JCAHO vs. non-JCAHO hospitals

outcomesfirst, BSN, RN · Dec 31, 2006

JCAHO certification is required to receive Medicare/Medicaid - really any government payment. Most Insurance companies will also require members to use JCAHO certified facilities. Frankly, healthcare is just too expensive for any organization to survive withput the gov't payments. It used to be less so, but I believe it is somewhere around 90%+ now. There is alot of info and opinions about JCAHO, makes a good internet search. Sounds like your institution has ongoing problems that need addressing.

Sheri257 · Dec 31, 2006

JCAHO certification is required to receive Medicare/Medicaid - really any government payment. Most Insurance companies will also require members to use JCAHO certified facilities. Frankly, healthcare is just too expensive for any organization to survive withput the gov't payments. It used to be less so, but I believe it is somewhere around 90%+ now. There is alot of info and opinions about JCAHO, makes a good internet search. Sounds like your institution has ongoing problems that need addressing.

Actually, I don't think that's entirely true. I believe hospitals can also qualify for Medicare, etc. if they're accredited by the American Osteopathic Association (AOA). One of the hospitals in my area, which basically didn't want to meet JCAHO's stringent requirements ... went with AOA instead. For example, I don't think the AOA does surprise inspections like JCAHO does.

:typing

PANurseRN1 · Dec 31, 2006

JCAHO= healthcare's version of the Mob.

outcomesfirst, BSN, RN · Jan 1, 2007

Actually, I don't think that's entirely true. I believe hospitals can also qualify for Medicare, etc. if they're accredited by the American Osteopathic Association (AOA). One of the hospitals in my area, which basically didn't want to meet JCAHO's stringent requirements ... went with AOA instead. For example, I don't think the AOA does surprise inspections like JCAHO does.
:typing

JCAHO certification is required to receive Medicare/Medicaid - really any government payment. Most Insurance companies will also require members to use JCAHO certified facilities. Frankly, health care is just too expensive for any organization to survive without the gov't payments. It used to be less so, but I believe it is somewhere around 90%+ now. There is allot of info and opinions about JCAHO, makes a good internet search. Sounds like your institution has ongoing problems that need addressing.

In stating 'required' I have overstated or simplified. I'll try to keep it brief. Title 42 of Federal Regulations on Public Health lists (makes or explicates law) or requirements for hospitals to receive payments. Individual States "license" hospitals. It is a huge bureaucracy (another source of employment for nurses with regulatory specialization). Specifically, hospitals are required to be in compliance with the Federal requirements set forth in the Medicare Conditions of Participation (CoP) in order to receive Medicare/Medicaid payment. The goal of a hospital survey is to determine if the hospital is in compliance with the CoP set forth at 42 CFR Part 482. See: 2004 CFR Title 42, Volume 3

Certification of hospital compliance with the CoP is accomplished through observations, interviews, and or document/record reviews. The survey process focuses on a hospitals performance of patient-focused and organizational functions and processes. The hospital survey is the means used to assess compliance with Federal health, safety, and quality standards that will assure that the beneficiary receives safe, quality care and services. Survey authority and compliance regulations can be found at 42 CFR Part 488 Subpart A.

2004 CFR Title 42, Volume 3

In order for a health care organization to participate in and receive payment from the Medicare or Medicaid programs, it must meet the eligibility requirements for program participation, including a certification of compliance with the Conditions of Participation, or standards, set forth in federal regulations. This certification is based on a survey conducted by a state agency on behalf of the Centers for Medicare and Medicaid Services (CMS). However, if a national accrediting organization, such as the Joint Commission, has and enforces standards that meet the federal Conditions of Participation, CMS may grant the accrediting organization "deeming" authority and deem each accredited health care organization as meeting Medicare and Medicaid certification requirements. The health care organization would have deemed status and would not be subject to Medicare's survey and certification process.

Accreditation is voluntary and seeking deemed status through accreditation is an option, not a requirement. Organizations seeking Medicare approval may choose to be surveyed either by an accrediting body, such as the Joint Commission, or by state surveyors on behalf of CMS.

