Doctors demand more input on hospital standards

Delegates call on the Joint Commission to give physicians earlier notification about proposed changes and to revise rules that unintentionally could harm patients.

By Kevin B. O'Reilly, AMNews staff. Dec. 4, 2006.

Las Vegas -- In the short term, the Joint Commission on Accreditation of Healthcare Organizations should reconsider recent proposals that are not good for medicine, the AMA's House of Delegates said at its policymaking meeting in November. In the long run, the commission should do more to communicate with and consider physicians' viewpoints in its standards-setting process, doctors said.

AMA delegates raised concerns that the Joint Commission's process is too obscure, too unwieldy and too slanted toward hospitals and the government.

"JCAHO is being used as a tool by the government to take over the practice of medicine through the hospitals," said David McKalip, MD, a St. Petersburg, Fla., neurological surgeon and alternate delegate for his state society.

Most significantly, the AMA wants the Joint Commission to notify doctors' groups six months before it adopts or modifies standards. Most field reviews of proposed revisions now last six to eight weeks, far too short a time according to delegates. For example, only 155 doctors participated in a recent Joint Commission field review on proposed revisions to a medical staff governance standard that the AMA said poses a grave threat to physician autonomy in hospitals.

At other times, physicians believe their views go unheeded. A standard requiring pharmacists to review any first-dose medication was adopted in spite of physicians' complaints that it was impractical and could create more harm than good by exacerbating emergency department wait times.