Who Anoints The Joint (Commission)?

By  |  January 14, 2019 | 

“The Joint Commission – [insert name of your institution here] is in the survey window.”

A message you have become accustomed to seeing every few years at your hospital–and one administrators liken to habanero sauce on a gaping cold sore.

But there is something else you should know.

Bet you were not aware of this BMJ study from 2018:

Therefore, my colleagues and I recently investigated whether patient outcomes were better at accredited hospitals and whether those differences were particularly pronounced at The Joint Commission–accredited hospitals. The study of 4400 US hospitals, of which 3337 were accredited (2847 by The Joint Commission) and 1063 underwent state-based review between 2014 and 2017, used Medicare data to compare mortality, readmissions, and patient experience across hospital accreditation status. First, we examined patient outcomes in accredited hospitals compared with nonaccredited hospitals, finding no statistically significant difference in 30-day mortality for medical or surgical conditions. Accredited hospitals performed slightly better on readmissions measures for medical conditions but not for surgical conditions.

Next, we examined whether patient outcomes at The Joint Commission–accredited hospitals differ from those at hospitals accredited by other entities. On average, we found no difference in mortality or readmission rates based on accrediting organization.

Finally, we examined patient experience across accrediting bodies and hospitals undergoing state survey. Surprisingly, accredited hospitals scored significantly lower on patient experience ratings, performing particularly badly on communication, staff responsiveness, and hospital quietness and cleanliness. The findings are clear: accredited hospitals do not seem to be providing better care.

The criticism that these organizations spend enormous amounts of energy requiring hospitals to focus on things like signs in the hallway or how documentation is done appears to have some merit. We need to reexamine the standards required for accreditation to ensure that they are promoting what’s actually important: the health, safety, and optimal experience of patients.

The WSJ joined in the blitz and pulled out their sniper rifle recently as well:

This certifier of hospital quality, however, typically takes no action to revoke or modify accreditation when state inspectors find serious safety violations, according to a Wall Street Journal database analysis of hundreds of inspection reports from 2014 through 2016.

But does the dual role of accreditor and consultant cause a fussy fuss:

Joint Commission Resources offers a substantial income stream—more than $6 million in net income on revenue of $63.5 million in 2016, according to its IRS Form 990. The Joint Commission’s accreditation division reported net income of $10.6 million on revenue of $164 million in 2016.

Oh, geez. Now you have pissed off Senator Grassley :

Under the changes announced Thursday, CMS will begin publicly posting performance data on accrediting organizations, such as safety problems they may potentially have missed, and will test a redesigned process for checking up on accreditors’ results.

Now, now. What could the problem be here???

The accreditation system is closely tied to the industry it oversees. Twenty of the Joint Commission’s 32 board members are executives at health systems accredited by the group or work at parent organizations of those health systems, the Journal found.

Other board members are chosen by health-care industry groups, such as the American Hospital Association and the American Medical Association. Hospitals pay the Joint Commission for inspections, which occur at least every three years and cost an average of about $18,000 in 2015.

Oh my.

Like me, you might be of two minds. You can view our industry and its chief accrediting body in bed together. Regulatory capture has its advantages, and smooth sailing for most participants has its benefits. However, if you see your institution as rolling up its sleeves, expending resources to identify vulnerable spots, and putting in the sweat equity to make reform happen, you might be a tad chastened.

The Joint Commission will get their screws turned. They will make some adjustments, say all the right things, but I am sure in five years, barring a genuinely embarrassing scandal, we will see the aforementioned only as a feathery bump in the road. I am an EBM practitioner after all [**cough**cough**]. I can only hope, however, that whatever band-aid gets tacked on, it does not translate to providers clicking more boxes and shoveling more data into a dead letter office.

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About the Author: Bradley Flansbaum

Bradley Flansbaum
Bradley Flansbaum, DO, MPH, MHM works for Geisinger Health System in Danville, PA in both the divisions of hospital medicine and population health. He began working as a hospitalist in 1996, at the inception of the hospital medicine movement. He is a founding member of the Society of Hospital Medicine and served as a board member and officer. He speaks nationally in promoting hospital medicine and has presented at many statewide meetings and conferences. He is also actively involved in house staff education. Currently, he serves on the SHM Public Policy Committee and has an interest in payment policy, healthcare market competition, health disparities, cost-effectiveness analysis, and pain and palliative care. He is SHM’s delegate for the AMA House of Delegates. Dr. Flansbaum received his undergraduate degree from Union College in Schenectady, NY and attended medical school at the New York College of Osteopathic Medicine. He completed his residency and chief residency in Internal Medicine at Long Island Jewish Medical Center in New York. He received his M.P.H. in Health Policy and Management at Columbia University. He is a political junky, and loves to cook, stay fit, read non-fiction, listen to many genres of music, and is a resident of Danville, PA.

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