Nowhere in Federal Law is it stated JCAHO is the required organized body - JCAHO saw an opportunity and have built a business - really they basically have a sanctioned monopoly. Now if another organization develops the expertise/organization/relationships they too can function as a "deeming authority" (Hmmmm - is this what Magnet is attempting to lay the groundwork for?????????????.....) It is a highly complex situation. Of course - any organization (and they are out there) may say no to JCAHO and interpret/implement/report on the guidelines themselves and have a different survey done and thus capture payment from CMS.- Or chose not to accept CMS payment and be strictly private (Some physician offices are seeking this business model think "we do not accept Medicare/Medicaid" they will see these patients, even help the patient to file a claim, but they collect their fee directly from the patient).

Sorry this is so long - simply stated JCAHO is the easiest business route out there. I looked up the AOA and it is a private member association for physicians, not hospitals, so I am not sure how this meets federal requirements for payment. Maybe it meets state requirements for Facility license - not sure.

So in sum: JCAHO is a way for the public to receive some assurance and protection, it is what we have for now. Hope this long post clarifies.

Daytonite, BSN, RN · Jan 1, 2007

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.

elizabeth321 · Jan 1, 2007

All that aside where did you work in canada?

Liz

Kyrshamarks, BSN, RN · Jan 1, 2007

A hospital DOES NOT have to be JACHO certified. JACHO is a private orginizatioj that does not have any governmental powers. It is completely voluntary to join. It is also illegal for an insurance compnay to ask no less require JACHO certifacation. They can be legally fined for even asking if you have JACHO certifacation.

GardenDove · Jan 1, 2007

I work for a small non-jacho community hospital and of course we serve medicare recipients, we could not afford to stay open otherwise.

NurseCherlove · Nov 30, 2007

I know this thread is old, but I just have to comment that hey, while we're at it, might as well have some other type of bureacracy to monitor JCAHO. As one previous poster has said, they do afterall, pretty much have a monopoly. (I am being facetious of course).

But seriously, I understand a need to have standards for entities as important as healthcare, but there really has to be a better way. I would be curious to know how much hospitals pay to have JCAHO certification. And, if going another route is perhaps cheaper or even free? Why can't "they" see that their money would be better spent on better staffing??????????????? That is all I wanna know!

elkpark · Dec 1, 2007

I know this thread is old, but I just have to comment that hey, while we're at it, might as well have some other type of bureacracy to monitor JCAHO. As one previous poster has said, they do afterall, pretty much have a monopoly. (I am being facetious of course).
But seriously, I understand a need to have standards for entities as important as healthcare, but there really has to be a better way. I would be curious to know how much hospitals pay to have JCAHO certification. And, if going another route is perhaps cheaper or even free? Why can't "they" see that their money would be better spent on better staffing??????????????? That is all I wanna know!

The fee that JCAHO charges hospitals for the "privilege" of being surveyed is prorated based on the number of beds (large hospitals pay more than small hospitals), but can easily be $25,000 or $30,000 for a large hospital. PLUS, there is a lot of pressure put on hospitals to hire "consultants" (former JCAHO surveyors who have set up private businesses) to help you prepare for your survey, and pressure to buy (from JCAHO) all kinds of JCAHO-logo merchandise (mugs, mouse pads, pens, etc.) to give out to employees to "celebrate" that you did well on your survey. It's quite a racket!

I understand you thought you were being facetious when you described JCAHO as a "monopoly," but that is a pretty accurate description. They've really got it made! The only problem (for them) is that, year by year, as all the hospitals come into compliance with all the existing JCAHO standards, it gets harder and harder to justify continuing to survey the hospitals (and charge a small fortune for doing so) -- their answer is to invent new standards every few years. Since most of the basic, meaningful safety/quality of care standards have been around for a long time, the new standards are getting pickier and weirder as time goes on (as we all know).

**canoehead, BSN, RN** · Dec 1, 2007

JCAHO certification is required to receive Medicare/Medicaid - really any government payment.

Not true- only state certification is required, but if you do not get surveyed more often the state will increase the frequency of their surveys.