it is not true. I know of at least one major hospital in my area that is not JCAHO accreditated and serves a large Medicare/Medicaid population. (probably the largest in the city)

[JustMe]

As someone who has worked closely with the JCAHO accreditation process at both the hospital and system level, I can tell you it isn't JCAHO's intent for nursing staff to have to memorize a list of prohibited abbreviations repeat them like a parrot when asked or document the same information in six different places.

When you read the JCAHO standards and the intent of those standards, there isn't a lot of prescriptive language - the JCAHO standards are mostly concerned with the existence of processes that ensure that the intent is met.

JCAHO isn't the "bad guys". The bad guys are the free-lance consultants and out-of-touch administrators that fail to balance the realities of the individual patient care setting with the meaningful expectations of the JCAHO survey/accreditation process. They're the ones that complicate process development and put JCAHO "behind the 8 ball"...

A JCAHO surveyor isn't interested in hearing a nurse rattle off an inclusive list of NPSGs -- he's interested in finding out "What's your process for assuring that patients at risk for falls are identified?" and "How do you know that process works?"

=^..^=

I beg your pardon, but that does happen--surveyors expect EXACT answers to really dumb questions. "What is my process for assuring that patients at risk for falls are identified?" ALL patients are at risk--they have IV lines, foleys, cardiac monitors, narcotics on-board, etc, etc, that affect their balance and they can fall. I'm a professional nurse, educated and dedicated. I think the surveyors look for problems where none exist. Please punish the facilities where problems are identified, but the rest of us are doing a good job and wish to continue doing so.

[justavolunteer]

I know that idiotic stuff goes on because of JCAHO, even though I'm justavolunteer. The nurses at my hospital had to memorize the NPSG's verbatim because it was expected that the JCAHO folks would ask for a recitation. They were also warned, under threat of disciplinary action, not to be drinking coffee, water, etc. anywhere in sight because JCAHO considers this a violation of their standards. The most idiotic thing is the fact that IV bags of saline are now considered 'medication' and have to be locked up. This means I can no longer enter the supply room because of the 'medication' there. Any outfit that makes my life as a volunteer more difficult is not going to get much positive press from me!

[Bill Levinson]

As I see it, JCAHO is part of the problem and not the solution.

http://www.wjla.com/news/stories/0704/160613.html

Note especially the fourth paragraph.

"A California hospital lacked "a sanitary environment to avoid sources and transmission of infections and communicable diseases and failed to develop a system for ensuring the sterilization of medical instruments," the GAO said.

===========================

Chicago Tribune, 10 November 2002

Patient Safety Suffers as Agency Shields Troubled Hospitals

Clean bills of health are awarded despite deaths, infection outbreaks By Michael J. Berens and Bruce Japsen Tribune staff reporters

...But the Tribune found that the Joint Commission often fails in its role as public guardian. Among the findings:

...Using a voluntary system of reporting, the Joint Commission vastly underestimates the number of avoidable patient deaths. The organization, for instance, documents just 12 cases of preventable hospital-borne infections since 1995. The Tribune found about 75,000 such deaths in just one year, a figure supported by state and government files. Joint Commission officials acknowledge substantial inaccuracies in their records.

...The Joint Commission often has failed to alter a hospital's accreditation when faced with overwhelming evidence that patient care may have been compromised.

In early 1997, Bridgeport Medical Center in Connecticut was experiencing a crisis. Hospital-borne germs infected dozens of patients. Up to one in five patients contracted antibiotic-resistant germs after open-heart surgery.

Dust and flies littered the operating room during surgeries

, according to internal hospital records obtained by the Tribune. ...state public health investigators conducted a surprise inspection and found myriad patient care and infection control violations, such as

failure by surgical assistants to wash hands

.

[How hospitals prepare for JCAHO visits: can anyone say "Potemkin Village?"]

...A Minnesota hospital bought hundreds of new towels and pillows to grace every empty bed, then returned the merchandise after the survey, according to a Midwest surveyor who learned of the purchases by interviewing nurses.

JCAHO's response suggests that JCAHO is part of the problem, not the solution.

"Resource constraints and staffing shortages create patient safety vulnerabilities and force even conscientious health care professionals, in some circumstances, to forego basic necessities such as handwashing in order to meet urgent patient care needs. It is problems such as these that set the stage for the types of serious and deplorable outbreaks of nosocomial (hospital acquired) infections portrayed in the Tribune article." This is like saying that, if your factory is shorthanded, it is an excuse to skip quality inspection activities. JCAHO's response to the

Tribune

article shows a total lack of understanding of management's responsibility to make sure there are enough qualified personnel to do the job.

State-of-the-art quality management systems like the IWA-1 modification of ISO 9000 are the way to go.