Hospitals stand behind Joint Commission standards as House investigates

Hospitals say the Joint Commission and other private accreditation organizations thoroughly assess their quality of care, balking at concerns from Congress and patient safety advocates that accreditors are negligent enforcers of safety.

Republican members of the House Energy and Commerce Committee are investigating the effectiveness of the hospital accreditation process after a Wall Street Journal report last year that found the Joint Commission accredited hospitals with major safety issues.

The committee said it is “concerned about the adequacy of CMS’ oversight” of accreditation organizations and the rigor of their survey processes. In addition to the Journal article, the committee pointed to a 2015 congressional report that found accreditation organizations often missed instances when a hospital didn’t meet Medicare’s conditions of participation. About 39% of those deficiencies were subsequently reported by state survey agencies in validation surveys.

Despite these findings, the American Hospital Association and hospital leaders stand behind the private accreditors’ work. “The private accrediting bodies continuously strive to identify improvements hospitals and health systems need to make and suggest effective strategies that might be tried,” said Nancy Foster, vice president of quality and patient safety policy at the AHA. The AHA is a corporate member of the Joint Commission and has a seat on its board of commissioners.

About 90% of U.S. hospitals are accredited by private organizations.

Chris Van Gorder, CEO of Scripps Health, which has four hospitals accredited by the Joint Commission, said he thinks the organization thoroughly looks for and cites hospitals for deficiencies; he added that he appreciates that the commission works with hospitals to help them improve in areas where they are struggling.

The Joint Commission prefers to help struggling facilities improve instead of removing accreditation, arguing a hospital will likely close as a result and healthcare access will be harmed.

The Journal investigation found that in 2014 the Joint Commission revoked accreditation for just 1% of facilities. Van Gorder said “there is a balance” that accreditation organizations and the CMS must achieve to determine which facilities are clearly unsafe and which ones have “one-off” misdemeanors but want to improve.

But patient safety advocates argue there’s an inherent conflict of interest between accreditation organizations and the hospitals they oversee. “The fact that a major part of their business is seeking consulting services for quality improvement puts them in a very challenging position,” consultant Rita Numerof said.

A solution to this conflict is publicly releasing private accreditors’ surveys and corrective action plans for hospitals, said Leah Binder, CEO of the Leapfrog Group. The CMS proposed such a rule last summer but backed down after private accreditors complained.

The commission said it plans to deliver documents sought by the House probe by March 23. The panel has asked the organization to provide copies of performance reviews; survey feedback; corrective action plans and any responses; and any CMS correspondence.