The Joint Commission Has Competition.  Alternatives in Healthcare Accreditation

Recently, our health organization decided to not renew our affiliation with the Joint Commission. Although I was initially surprised by my organization's decision to change accreditation affiliation, the experience spurred me to better educate myself about the alternatives to healthcare accreditation.

With all of the complaining and fear-mongering about the Joint Commission, one would think there are no alternatives other than just rolling over and capitulating to the JCAHO's wishes. But that's not really the truth. And with the recent addition of DNV (Det Norske Veritas), 
the first new hospital accreditation organization approved by CMS in over 30 years, healthcare organizations now have numerous alternatives. 

It is hardly arguable that the Joint Commission has enjoyed considerable power in terms of its ability to regulate healthcare institutions. Although JCAHO is a private sector not-for-profit corporation with no inherent regulatory authority (membership and participation is voluntary), there is some legal precedent for its power. 42 U.S.C. 1395bb(a),(b), states that a hospital that meets Joint Commission accreditation is deemed to meet the Medicare Conditions of Participation. Medicare Conditions of Participation are obviously required for reimbursement under this program. Many insurers and other government-funded reimbursement models have tied their reimbursement to similar accreditation standards.

It is interesting to note however that the same free market spirit which has allowed JCAHO to enjoy success, credibility, and a veritable monopoly on healthcare accreditation, is the same environment which now opens the Joint Commission to increased competition. 

Some of the options with regards to healthcare accreditation include:

1.JCAHO
2.The American Osteopathic Association
3.Commission on Accreditation of Rehabilitation Facilities (CARF) 
4.Community Health Accreditation Program (CHAP) 
5.Accreditation Commission for Health Care (ACHC) 
6.Utilization Review Accreditation Commission 
7.Healthcare Quality Association on Accreditation (HQAA) (Specifically for DME companies)
8.Det Norske Veritas (DNV) National Integrated Accreditation for Healthcare Organizations (NIAHO)
9.American Association for Accreditation of Ambulatory Surgery Facilities 

A little competition is usually not a bad thing. DNV has managed to combine the use of ISO 9001 with the CMS Conditions of Participation as the directive which makes their healthcare accreditation standard unique from that of the Joint Commission. It would appear that some organizations are at least investigating a change of healthcare accreditation affiliation. To their credit, DNV appears to have at least one significant advantage over the Joint Commission: a considerable integrated national presence.With healthcare becoming more global, the use of a standard such as ISO 9001 may be more easy to integrate into a global healthcare economy than the more individualized standards imposed by the Joint Commission. 

Healthcare organizations should carefully consider their missions and assure that their accreditation organization's mission is compatible with their goals and objectives. It should be noted that regardless of which accreditation organization is ultimately selected, the process is not likely to be any less rigorous. Organizations who think that changing accreditation  systems will make the continual process of healthcare quality assurance and safety an easier process are simply misinformed. QI/QA and patient safety improvement are challenging subject matter - as well they should be - regardless of the accreditation organization.

If you're a physician, check out what other physicians are saying about healthcare accreditation organizations.iMedExchange 
is an online physician community where your colleagues are discussing ideas and topics such as this one. Come join a discussion, learn about one of our physicians whose healthcare organization recently changed affiliation from JCAHO to DNV  and share your opinions regarding hospital accreditation organizations. 

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