The important role of the Joint Commission - Health Policy Issues - Joint Commission Accreditation of Health Care Organizations

AORN Journal,  June, 2002  by Frederick P. Franko

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During the seemingly endless whirlwind work days in health care facilities, many perioperative nurses may not realize the myriad influences that affect their daily professional practice and how patient care is delivered. Besides the obvious facility influences (eg, other members of the surgical team, interdepartmental relationships, staff member structure), government is a major influence. Health care organizations are highly regulated by federal, state, and local laws and regulations, including those of the Environmental Protection Agency, the US Food and Drug Administration, and the Occupational Safety and Health Administration. (1) Another entity with which health care organizations likely interact is an accrediting body, the best known being the Joint Commission on Accreditation of Healthcare Organizations (JCAHO).

The Joint Commission is a private, not-for-profit organization committed to improving safety and quality of care by providing standards, survey evaluations, sentinel event alerts, and professional consulting services to health care organizations. In its main capacity as an accrediting body, JCAHO evaluates and accredits approximately 18,000 health care organizations, including hospitals, ambulatory surgery centers (ASCs), health care networks, and clinical laboratories. (2)

The Joint Commission is not a government regulatory agency. It does not have the authority to cite or fine health care organizations for not meeting standards or responding to its sentinel alerts. Joint Commission standards, however, carry considerable weight. Failure to meet these standards as evaluated through the JCAHO survey process can result in loss of accreditation, which can mean the loss of millions of dollars from Medicare and Medicaid programs.

BRIEF HISTORY OF JCAHO

The first hospital inspections were performed by the American College of Surgeons (ACS) in 1918, based on the ACS Minimum Standard for Hospitals. (3) In 1951, the ACS joined with the American College of Physicians, the American Hospital Association, the American Medical Association, and the Canadian Medical Association to form the Joint Commission on Accreditation of Hospitals (JCAH)--an independent, not-for-profit organization whose primary purpose was to provide voluntary accreditation. In 1952, JCAH took over the hospital standardization program from ACS, and in 1953, it published the JCAH Standards for Hospital Accreditation.

With the passage of the Medicare Act in 1965, the role of JCAH shifted, becoming more closely tied with government. The law provided that hospitals accredited by JCAH were "deemed" in compliance with most of the Medicare Conditions of Participation for Hospitals and, thus, were deemed eligible to participate in the Medicare program. (4)

In 1975, JCAH broadened its reach by accrediting ambulatory health care facilities through the Accreditation Council for Ambulatory Health Care. Four years later, JCAH established professional and technical advisory committees (PTAC) for each accreditation program. It is through this latter advisory structure that AORN has interacted most consistently with JCAH. In 1987, JCAH changed its name to the Joint Commission on Accreditation of Healthcare Organizations to reflect its expanded scope of activities. Five years later, JCAHO recognized the importance of including a voice for nursing in policy leadership by adding an at-large nursing representative to its board of commissioners.

GOVERNMENT INFLUENCE

The federal government, through the Centers for Medicare and Medicaid Services (CMS), runs Medicare, the nation's largest insurance program, which includes coverage for people older than age 65, those with disabilities, and those with permanent kidney failure. Medicare covers more than 39 million people and costs nearly $200 billion annually. (5) Medicaid, which was established to benefit qualified low-income people, is funded by federal and state governments but is administered by individual states with some flexibility. More than 36 million people are eligible for Medicaid.

To participate in Medicare and Medicaid programs, health care organizations, including hospitals and ASCs, must meet certain conditions of participation and conditions for coverage established by CMS. These standards are used to improve quality and protect the health and safety of Medicare and Medicaid beneficiaries. The CMS also ensures that the standards of accrediting organizations recognized by CMS, through a process called "deeming," meet or exceed Medicare standards. (6) The CMS recognizes hospitals and ASCs accredited by JCAHO as meeting the conditions of participation for Medicare and Medicaid.

Last fall, CMS deemed the American Osteopathic Association (AOA) as a recognized accrediting body for critical access hospitals. (7) Critical access hospitals generally are defined as small rural hospitals located outside of metropolitan statistical areas.

PERIOPERATIVE NURSES AND JCAHO

Many perioperative nurses may be more familiar with their hospital's or ASC's policies and procedures than with JCAHO and its standards or surveys. Many facilities' policies and procedures, however, are based on JCAHO's Comprehensive Accreditation Manual for Hospitals: The Official Handbook or the Comprehensive Accreditation Manual for Ambulatory Care. These standards are written in broad terms, and it can be difficult to understand their application to the OR. AORN's Standards, Recommended Practices, and Guidelines can help perioperative staff members develop specific policies and procedures that satisfy the broad JCAHO standards.