Accreditation extends to clinical trials, offices

The process has gone beyond hospitals to address the quality of other health arenas. Meanwhile some hospitals are dropping out, by closure or by choice.

By Damon Adams, amednews staff. Aug. 27, 2001.

At one time, accreditation was a process designed to fit hospitals. But today, there seems to be no shortage of health care arenas that are ripe for the "seal of approval" and aura of quality that comes with a successful accreditation.

Those arenas include clinical studies, office-based surgery and health Web sites.

Links

Some accrediting groups are even eyeing doctors' offices as the next frontier.

Much of the expansion is sparked by a push toward recognizing quality care, which is fueled by government reports about hospital errors and a struggling health care system.

"People are concerned about who is assuring them that everything to manage safety is being done," said Russell P. Massaro, MD, Joint Commission on Accreditation of Healthcare Organizations executive vice president of accreditation operations.

A federal report in April recommended that private accreditation be established to certify that research programs meet strict standards to safeguard participants of medical studies. Prompting the call to action was the death of a human subject in a gene therapy experiment and the closing of programs that had flaws in the way they conducted research.

The Institute of Medicine report said accreditation should be done by independent, nongovernmental agencies and should apply to all research programs, including doctors' offices that conduct drug trials.

In September, the National Committee for Quality Assurance will start conducting surveys for a new accreditation program to protect human research participants at Veterans Affairs medical centers. The Assn. for the Accreditation of Human Research Protection Programs will begin accrediting research institutions in January 2002.

Also new among safety efforts: The Joint Commission in July introduced new standards that require hospitals to tell patients when they are harmed by medical errors. If a hospital fails to notify a patient, it faces losing its accreditation. The Illinois-based Joint Commission accredits 80% of the nation's hospitals at an average cost to each hospital of $19,000 every three years.

But even as new accreditation initiatives sprout up, others are questioning whether the process is imperative to their institution's survival.

Opting out

John C. Lincoln Health Network in Phoenix stopped using the Joint Commission in July. Lincoln President and CEO Dan Coleman said the health system did not agree with policy that its health care services needed to be surveyed along with its hospitals. Coleman said the standards needed to be simplified.

He also said accreditation was a "very expensive process," costing Lincoln $86,000 during survey years.

"At a time when we are challenged to muster the resources just to take care of patients," Coleman said, "we have concluded that the cost ... is out of proportion to the value received."

Hospitals that opt out of the Joint Commission accreditation process continue to be eligible for Medicare payment by getting accredited elsewhere or through state health department inspections. However, such departures are uncommon, according to the American Hospital Assn.

"We have not seen any trend of hospitals dropping accreditation," said Don Nielsen, MD, AHA senior vice president for quality leadership.

Some health system leaders say accreditation helps promote improvements and quality care.

"It tries to give some standardization as to what all hospitals should be like," said Gladys Grassini, RN, director of case management and social services at the John Muir Medical Center near San Francisco.

More threatening to the livelihood of accrediting bodies are hospital closures and mergers.

"With hospital closings across the country, everybody is losing clients," said George A. Reuther, director of the division of Healthcare Facilities Accreditation at the American Osteopathic Assn., which accredits about 200 health care facilities.

From 1995 through May 2001, 484 hospitals that were participating in Joint Commission accreditation closed.

Diversifying key to survival

But accrediting bodies are forging ahead by exploring other areas of health care.

The nonprofit Joint Commission, which accredits about 19,000 health care organizations, has tagged office-based surgery for potential growth. Its accreditation for such surgical centers covers areas such as medication and anesthesia, safety and practitioner credentials.

"If care is going to shift into a new setting, then we have to be able to shift with it," Dr. Massaro said.

Accreditation of health plans has expanded in recent years. URAC started giving its stamp of approval to preferred provider organizations in 1996, and will accredit its 100th PPO this month. The NCQA launched its PPO program a year ago.

In early October, URAC will roll out its new program for health Web sites -- its 12th accreditation program. The nonprofit group will audit each Web site and review the host company's policies and procedures. Cost is $5,000, renewable yearly.

"What URAC has tried to do is track where the marketplace is going. We've diversified," said Garry Carneal, president and CEO of URAC, the American Accreditation HealthCare Commission.

The AMA's effort to accredit individual physicians, the American Medical Accreditation Program, was discontinued in 2000 because it was not fiscally viable. Some accrediting bodies accredit group practices, and other organizations said they are looking to expand to the doctor's office, too.

Margaret O'Kane, president of the National Committee for Quality Assurance said, "It's pretty likely that we'll be accrediting group practices at some point."