President's Letter

Timothy P. Villegas, M.D.

Timothy P. Villegas, M.D. | President's Letter

I'm sure you've all noticed by now that every few years, hospitals go into crisis mode as they prepare for the inevitable and formidable Joint Commission survey. I admit I find it a bit entertaining to watch all of the nursing and administrative staff in high-alert, working to cross every "T" and dot every "I" as the inspectors make their rounds. Recently, Midtown Medical Center had their inspection completed and reportedly received a stellar evaluation. Kudos to everyone involved! That said, watching this process yet again has made me wonder how this whole credentialing system originated, and why this has become such an entrenched recurring tri-annual event in the life of a hospital.

The Joint Commission, a nonprofit, tax-exempt organization, was known until 2007 as the Joint Commission on Accreditation of Healthcare Organizations (hence the "JCAHO" acronym that is still used by many today). It was established in 1951 by merging several existing hospital standardization programs to include the American College of Surgeons, the American College of Physicians, the AMA and several others. These programs began as a way to improve and standardize patient outcomes, but in 1965 the federal government ruled that having JCAHO certification automatically met the standard for participating in Medicare. At that point many U.S. hospitals realized that paying JCAHO to perform their survey was the least painful way to achieve this goal. Presently the Joint Commission accredits more than 21,000 U.S. healthcare organizations and programs, and all but a few state governments recognize accreditation as a condition of licensure and for the receipt of CMS reimbursements. While the Joint Commission is the most well-known and ubiquitous credentialing body, there are actually several others that are recognized by various state or federal regulatory agencies.

Not surprisingly, there are quite a few criticisms of Joint Commission accreditation. For example, hospitals have to pay substantial fees for inspections and to maintain their status and it has become a big business. The Joint Commission takes in over $150M annually and pays its CEO over $1M in salary. Many of the Joint Commission board members are appointed by lobbyist groups and/or are executives at health systems it accredits - clearly a potential for conflict of interest. Perhaps most importantly, there is very little evidence to show that these inspections actually improve patient outcomes at all, and detailed survey findings are not made available to the public. In 2007 it was reported that over 99% of inspected facilities are accredited, thus the validity and meaningful impact of the inspection process is questionable. A recent publication even concluded there is no lower mortality or reduced readmission rates in facilities accredited by the Joint Commission.

So, the Joint Commission survey has evolved over decades as a ubiquitous "standard" that places a large financial burden on hospital systems as well as a tremendous demand on the time and energy of healthcare workers and organizations while having little if any objective data to support a positive impact on patient outcomes and satisfaction. And, like so many things in healthcare, we as providers often feel as if we can only stand by and watch the devolution as bystanders. Perhaps in the future, medical societies such as ours, in conjunction with state and national organizations and healthcare systems, can continue to work to reassess these programs and policies in order to find more meaningful and less burdensome strategies to truly optimize patient care.