ACCREDITATION

Accrediting bodies are independent, not-for-profit, nongovernmental entities that are governed by boards composed of health care professionals, consumers, representatives of provider organizations, and purchasers. Through an evidence-based and consensus-building process, accrediting bodies set standards for quality and safety in health care provider organizations and make the standards publicly available. The accrediting bodies then evaluate provider organizations that volunteer to be assessed against these standards. Successful compliance with the standards leads to “accreditation” of the provider organization, and the accrediting organization's decision, as well as a summary of the findings that led to that accrediting, are made public. In the long-term care arena, accreditation programs currently exist for some nursing homes, home health care, adult day care, hospice, assisted living, and long-term care pharmacies.

Accreditation standards are usually intended to “raise the bar” by promoting and recognizing performance beyond basic, legally established levels, including through programs of continuous quality improvement. In some cases a government agency can grant an accrediting body “deemed status” for a specific accreditation program—that is, a provider organization accredited by that body is deemed to be in compliance with the quality-related regulations for the organization's participation in the Medicare or Medicaid program, or with state regulations for licensure. Under these circumstances, the provider organization does not have to undergo a separate government survey; instead, the government agency relies on the accrediting body's evaluation to make its Medicare or Medicaid certification or licensure decision, as described above for home health agencies.

The 1986 IOM report on nursing home quality discussed accreditation and deemed status at length and rejected it for nursing homes. At the request of Congress, HCFA (1998b) evaluated whether private accreditation of nursing homes would be preferable to the current system of public accreditation. HCFA secured an independent evaluation by ABT Associates. HCFA concluded that the private survey process done by JCAHO was not effective in protecting the health and safety of nursing home residents. According to HCFA, granting “deeming” authority to JCAHO may place nursing home residents at serious risk. As one example, in more than half of the 179 cases where both JCAHO and HCFA conducted inspections of the same nursing homes, JCAHO failed to detect serious problems identified by HCFA (HCFA, 1998b). Nevertheless, accreditation can play a role in encouraging providers to go beyond the basic governmental regulations and strive towards higher standards.



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