Thursday, April 06, 2006

JCAHO Defines (Hospitals' Quality of Care) Deviancy Down

The Los Angeles Times reported how the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) has lowered their quality standards for hospitals. Apparently after getting "better-trained inspectors and switch this year to surprise reviews," JCAHO found they were finding more problems when they inspected hospitals. So, Joseph L Cappiello, Vice President of Accreditation Field Operations for JCAHO, said, "we shouldn't deny accreditation to 10 or 15 or 20% of all hospitals in the United States." Instead, they have increased the allowable number of deficiencies.

US Senator Charles E Grassley (R-Iowa), Chair of the Senate Finance Committee, commented, "goverment investigators have already documented that the Joint Commission misses too many serious problems and rarely drops any hospital's accreditation. This move to weaken standards seems to be going in the opposite direction of what makes sense for quality of care."

We physicians hear more and more about how many errors we allegedly commit, and about how our reimbursements will soon be subject to pay-for-performance (see previous post). Yet while physicians feel ever increasing pressure to increase quality of care, when more stringent hospital inspections find more problems, the hospital inspectors decide that they will make their grading standard more lenient. How curious.

The LA Times article did note that JCAHO is paid by the hospitals it inspects, and "owns a consulting business that helps hospitals prepare for its reviews." In a previous post, we also noted reports of other possible conflicts of interest affecting JCAHO. These possible conflicts are important because the federal government has given JCAHO responsibility for most evaluations of hospital quality. Do these possible conflicts of interest have anything to do with what could not be called JCAHO's defining down (hospitals' quality of care) deviancy? Once again, inquiring minds want to know.

Addendum (14 April, 2006): In a letter to the LA Times, Dr Dennis S O'Leary, Presidence of JCAHO, stated that "this article misses the markin in suggesting recent changes ... reflect a relaxation in performance expectations for hospitals." He noted, "the changes in the review threshold are simply designed to assure that the right hospitals are the subject of intensified review. The changes are part of a series of steps being taken to refine the accreditation decision process. Pending their finalization, no adverse decisions for hospitals evaluated in 2006 have yet been rendered. This will begin to happen in May. Because nothing has happened yet, there have been no expressed concerns among accredited organizations about the new process, and the joint commission has received no pressure from any source to make its accreditation process more rigorous."

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