Hospital Accreditation by JCAHO Under OIG and HCFA Scrutiny
 
September 1, 1999
 

On July 21st, the OIG released the results of a two-year study concerning hospital accreditation by private entities, specifically the Joint Commission on Accreditation of Healthcare Organization (JCAHO) and state survey agencies, and the role of the Health Care Financing Administration (HCFA) in this process. Federal regulations state that hospitals that receive JCAHO accreditation are eligible to participate in the Medicare program.

The OIG study, entitled "The External Review of Hospital Quality," consists of four parts: "A Call for Greater Accountability" (96 pages), "The Role of Accreditation" (47 pages); "The Role of Medicare Certification" (31 pages); and "Holding the Reviewers Accountable" (34 pages). The OIG cites many objections to the current hospital system and, among its recommendations, calls for a shift away from the "collegial mode of oversight, focusing on education and improved performance, [more toward] a regulatory mode of oversight, focusing on investigation and enforcement of minimum requirements."

In response, HCFA Administrator Nancy Ann DeParle offered a detailed hospital quality oversight plan to incorporate the OIG's recommendations as supplemented by HCFA's own initiatives. The primary focus areas of the oversight plan are: (1) strike a balance between both the quality improvement approach and the regulatory approach to hospital oversight; (2) improve oversight of JCAHO's activities, state accreditation activities, and non accredited hospitals; and (3) enact a new performance measurement strategy in hospital to increase standardization of hospital performance measurement.