Accreditation is a recognized seal of approval for many institutions in the United States. It is needed by the hospitals to become providers in the Medicare program. In order to receive payment from the Centers for Medicare and Medicaid Services (CMS), hospitals are required to meet a set of minimum requirements called conditions of participation. There are three organizations that can accredit hospitals based on the participation requirements– the Joint Commission, the American Osteopathic Association (AOA), or the state certification agencies . More than 80% hospitals in the country voluntarily use the Joint Commission for accreditation purposes.
Majority of US hospitals use Joint Commission because it has deemed status from CMS unlike the state and other agencies. “CMS is federal and Medicare payment is federal. If hospitals want to be reimbursed for care given to Medicare covered patients, then they are required to have Joint Commission accreditation for reimbursement. Medicaid is state funded but has federal mandates. Joint Commission accreditation pretty much covers all ground in ensuring that all federal or state paying entities will honor reimbursement,” said Cathleen Wheatley, Senior Vice President and Chief Quality Officer at Dekalb Medical.
Traditionally, Joint Commission reviews hospitals every three years on a scheduled basis. A team consisting of atleast a physician, a registered nurse, and a hospital administrator conduct a full survey of each participating medical facility. There are several hundred performance standards that investigators use to evaluate compliance. Each performance area receives a score of 1 to 5. A score of 1 indicates full compliance with the standards of that performance area. The minimum acceptable score is a 2. A score of 3, 4, or 5 requires a future re-inspection of that area. An accreditation decision is awarded along with a performance area score, full survey score and an updated survey score. The...
References:  L. Sprague, “Hospital Oversight in Medicare: Accreditation and Deeming Authority,” NPH Issue Brief, no. 8, pp. 1-15, May 2005.
 M. L. Moffett and A. Bohara, “Hospital Quality Oversight by the Joint Commission on the Accreditation of Healthcare Organizations,” Eastern Economic Journal, vol. 31, no. 4, pp. 629-647, 2005.
 Boston Globe, “Surprise checks faults MGH quality of care,” March 2007, http://www.boston.com/news/local/articles/2007/03/17/surprise_check_faults_mgh_quality_of_care/
 Washington Post, “Accreditors Blamed for Overlooking Problems,” July 2005, http://www.washingtonpost.com/wp-dyn/content/article/2005/07/24/AR2005072401023.html
 J. Chen, S. S. Rathore, M. J. Radford, and H. M. Krumholz, “JCAHO Accreditation and Quality of Care for Acute Myocardial Infarction,” Health Affairs, vol. 22, no. 2, pp. 243-254, March/April 2003.
Please join StudyMode to read the full document