"LR" Focuses on the Facts

"Local Reflector" finds the following:

I found a U.S. Dept. of Health and Human Services Inspector General Report called "The External Review of Hospital Quality: A Call for Greater Accountability." You'll find a summary conclusion on page 4 of the 96-page long report. It was released in 1997 so it may contain some relevancy problems. I don't know as I'm not a healthcare worker (never have been), but gov't. programs rarely undergo fundamental reform.

The Report says about the Joint Commission:

"Joint Commission surveys provide an important vehicle for reducing risk and fostering improvement. Hospital leadership takes these accreditation surveys seriously. Hospitals spend months preparing for them, seeking to ensure that their hospitals meet and, where possible, exceed the Joint Commission’s standards."

However, the report lists this as a major deficiency:

"Joint Commission surveys are unlikely to detect substandard patterns of care or individual practitioners with questionable skills. Quick-paced, tightly structured, educationally oriented surveys afford little opportunity for in-depth probing of hospital conditions or practices. Rather than selecting a random sample, the surveyors tend to rely on hospital staff to choose the medical records for review. Further, the surveyors typically begin the process with little background information on any special problems or challenges facing a hospital. "

The report also says on page 11 - for us lay people - that Joint Commission accreditation means, by federal statute, that a hospital simply meets Medicare's standards to participate in the program and it's a form of self-regulation under which hospitals pay a fee.

I also found this on page 17 of this same Accountability Report as printed:

"Joint Commission surveys are unlikely to detect substandard patterns of care or individual practitioners with questionable skills. Joint Commission surveyors get a broad rather than in-depth view of hospitals they survey. The surveys generally last just a few days. The survey agendas are packed with back-to-back sessions that allow 45 minutes to an hour for most areas of the hospital. Furthermore, the surveyors lack much background information on the hospital that could help them hone their surveys.

The surveyors’ broad view of the hospitals, coupled with the Joint Commission’s approaches to medical record and credentials reviews, make such surveys unlikely to uncover patterns or individuals responsible for poor care. First of all, surveyors do not select the records for review based on indications of poor quality. Indeed, the hospitals themselves often choose the records for review. In reviewing medical records, surveyors focus more on processes than appropriateness of care: surveyors "do not judge directly whether the care given is good or bad, right or wrong."

Likewise, the review of physician credentials and privileges falls short of identifying individuals whose skills may be questionable: the sessions are too short for an in-depth review, hospitals often choose the records themselves, and the questioning rarely uncovers marginal practitioners. The Joint Commission’s own publications note that the process "does not evaluate the quality of care provided by individual medical staff members."

Maybe I've found "ancient" data. Maybe not. But it has turned up concerning the Joint Commission. I have no dog in the fight other than an interest in the Joint Commission's methods of accreditation. Forthright's reply sent me researching to enlighten myself and maybe a few others.

I'm still not 100% sure, but it appears - if this report is even partially relevant - questions or cynicism can be raised about JCAHO accreditation, especially if the accreditation process simply is a self-regulatory measure to ensure a hospital meets Medicare's standards. I don't see how ANY Delta hospital, DRMC included, couldn't be accredited given government subsidies through federal entitlements are such life-blood.

Yeah, it's an award - but how should ordinary people (customers) treat it when deciding the quality of a hospital. This report suggests the Joint Commission accreditation is only good for the days when auditors are ACTUALLY and PHYSICALLY on a hospital's premises and offers no insight on the quality of care and the skill of the physician.

Darn it.....I've cracked the rose colored glasses I packed away, but had retrieved to enter this discussion. By the way, follow the link or Google the report title and it pops up easily. Here's the link:

http://oig.hhs.gov/oei/reports/oei-01-97-00050.pdf

Make your own decision. Think. Discuss the facts - as much as facts can be gathered. Forthright, the discussion is educational when you get right down to it. Are my conclusions appropriate, whether or not people agree with them?

Local Reflector.

Thanks for your research LR. Admittedly, the report is a bit dated, but as you noted, while processes may be revised in governmental regulatory agencies, their objectives rarely change. Such is the case with JCAHO's accreditation.

In the past 5 years, JCAHO's approach to surveys has changed a bit. As described above, the old survey process was like preparing for a three act play. The dates of the play were well known in advance. Everyone had rehearsed their "lines", the hospital decorated the "set" with a new coat of paint (make-up) and the "staging" was totally directed by hospital administration.

The surveyors (audience) were paraded around the campus on a strategically preplanned tour, pointing out recent improvements, while avoiding numerous "locked doors" concealing countless "peccadilloes". During the final act, the "score" was revealed to the hospital administration.

If the score was low, the hospital was given 6-8 weeks to correct the "specific" problems. If adequate documentation (re-writing of script) was subsequently presented to JCAHO, you were ceremoniously awarded the "Medicare Medal of Honor", good for another 3 years.


As soon as the surveyors left the campus, the set was struck, the players returned to "reality" and the JCAHO decals (Oscars) were proudly displayed throughout the facility. Everyone congratulated each other on their score (the reviews).

The good news is that the survey process has significantly changed in recent years. It is now a tracer methodology in which the surveyors randomly select medical records and literally trace them backwards, from discharge to admission. Everyone who deals with the patients is subject to scrutiny, which makes both hospitals and employees more accountable for ongoing compliance as opposed to the former series of "Great Performances".

Now, does this change the previous findings that JCAHO accreditation is not intended to suggest quality? No, it is simply means that hospitals are now held to a bit higher standard in being approved for Medicare funding... the lifeblood of rural hospitals.

Although vastly improved in the past few years, I still liken the process of JCAHO hospital accreditation to our Mississippi Vehicle Inspection System...

Scenario: You are stopped by a highway patrol officer for violations including: no muffler, improper emissions, broken windshield, no tail-lights or rear-view mirror and illegally tinted windows. The officer glances down at your "cracked and illegally tinted" windshield and sees a valid inspection sticker dated only two weeks earlier. The officer questions the driver, "How did you ever get that inspection sticker?"

The driver responds, "Man, wasn't nothing wrong with this car two weeks ago."

I urge all readers to become more informed, like LR. The Internet has a wealth of information for those who seek it. Log on to the above website to learn more about JCAHO. (Warning: It is rather dry.) Keep informed, keep caring and keep writing...

Forthright